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ABSTRACT: Contact allergy (CA) surveillance networks provide information to a multitude of stakeholders, which is indispensable for evidence-based decision-making in the field of prevention. Methods and results of the German surveillance system on CA are reviewed and discussed with reference to other systems. The German network structure comprises 56 departments of dermatology and includes all patients who are patch-tested for suspected CA. Data analysis considers the results of patch testing and further pertinent information for each patient. Following aspects are addressed: (i) the description of the clinical population, (ii) evaluation of patch test reactions, (iii) relationship between patch test results and population characteristics. Trend analyses on chromate (decreasing), epoxy resin (increasing) and nickel (heterogeneous) served as examples for surveillance system analyses, with the identification of sentinel events, as well as proof of success or failure of prevention. In addition, external data sources can be used such as sales data of patch test preparations to estimate frequencies of sensitization on a population level. National prescription data of drugs and statistics of labelling of preservatives on cosmetics can be included, the latter two approaches allowing for risk estimates conferred by specific allergens.
Allergy 05/2012; 67(7):847-57. · 6.27 Impact Factor
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ABSTRACT: Ständige Veränderungen in der Exposition gegenüber Kontaktallergenen, zum Teil bedingt durch gesetzliche Regelungen oder Empfehlungen
von Industrieverbänden, erfordern ein epidemiologisches Monitoring der Kontaktallergie. Hier soll anhand einer Analyse von
Daten des Informationsverbundes Dermatologischer Kliniken (IVDK) aus dem Jahr 2010 der aktuelle Stand unter besonderer Berücksichtigung
von Duftstoffen und Konservierungsmitteln wiedergegeben werden. Im Jahr 2010 wurden in den am IVDK beteiligten dermatologischen
Abteilungen 12.574Patienten epikutan getestet. Das häufigste Kontaktallergen ist zwar nach wie vor Nickel, die kontinuierlich
verbesserte EU-Nickeldirektive zeigt jedoch bereits gewisse Erfolge. So ist die Sensibilisierungsquote bei jungen Frauen rückläufig.
Ebenso führte die seit einigen Jahren in Deutschland praktizierte Verwendung von chromatarmem Zement zu einem Rückgang der
Neusensibilisierungen gegen Chromat bei Maurern. Die beiden in der DKG-Standardreihe enthaltenen Duftstoff-Mixe sind nach
wie vor aktuell. Die wichtigsten Allergene sind noch immer Eichenmoos absolue bzw. Hydroxyisohexyl 3-cyclohexen carboxaldehyd.
Allerdings ist bei beiden Mixen ein relativer Anstieg allergischer Reaktionen auf die anderen im jeweiligen Mix enthaltenen
Duftstoffe festzustellen. Unter den Konservierungsmitteln hat MCI/MI – im Gegensatz zu MDBGN – nicht an Bedeutung verloren.
Sensibilisierungsquellen für MCI/MI finden sich offenbar vermehrt im beruflichen Bereich. Methylisothiazolinon ist eher im
beruflichen Kontext als im Bereich der Körperpflegeprodukte als Allergen von Bedeutung.
Ever-changing exposure to contact allergens, partly due to statutory directives (e.g. nickel, chromate, methyldibromo glutaronitrile)
or recommendations from industrial associations (e.g. hydroxyisohexyl 3-cyclohexene carboxaldehyde), requires on-going epidemiologic
surveillance of contact allergy. In this paper, the current state with special focus in fragrances and preservatives is described
on the basis of data of the Information Network of Departments of Dermatology (IVDK) of the year 2010. In 2010, 12,574 patients
were patch tested in the dermatology departments belonging to the IVDK. Nickel is still the most frequent contact allergen.
However the continuously improved EU nickel directive already has some beneficial effect; sensitization frequency in young
women is dropping. In Germany, chromate-reduced cement has been in use now for several years, leading to a decline in chromate
sensitization in brick-layers. Two fragrance mixes are part of the German baseline series; they are still relevant. The most
important fragrances in these mixes still are oak moss absolute and hydroxyisohexyl 3-cyclohexene carboxaldehyde. However,
in relation to these leading allergens, sensitization frequency to other fragrances contained in the mixes seems to be increasing.
Among the preservatives, MCI/MI has not lost its importance as contact allergen, in contrast to MDBGN. Sources of MCI/MI sensitization
obviously are increasingly found in occupational context. Methylisothiazolinone is a significant allergen in occupational
settings, and less frequently in body care products.
SchlüsselwörterKontaktallergene–Nickel–Konservierungsmittel–Duftstoffe–Epikutantest
KeywordsContact allergens–Nickel–Preservatives–Fragrances–Patch testing
Der Hautarzt 04/2012; 62(10):751-756. · 0.58 Impact Factor
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ABSTRACT: Das beruflich bedingte allergische Kontaktekzem kann durch eine Vielzahl verschiedener Stoffe ausgelöst werden. Im individuellen
Fall ist die Identifizierung der potenziellen oder tatsächlich relevanten Allergene am Arbeitsplatz oft schwierig. Daher ist
es erforderlich, dass der Arzt, der entsprechende Patienten betreut, eine umfassende Kenntnis der in den verschiedenen beruflichen
Bereichen häufigen und infrage kommenden Allergene hat. Nur so kann die Anamnese gezielt erhoben, die Diagnostik effizient
durchgeführt und die Sekundärprävention durch Meidung des Allergenkontaktes sinnvoll eingeleitet werden. In dieser Übersicht
werden zunächst praxisbezogene allgemeine Hinweise zur Epikutantestung bei Verdacht auf berufsbedingte Kontaktallergie gegeben.
Anschließend werden die häufigsten Berufsallergene der am meisten betroffenen Berufsgruppen vorgestellt, und es werden berufsgruppenspezifische
Empfehlungen für die Epikutantestung gegeben bzw. referiert.
A broad spectrum of various substances may cause occupational allergic contact dermatitis. Often, it is difficult to identify
potentially or truly relevant allergens at the workplace. Therefore, the consulting physician must have a comprehensive knowledge
of possible allergens in different occupations to perform specific diagnostics and to initiate efficient secondary prevention
by allergen avoidance. In this review, we give some practically relevant general comments on patch testing in occupational
dermatitis, followed by a discussion of important occupational allergens in those occupational groups most frequently affected
by occupational dermatitis. Finally, recommendations on which allergens should be tested in the respective occupational groups
are given or reported from the literature.
Der Hautarzt 04/2012; 60(9):708-717. · 0.58 Impact Factor
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Der Hautarzt 04/2012; 59(7):594-597. · 0.58 Impact Factor
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ABSTRACT: A total of 56 departments of dermatology from Germany, Austria, and Switzerland collaborate to study the clinical epidemiology of contact allergies (CA). Data generated in the course of the diagnostic work-up of CA (e.g., patch test data) have been stored since 1989 in the data center in Göttingen, Germany, including data for more than 200,000 patients (March 2011). These data can be used as a register and as a surveillance system. Analysis of the register may identify and quantify risk factors of sensitization to an allergen, which is exemplified with the case of the allergen para-phenylenediamine. It turned out that-in addition to the risk factor hair dyeing-other important risk factors must be considered. In contrast, data collected every 6 months (from approximately 6,000 patients) allow for time-trend analyses of allergens, thus, identifying allergens of concern, which is of utmost importance for early preventive intervention. Here, the epidemiology of allergies to epoxy resins serves as an example. Continuous monitoring of contact allergens will also be mandatory in the future, as the CA premarketing screening systems will have imperfect predictive values with regard to human CA risk. Unfortunately, the (current) national regulatory framework severely hampers clinical surveillance/epidemiology of contact sensitization and, thus, prevention of contact allergy.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 03/2012; 55(3):329-37. · 0.66 Impact Factor
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ABSTRACT: Ever-changing exposure to contact allergens, partly due to statutory directives (e.g. nickel, chromate, methyldibromo glutaronitrile) or recommendations from industrial associations (e.g. hydroxyisohexyl 3-cyclohexene carboxaldehyde), requires on-going epidemiologic surveillance of contact allergy. In this paper, the current state with special focus in fragrances and preservatives is described on the basis of data of the Information Network of Departments of Dermatology (IVDK) of the year 2010. In 2010, 12,574 patients were patch tested in the dermatology departments belonging to the IVDK. Nickel is still the most frequent contact allergen. However the continuously improved EU nickel directive already has some beneficial effect; sensitization frequency in young women is dropping. In Germany, chromate-reduced cement has been in use now for several years, leading to a decline in chromate sensitization in brick-layers. Two fragrance mixes are part of the German baseline series; they are still relevant. The most important fragrances in these mixes still are oak moss absolute and hydroxyisohexyl 3-cyclohexene carboxaldehyde. However, in relation to these leading allergens, sensitization frequency to other fragrances contained in the mixes seems to be increasing. Among the preservatives, MCI/MI has not lost its importance as contact allergen, in contrast to MDBGN. Sources of MCI/MI sensitization obviously are increasingly found in occupational context. Methylisothiazolinone is a significant allergen in occupational settings, and less frequently in body care products.
Der Hautarzt 09/2011; 62(10):751-6. · 0.58 Impact Factor
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ABSTRACT: Preservatives are well-known and important contact allergens.
To examine the frequency of sensitization to preservatives, including time trends.
Retrospective analysis of data on patch testing of preservatives contained in the standard series and special series collected by the IVDK during 1996-2009.
Some 120,000 and 80,000 patients were tested with the baseline and the preservative series, respectively. Sensitization frequencies of the standard series allergens all ranged above 1%: methyldibromoglutaronitrile (MDBGN) 2·36-4·5%, methy(chloro)isothiazolinone (MCI/MI) 2·22%, formaldehyde 1·54%, paraben mix 1·33% and Bronopol® 1·25%. Regarding the special preservative series, 1·54% reacted positive to methylisothiazolinone (MI), and < 1% to the other preservatives. Concomitant reactions to formaldehyde in formaldehyde releasers ranged from 15% to almost 50%, and 67% of MI positives reacted to MCI/MI. As indicated by the MOAHLFA index, sensitization to MI, iodopropynylbutyl carbamate (IPBC) and quaternium 15 was associated more often with occupational dermatitis, whereas sensitization to imidazolidinyl urea and diazolidinyl urea was associated with face dermatitis, indicating cosmetic exposure. Epidemiologically relevant decreases (> 10%) were seen in chloroacetamide, benzyl alcohol and MDBGN. Epidemiologically relevant increases were noted in IPBC, sodium benzoate and MI.
Preservatives are still important contact allergens. The introduction of new preservatives should consider the specific characteristics of occupational and of nonoccupational (cosmetic, household) exposure, and preventive measures should aim equally at both areas.
British Journal of Dermatology 02/2011; 164(6):1316-25. · 3.67 Impact Factor
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Allergy 02/2010; 65(9):1203-4. · 6.27 Impact Factor
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ABSTRACT: A broad spectrum of various substances may cause occupational allergic contact dermatitis. Often, it is difficult to identify potentially or truly relevant allergens at the workplace. Therefore, the consulting physician must have a comprehensive knowledge of possible allergens in different occupations to perform specific diagnostics and to initiate efficient secondary prevention by allergen avoidance. In this review, we give some practically relevant general comments on patch testing in occupational dermatitis, followed by a discussion of important occupational allergens in those occupational groups most frequently affected by occupational dermatitis. Finally, recommendations on which allergens should be tested in the respective occupational groups are given or reported from the literature.
Der Hautarzt 08/2009; 60(9):708-17. · 0.58 Impact Factor
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ABSTRACT: Tape stripping the skin prior to patch testing (strip patch test, SPT) may enhance percutaneous penetration of test substances and increase skin reactivity to test substances.
To evaluate the test sensitivity of SPT in compliance with our recently presented practical method vs. conventional patch test (PT) in nickel- and dichromate-sensitive subjects.
Thirty subjects participated in the prospective, randomized, controlled, investigator-blind study. Serial dilution tests of nickel sulphate (10,000-50 ppm aq.) and potassium dichromate (1000-5 ppm aq.) were used. Tests were applied in duplicate to both sides of the upper back of the subject, where one, randomly chosen side was tape stripped.
According to the estimated test sensitivities, SPT is more sensitive than PT in nickel- and dichromate-sensitive subjects, regardless of the interindividual different numbers of tape strips. The superiority of the SPT grows with diminishing concentrations of the allergens.
Test sensitivity of SPT vs. PT is increased. If no positive results are obtained by PT, the SPT could help to detect hidden allergens in case of weak sensitization or low concentration and poor percutaneous penetration of the test substances.
Journal of the European Academy of Dermatology and Venereology 04/2009; 23(9):1018-25. · 2.98 Impact Factor
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Der Hautarzt 08/2008; 59(7):594-7. · 0.58 Impact Factor
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Allergy 06/2008; 63(7):946 - 947. · 6.27 Impact Factor
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ABSTRACT: Prompted by a recent publication on contact allergy to the fragrance mix (FM) declining with age, patch test data of the IVDK (1992–2002, http://www.ivdk.org, n = 90824 patients) were subjected to a multifactorial logistic regression analysis, employing a finer age categorization than previously used (Uter W et al., Occup. Environ. Med. 2001; 58: 392–8), additionally adjusting for “polysensitization”, operationalized as the number of additional positive patch test reactions to other standard series allergens. The aim was to disentangle a possible association between age and contact sensitization in general, and age and FM contact allergy in particular. The strongest of all associations observed was to the number of additional positive patch test reactions (“polysensitization”; OR for 1 vs. 0 additional reactions: 2.7 [95% CI: 2.6–2.9] steadily increasing to OR for 4+ vs. 0 additional reactions: 12.8 [11.7–13.9]). Independently from this, the well-known increase of FM contact allergy with age (OR 1.9 beyond age 60) and higher prevalence in female patch test patients, but only up to age 60, was confirmed, however, no decline beyond age 80 was observed. Moreover, it was found that not health care workers in general, but masseurs/physiotherapists, and, to a lesser extent, geriatric nurses have a high risk of FM contact allergy. In conclusion, our results confirm the profound impact of age, and partially of sex, on FM contact allergy, which makes stratification, standardization or adjustment a prerequisite for meaningful comparative analyses. The phenomenon of “polysensitization” deserves further attention.
Contact Dermatitis 06/2008; 50(3):191 - 191. · 3.51 Impact Factor
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Journal of the European Academy of Dermatology and Venereology 04/2008; 22(12):1516-7. · 2.98 Impact Factor
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ABSTRACT: Assessment of the value of patch testing patients' own perfumes, eau de toilette, deodorants and shaving lotions with regard to diagnosing contact allergy to fragrances, and an analysis of the spectrum of concurrent patch test reactions to single fragrance allergens.
Data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) regarding patch test results with above products brought in by the patient, considered as possible cause of contact dermatitis, were retrospectively analysed. Between 1998 and 2002, 1468 patients were patch tested with 2557 single products (deodorants, n = 1094; eau de toilette, n = 598; perfume, n = 530; and pre- or after-shave, n = 325; remainder not classifiable), mostly 'as is'.
Positive reactions were observed in 129 patients (to 191 products). In 58 of these patients, no further patch test reactions to the fragrance mix (FM-I), Myroxylon pereirae resin (balsam of Peru) or 4-(4-hydroxy-4-methyl-pentyl)-3-cyclohexencarboxaldehyde (e.g. Lyral(R)) were found. A strong association between contact sensitivity to the above commercial allergens and positive reactions to products was observed. Some single compounds such as ylang-ylang oil, propolis and especially oak moss absolute are important allergens in the 'perfume-positive' subgroup, but less in a subgroup positive to own deodorants.
Patch testing this scope of products, brought in by the patient, can be regarded as a simple, safe and effective method to diagnose clinically relevant contact sensitization - the more so, as the composition of such products is ever-changing, and the sensitivity of established 'screening allergens' is thus insufficient.
Journal of the European Academy of Dermatology and Venereology 04/2007; 21(3):374-9. · 2.98 Impact Factor
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ABSTRACT: Patch testing is the standard clinical procedure to prove contact sensitization. It is a common practice to attach multiple patch tests at the same time. However, synchronous reactions to unrelated allergens may not be completely unassociated. If so, the reaction in a given test field might be influenced by other positive test reactions in a distance-related degree. This article analyses whether there is a distance-related effect of synchronous positive patch test reactions on the outcome of a target patch test.
Data collected from patients patch tested for diagnostic purposes with 15 standard allergens attached in a specific pattern between 1992 and 2004 in 20 centres in a Central European network were retrospectively evaluated. The association between the target patch test result (allergic vs negative reaction to the thiuram mix) and the number and cumulated strength of synchronous positive reactions (positive patch test load) to allergens placed in nearby or distant positions to the target patch was analysed by using logistic regression analysis.
The likelihood of a positive reaction to thiuram mix significantly increased with an increasing synchronous positive patch test load generated by positive reactions to allergens unrelated to thiuram mix. The effect of allergens neighbouring the target allergen was not significantly stronger than that of allergens placed in distant positions.
For the interpretation of patch test results, the potentially enhancing effects of a synchronous positive patch test load should be considered. The local distribution of the patches on the back is, however, not critical.
Allergy 01/2007; 61(12):1411-5. · 6.27 Impact Factor
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Contact Dermatitis 12/2006; 55(5):314-6; author reply 316. · 3.51 Impact Factor
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ABSTRACT: Late patch-test reactions, developing at day (D) 7 or later have been described for several allergens. Late reactions may reflect patch-test sensitization. Para-phenylenediamine (PPD) and epoxy resins (ER) are potent allergens and therefore may potentially induce patch-test sensitization. Up to now, there has been no prospective study on the frequency of late reactions in routine patch testing with these allergens.
To assess the frequency of late reactions to PPD and ER.
In 1748 patients PPD (PPD-base, 1% pet.) and ER [based on diglycidylether of bisphenol A (DGEBA, 1% pet.)], and in 812 patients, nickel sulphate (5% pet.) were removed from the test panel of the standard series and applied on the medial side of the upper arm. Patch-test occlusion time was 24 h in 588 (PPD and ER) and 241 patients (nickel sulphate), respectively, and 48 h in 1160 (PPD and ER) and 571 (nickel sulphate) patients, respectively. Patch tests were read on D1-3 and D2-3, respectively; additional late readings were performed on D7, D14 and D21 after patch-test application. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14 or D21, and questioned about a reaction at the test sites. Patients were instructed to perform daily self-examination from D4 onwards and to return immediately to the clinic if a reaction at the upper arm became visible.
Data of 1428 patients (ER and PPD) and 638 patients (nickel) were evaluable. In 25 patients (1.8%), patch tests became positive not before D7, among them 21 reactions to PPD (1.5%) and four reactions to ER (0.3%). In five of seven patients, repeated patch tests with PPD disclosed patch-test sensitization as the cause of the late reaction. All late reactions, except for one, occurred in patients in whom patch tests were applied for 48 h. No late reactions were seen with nickel sulphate.
PPD (1% pet.) elicited late reactions in 1.5% of routine patch tests, the majority of them probably being caused by patch-test sensitization. Therefore, the German Contact Dermatitis Research Group decided to remove PPD 1% pet. from the German standard series and to take efforts to optimize the patch-test conditions of PPD. One way to optimize PPD testing could be to reduce the exposure of PPD 1% to 24 h. Alternatively the patch-test concentration of PPD might be reduced.
British Journal of Dermatology 05/2006; 154(4):665-70. · 3.67 Impact Factor
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A. Schnuch, J. Geier,
W. Uter,
P.J. Frosch,
W. Lehmacher,
W. Aberer,
M. Agathos,
R. Arnold,
Th. Fuchs,
B. Laubstein,
G. Lischka,
P.M. Pietrzyk,
J. Rakoski,
G. Richter,
F. Rueff
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ABSTRACT: Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis address possible differences between centers remaining after elimination of these confounders, and analyzes other factors which might influence rates, e.g. the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates of the “patch test population” in Central Europe (e.g. nickel sulfate 12.9%, fragrance mix 10.5″. balsam of Peru 7.3%. thimerosal 5.6%). For this analysis, data of those departments which contributed more than 2000 patients or of those with extreme proportion concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably will regard to the items of the MOAHL index and with regard to standardized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only ‘atopic dermatitis’ seems to have little influence on (standardized) rates. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age > 40 years, in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and to a lesser extent Austria) seems to have a great influence on the sensitization pattern observed in a department. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially delined subgroup. Future studies should focus on these factors, as well as on factors concerning patch test practices and quality control.
Contact Dermatitis 04/2006; 37(5):200 - 209. · 3.51 Impact Factor
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ABSTRACT: Patch testing is the standard procedure to detect contact sensitivity. The most frequent contact allergens are included in the standard series. We report on current trends regarding results obtained with the standard series from 2001-2004 in Germany, Austria (Graz, Vienna) and Switzerland (Basel). This analysis includes the frequency of the most common contact allergens and other aspects such as age and gender distribution and parameters of diagnostic quality such as reaction index and positivity ratio. Information on the most common contact allergens is updated.
Der Hautarzt 01/2006; 56(12):1114-24. · 0.58 Impact Factor
