Article

Allergic contact dermatitis to detergents: A multicenter study to assess prevalence

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  • Associates in ermatology
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Abstract

Allergic contact dermatitis (ACD) to optical brighteners and enzymes in laundry detergents was the focus of numerous reports in the early 1970s. Subsequently, there has been little published on the incidence of allergic reactions to chemicals in laundry detergents. Nonetheless, consumers and physicians continue to ascribe allergic contact reactions to laundry detergents. This article reports the findings of a multicenter study on the prevalence of patch test reactions to a liquid and a granular laundry detergent provided by Procter & Gamble Company (Cincinnati, Ohio). Patients referred to members of the North American Contact Dermatitis Group for evaluation of potential ACD were invited to participate in the study, which involved the placement of 2 patch tests (a 0.1% aqueous dilution of a granular laundry detergent and a 0.1% aqueous dilution of a liquid laundry detergent). Whether the patients had atopic dermatitis and whether they or their physicians felt that their dermatitis might be related to laundry detergents were noted. Reactions to the laundry detergents were correlated with allergic reactions to the following screening chemicals: fragrances, nickel, and potassium dichromate. Patients who experienced a reaction to at least one of the laundry detergents could enter phase II of the study, which involved testing to varying dilutions of the laundry detergents, to 0.1% sodium lauryl sulfate (as an irritant control), and to laundered patches of cotton. Patients positive in phase II could enter phase III, which involved wearing a garment laundered with the detergent. Phases II and III were double blinded. Of the 3120 patients seen by members of the North American Contact Dermatitis Group during the 2 years of this study, 738 patients volunteered to enroll. Enrollment was not statistically randomized. Of these 738, 5 (0.7%) had positive patch test reactions to granular laundry detergent (0.1%, aqueous); 3 of these 5 also had positive reactions to the liquid laundry detergent (0.1%, aqueous). In 4 of the 5 patients, the reaction to detergent was thought to have present relevance to their dermatitis; in 1 of the 5, the reaction was deemed to have past relevance. One of these 5 patients had allergy to fragrances. None of the patients was positive to nickel or chromate. Two of the 5 entered phases II and III. Of these 2 patients, 1 had essentially negative repeat dilutional patch testing and "use testing" suggesting that the earlier reaction patterns may have been irritant. The remaining patient had positive dilutional reactions to both the liquid and granular laundry detergent; however, she also had a positive reaction to sodium lauryl sulfate and to a swatch from a T-shirt laundered without detergent. Upon "use testing" in phase III, this latter patient experienced diffuse dermatitis under both the half of the T-shirt laundered with detergent and that laundered without detergent. Laundry detergents appear to be a rare cause of ACD. Among 738 patients with dermatitis, 5 (0.7%) reacted to a 0.1% aqueous dilution of a laundry detergent. Only 2 of these 5 patients could be evaluated in greater detail to differentiate allergic from irritant patch test reactions to detergents. Upon further testing in 2 patients, the reaction in 1 of 2 could not be reduplicated and the reaction in the other was invoked both by the detergents and the controls. Thus, whether our study patients were truly allergic and, if so, what the allergenic material(s) in detergents might be, remains unknown. Therefore the reported incidence rate for detergent-induced allergy of 0.7% in dermatitic patients may be too high, possibly because of false-positive irritant reactions.

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... The earlier of these two publications suggests that perfumes play no significant role in hand dermatitis, certainly in respect of the primary induction of contact allergy [55]. In the most recent textbook, there is a comment concerning detergent products which indicates that it is the additives, rather than the surfactant agents, which should be suspected, although it notes that the frequency of contact allergy to this type of product is apparently often overestimated, a remark based on an extensive US survey concerning allergic contact dermatitis to detergents, which found only a single case that could be explained by fragrance allergy [57]. The online database PubMed was searched using combinations of the following terms: skin sensitization, contact allergy, allergic contact dermatitis, detergents, household cleaning and laundry. ...
... Even under 48 hours of occlusion, fabric which was impregnated with either of these allergens at more than ten times the expected maximum level found on laundered clothing, failed to produce any evidence of an allergic skin reaction in these sensitised individuals. The experimental data gives credence to the view expressed earlier, that the elicitation of fragrance allergy from exposure to household cleaning products, although possible, appears in practice to be relatively uncommon [56,57]. Elicitation responses have been reported in association with occupational exposure, although again, these appear to be uncommon [66]. ...
Article
The induction of contact allergy to fragrance ingredients and the consequent risk of allergic contact dermatitis (ACD) present a human health concern that cannot be ignored. The problem arises when exposure exceeds safe levels, but the source(s) of exposure which lead to induction often remain unclear. This contrasts with the elicitation of ACD, where the eczema frequently can be traced to specific source(s) of skin exposure. Cosmetic products are often implicated, both for induction and elicitation. However, other products contain fragrance ingredients, including household cleaning products. In this paper, the risk assessment concerning the ability of these products to induce fragrance contact allergy is considered and the clinical evidence for the induction and/or elicitation of ACD is reviewed. It can be concluded that the risk of the induction of fragrance contact allergy from household cleaning products is low. Especially where more potent fragrance allergens are used in higher exposure products, the aggregated exposure from such products can augment the risk for the elicitation of ACD. This supports the need to manage this risk via the provision of information to consumers.
... Existing studies on fragrance allergens in detergents are describing the allergy risk from the exposure, e.g. through laundered fabric, as very low (Basketter et al., 2010;Corea et al., 2006;German Cosmetic, Toiletry, Perfumery and Detergent Association, 2016). Contact dermatitis through laundry detergents seems to be rare (Belsito et al., 2002). However, for certain users the exposure to fragrance allergens can indeed be mainly driven by the use of detergents (Nijkamp et al., 2015). ...
Article
Consumers are confronted with a large number of fragrance allergens from various sources. Until now, the discussion of exposure sources has mainly addressed cosmetic products and neglected other scented products in households. For the first time, fragrance allergens were evaluated in a complete set of detergents in households. In 131 households, we investigated the prevalence of detergents and searched their lists of ingredients for 26 fragrance allergens liable to be indicated on products according to the European Detergents Regulations. On the ingredient lists of 1447 products, these 26 fragrance substances were named almost 2000 times, most often limonene, linalool and hexyl cinnamal. Benzyl salicylate was used frequently in all-purpose cleaners. Linalool and limonene, hexyl cinnamal and butylphenyl methylpropional and citronellol and linalool co-occurred most often together in products. Fragrance allergens co-occurring together most frequently within households were eugenol, coumarin and cinnamyl alcohol. The study shows that detergents could play a relevant role for the exposure of consumers towards fragrance allergens and that they should not be underestimated as an exposure source during the exposure assessment.
... Their amphiphilic nature makes them suitable for applications such as detergency and washing. An excessive use of detergents is, however, causing major problems for the environment [2][3][4] and humans [5][6][7][8][9][10][11]. More than 60 % of the total surfactant production enters the aquatic environment resulting in water and environmental pollution. ...
Article
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Hypothesis Detergents used in everyday life for cleaning and washing are a source of water pollution and can have a negative effect on human health and the environment. To reduce their negative impact, a new trend of using only purified water for washing and cleaning applications is emerging. A scientific basis of this method needs to be established, as its mechanisms and the efficiency should be better understood. Experiments In this work, we investigate the effect of water purity on the removal of hydrophobic films from solid surfaces using quartz crystal microbalance with dissipation monitoring (QCM-D) and gravimetric experiments. We compared the cleaning efficiency of TAP water, two grades of purified water, NaCl solution and SDS solution. Findings The QCM-D results show that both grades of purified water remove more than 90% of Vaseline deposited of the surface while tap water only 75%. SDS solution fully removes the deposited layer. Gravimetric experiments with removal of olive oil from hydrophilic and hydrophobic surfaces also indicate higher efficiency of purified water grades. Contact angle experiments show that pure water facilitates roll-up mechanism of cleaning. We suggest that due to lower ionic strength, purified water increases electrostatic repulsion and promotes the cleaning process.
... (A) In a prospective, controlled study of consumers for evaluation of potential ACD to granular and liquid detergents, 0.7% had a positive patch test result. 243 On further testing, these reactions either could not be replicated or were identical to control patch test sites. These findings suggest that this was an irritant rather than an allergic response. ...
... Bioaccumulation of toxic heavy metals has several practical limitations. Sometimes even the bacteria might pose serious side effects (Belsito et al. 2002;Deguchi et al. 2015). Also, other factors like requirement of ideal nutrient media, definitive physicochemical parameters, stringent temperature or pH obligation, large-scale operators, and judicious effluent treatment often make such processes tedious and cumbersome (Wang 2016). ...
Article
Full-text available
Globally, the underlying peril of cumulative toxicity of heavy metals in water bodies contaminated by industrial effluents is a matter of great concern to the environmentalists. Heavy metals like lead, cadmium, and nickel are particularly liable for this. Such toxic water is not only hazardous to human health but also harmful to aquatic animals. Remedial measures are being taken by physico-chemical techniques, but most of them are neither eco-friendly nor cost-effective. Biological means like bioaccumulation of heavy metals by viable bacteria are often tedious. In the present study, biosorption of heavy metals is successfully expedited by surfactant exopolysaccharide (SEPS) of Ochrobactrum pseudintermedium C1 as a simple, safe, and economically sustainable option utilizing an easily available and cost-effective substrate like molasses extract. Its efficacy in bioremediation of toxic heavy metals like cadmium, nickel, and lead have been studied by UV–Vis spectrophotometry and verified by inductively coupled plasma–atomic emission spectroscopy (ICP-AES). FTIR and zeta potential studies have also been carried out to explore this novel biosorption potential. Results are conclusive and promising. Moreover, this particular SEPS alone can remediate all these three toxic heavy metals in water. For futuristic applications, it might be a prospective and cost-effective resource for bioremediation of toxic heavy metals in aqueous environment.
... A few occupations (e. g. medical clinic workers) require visiting hand washing, and the use of cleansing specialists can negotiate skin obstruction and lead to aggravated hand dermatitis. Since the specialist may be uninformed of explicit chemicals to which the individual in question is uncovered, it may be useful to have MSDS acquired from the producer; as it may be, key sharpening fixations found at low fixations are regularly overlooked [19]. ...
Article
Full-text available
Hand hygiene (HH) is the single most important procedure that can be followed by healthcare workers (HCWs) to reduce the risk of spreading healthcare-associated infections. The irritating contact dermatitis (ICD) that occurs due to the rehashed presentation of HH products and technique is one reason often referred to for resistance. HH is the most vital method that can be followed by HCWs to reduce the possibility of spreading of infection in human being, followed by50% of HCWs. Limited researches are published related to different features of irritant contact disorders among HCWs. This study concentrates manly on the clinical application of irritant contact dermatitis on hands and its diagnosis based on an extensive research review process. It can be concluded from this review that by proper adherence and compliance to necessary HH techniques lead to skin damage and higher pathogen load. Therefore, it is important that HCWs should appreciate this concept and are given methods or tactics of expertise to avoid skin irritation and damage. Inability to provide proper policies, practices and guidelines to these workers may lead to adherence in case of an ICD appearance.
... 4 Clinical studies have suggested that residual detergent on clothing can react with skin on an irritant basis. 5 Several commercially available laundry detergents designed for sensitive skin are formulated without fragrances and dyes; these detergents are typically referred to as "free detergents". While laundry detergents have been associated with sensitive skin, there is no present link between laundry detergents and other skin conditions such as atopic dermatitis. ...
Article
Full-text available
Sensitive skin, an often self-reported condition, is characterized by an unpleasant sensory experience to a variety of consumer products. Certain ingredients in consumer products, such fragrances and dyes, are believed to exacerbate skin sensitivities. Due to an increased prevalence of people reporting sensitive skin, a variety of consumer products are formulated for people with this condition. A segment of commercially marketed laundry detergents, commonly known as free detergents, have been formulated without dyes and perfumes to accommodate skin sensitivities. In the US and Canada respectively, 80% and 97% of dermatologist recommend the use of free detergents for their patients with sensitive skin. However, consumers have expressed dissatisfaction with free detergents, with 39% reporting they are not satisfied with their free detergent’s cleaning performance. When people switch from the leading free laundry detergent, they will switch to a non-free detergent 60% of the time, going against dermatologist recommendations and potentially further aggravating their skin sensitivities. Recently, a survey of US households with sensitive skin showed that 98.8% said that they would be more likely to consistently use a detergent that cleans better. Herein are reported data showing Tide Pods Free & Gentle outperformed other free detergents in cleaning across a wide variety of laundry stains and in SEM visual analysis of soil residues on fibers. It is postulated that the better cleaning detergent may help drive patient compliance with dermatologist recommendations for usage of a free detergent for their patients with sensitive skin.
... To study the effect of a protract contact between skin and a carbon-particle-including fabric, a patch test was carried out and skin physiological parameters investigated. Residual detergent, a responsible of textile-induced dermatitis (Belsito et al., 2002), may be present in a larger amount on a carbon-particle-containing fabric than in a conventional one as carbon particles tends to retain detergent. The aim of the work was to evaluate whether carbon particle inclusion would increase the overall comfort of the garment both on an objective and subjective evaluation scale. ...
Article
Full-text available
Purpose The purpose of this paper is to consider the thermal‐physiological comfort performances of a sport shirt made of a polyester (PES) fabric with incorporated activated carbon. After having characterized the modified PES fabric in Part I, the results of a wear trial campaign are shown and discussed in this work. Design/methodology/approach The wear trials have been carried out under a controlled physical activity. A short‐and‐intense effort and an intermittent effort of milder intensity were carried out twice by each volunteer: once wearing a shirt made of the modified PES fabric and the other one wearing an analogous shirt made of a conventional PES fabric. Findings When sweating was moderate, the modified PES shirt was judged as more comfortable on the average. As the effort became harder, the modified PES fabric turned out to be less comfortable than the conventional one. In the final recovery stage, the conventional PES was still more comfortable than the modified PES. This behaviour was justified according to the findings of Part I: at the beginning, the prevailing effect was the adsorbing ability of carbon particles that buffer sweat impulses, giving the user a pleasant dry sensation. Then, when sweating became intense, the lower evaporative cooling of the modified PES fabric became the key factor governing the physiological comfort of the garment. This is confirmed by a slightly higher skin temperature measured during the modified PES fabric trials. Finally, a post‐exercise chill sensation was felt with the modified PES fabric, due to a longer drying time. Originality/value The paper presents a comprehensive study of the thermo‐physiological comfort of a fabric containing activated carbon particles.
... Canadian data are based on an Internet survey conducted in January 2018 of 150 dermatologists licensed to practice in Canada.) Although outright contact dermatitis from laundry detergents is a rare event, occurring in less than 1% of sensitive-skin patients (14,15), it is still important to understand the potential for irritation from detergent products because these products do come into direct and indirect contact with the skin. Although there are many methods to evaluate detergent effects on the skin, from simple laboratory tests to in vitro evaluations such as cell culture, the most relevant to real-world skin responses are observations in controlled clinical studies (5). ...
Article
The skin mildness of two commercial laundry detergents designed for sensitive skin, Tide Free and Gentle® (TFG) versus All Free Clear® (AFC), was compared in clinical studies, and the role of marked product pH differences was assessed. Two double-blind randomized human studies were conducted. Study 1 was a 1-day repeat insult forearm test, in which four exposures to solutions of TFG or AFC were performed to mimic direct exposure to dilute detergent during hand-laundering. Corneometer, erythema and dryness grading, transepidermal water loss (TEWL), and skin surface pH evaluations were carried out. Study 2 was a 21-day arm patch test of fabrics washed with TFG or AFC to mimic indirect contact to skin of detergent residues, with erythema grading. Separately, pH and reserve alkalinity were determined for each detergent. In Study 1, TFG was significantly milder than AFC in all measures except TEWL (no significant difference). In Study 2, the detergents were approximately equivalent in erythema grading. Analysis showed AFC was substantially more alkaline (pH 10.8) than TFG (pH 7.9) with higher reserve alkalinity. TFG was significantly milder than AFC in Study 1, which may be due in part to the increased skin surface pH seen with direct exposure to AFC's high alkalinity.
... Contrary to popular belief, laundry detergents are rare causes of exacerbation of ADE. 15 Clothes should be washed in a mild detergent followed by the addition of a fabric softener. 16 To ensure no residual product in the clothing, an extra rinse with clean water should be performed. ...
Article
Atopic dermatitis/eczema (ADE) is a common condition affecting up to 20% of children in some countries. Atopic dermatitis/eczema impairs quality of life, not only of the patient, but also of family members. Due to the increasing prevalence noticed in westernised populations since the 1940s, particular attention should be paid to triggers, which may be contributing to this rise. Identifying a trigger is fraught with difficulty due to the fluctuating natural course of ADE. Triggers of ADE include irritants (such as soap and detergents), allergens (including standard patch test defined allergens, aeroallergens and food allergens), skin infections (such as Staphylococcus aureus, group A streptococci, herpes simplex virus, malassezia and tinea infections) and others, including cigarette smoke exposure and psychological stress. Many commonly believed triggers, such as extreme temperatures and exposure to sand, have meagre supporting evidence. Nevertheless, they may aggravate the disease. The literature dealing with triggers is sparse. In this article an overview will be given regarding the relevant literature dealing with this difficult topic.
... Allergies resulting from skin contact with surfactants are noted relatively rarely, however there are literature reports describing skin intolerance to a range of compounds including sodium lauryl sulphate [19,138,146], cocamidopropyl betaine [147], alkyl polyglycosides [148][149][150] or sarcosinates [151]. More common allergy-causing agents, which occur both in cosmetics and household chemicals, are colourants, preservatives, plant extracts and fragrances [152][153][154]. ...
Article
One of the primary causes of skin irritation is the use of body wash cosmetics and household chemicals, since they are in direct contact with the skin, and they are widely available and frequently used. The main ingredients of products of this type are surfactants, which may have diverse effects on the skin. The skin irritation potential of surfactants is determined by their chemical and physical properties resulting from their structure, and specific interactions with the skin. Surfactants are capable of interacting both with proteins and lipids in the stratum corneum. By penetrating through this layer, surfactants are also able to affect living cells in deeper regions of the skin. Further skin penetration may result in damage to cell membranes and structural components of keratinocytes, releasing proinflammatory mediators. By causing irreversible changes in cell structure, surfactants can often lead to their death. The paper presents a critical review of literature on the effects of surfactants on the skin. Aspects discussed in the paper include the skin irritation potential of surfactants, mechanisms underlying interactions between compounds of this type and the skin which have been proposed over the years, and verified methods of reducing the skin irritation potential of surfactant compounds. Basic research conducted in this field over many years translate into practical applications of surfactants in the cosmetic and household chemical industries. This aspect is also emphasized in the present study.
Article
Rowe, Helen D. Detergents, clothing and the consumer with sensitive skin. 2006, vol. 30, no. 4, 369-377. Published by and copyright Wiley-Blackwell Publishing. The definitive version of this article is available from http://www.blackwell-synergy.com/ A typical detergent formulation for domestic garment washing is a complex formulation comprising: surfactants, builders, bleaches and auxiliary agents. Repeated exposure to surfactants can cause damage to the lipid film layer of the skin. Textile constructions used in clothing are also complex. Most apparel fabrics will be subject to a laundering process containing detergent at some time in the life cycle and thus it can be surmised that the combination of clothing and detergent is likely to be the cause of some skin problems. Certain fibre types show higher absorption rates than others. If surfactants present in domestic detergents are preferentially absorbed into the fabric during laundering and inadequately removed by rinsing a build-up of the surfactant may exacerbate skin irritation. This paper offers a review of the debate on the effects of detergents on skin disorders plus recent research on clothing and detergents.
Chapter
Contact dermatitis from clothing is not rare and frequently offers a typical pattern, mainly located in body areas in contact with the garment. With the exception of rubber derivatives, textile fibers mostly induce irritant dermatitis. Among the textile resins, used to enhance the touch and quality of clothing, older ones significantly release formaldehyde, whereas current cyclized urea resins release fewer or no formaldehyde. Disperse dyes (azo or anthraquinone type) are the most employed dyes and the most frequent inducers of textile allergy, due to synthetic fibers. Among disperse azo dyes, Disperse Blue 106/124 are currently the main sensitizers, found in synthetic fibers. Standard series are generally unable to detect textile dyes allergy, and the gold standard is patch testing with the patient’s clothing. Systematic addition of textile dye(s) such as Disperse Blue 106/124 can be recommended. Detection of formaldehyde and extraction of dyes from clothing for subsequent identification and patch testing are useful methods to ascertain the diagnosis of textile contact allergy.
Chapter
Patch testing with the baseline series may detect only 40–70% of the responsible allergens in the diagnosis of contact dermatitis. Using additional commercially available test series will detect another 25% of the relevant allergens. Only about 10% will be recognized, if the patient´s own materials are patch tested. In this chapter, detailed guidelines for various products will be given: cosmetics (leave on and wash-off type), hair dressing, disinfecting agents, clothing, plants, construction materials, metal working fluids etc. The test concentration is crucial, because some of these materials are irritants and may even cause necrotic reactions, if tested undiluted. Before testing, detailed information about chemistry, pH, toxicity, and sensitization properties should be obtained. A semi-open test without occlusion is helpful for materials with irritant potential. A dilution series, control testing on informed volunteers, and repeated open application tests have frequently identified new contact allergens in various occupations and in products contacting the skin in daily life.
Article
Detergent enzymes have a very good safety profile, with almost no capacity to generate adverse acute or chronic responses in humans. The exceptions are the limited ability of some proteases to produce irritating effects at high concentrations, and the intrinsic potential of these bacterial and fungal proteins to act as respiratory sensitizers, demonstrated in humans during the early phase of the industrial use of enzymes during the 1960s and 1970s. How enzymes generate these responses are beginning to become a little clearer, with a developing appreciation of the cell surface mechanism(s) by which the enzymatic activity promotes the T-helper (T(H))-2 cell responses, leading to the generation of IgE. It is a reasonable assumption that the majority of enzyme proteins possess this intrinsic hazard. However, toxicological methods for characterizing further the respiratory sensitization hazard of individual enzymes remains a problematic area, with the consequence that the information feeding into risk assessment/management, although sufficient, is limited. Most of this information was in the past generated in animal models and in vitro immunoassays that assess immunological cross-reactivity. Ultimately, by understanding more fully the mechanisms which drive the IgE response to enzymes, it will be possible to develop better methods for hazard characterization and consequently for risk assessment and management.
Article
Although it is well known that the skin in patients with atopic dermatitis becomes drier in winter, the mechanisms of winter deterioration of dry skin are not fully understood. Our purpose was to determine whether residual washing detergent in cotton clothes plays a role in the winter deterioration of atopic dry skin. We studied 148 Japanese patients with atopic dermatitis who visited our dermatology clinic during winter months. They wore cotton underwear, which they had washed in cold tap water. We examined the distribution of dry skin on their trunks. We then asked them to stop washing their clothes with common anionic, additive-enriched detergents, and to use a nonionic, additive-reduced detergent for a period of two weeks. Photographs of 2 or 3 representative dry skin sites on the trunk were taken before and after the trial. By comparing the before-after trial photographs, the severity of dry skin at the end of the trial was assessed on a 5-point scale ranging from markedly improved to worsened. Of the 148 patients examined, 115 (78%) had widespread or localized dry skin on the trunk. The dryness of the skin was prominent around the shoulders. Of these 115 patients, 87 (76%) showed marked or moderate improvement of dry skin after the two-weeks of use of the nonionic, additive-reduced washing detergent. No patient showed worsening of the dry skin. These results suggest that residues of common washing detergents in cotton underclothes play an important role in the winter deterioration of dry skin in patients with atopic dermatitis who use cold tap water for washing their clothes.
Article
Background: Irritant contact dermatitis (ICD) is commonly treated with topical corticosteroids. MAS063D (‘Atopiclair’) is a nonsteroidal effective in atopic dermatitis. Objective: To determine the efficacy of a topical agent, MAS063D, in managing ICD. Methods: Two sites of ICD were created using sodium lauryl sulfate (SLS) in 20 volunteers; MAS063D was then applied to one and a vehicle-only control to the other. Measurements were taken at baseline, 24, 48 and 72 h. Results: The objective measurements of blood flow volume (BFV), skin color (a*) and transepidermal water loss (TEWL) all showed statistically significant benefits of MAS063D over the vehicle-only control. BFV and a* were significantly better at all time points (p = 0.046, p = 0.045, respectively, at 72 h) and TEWL at 48 and 72 h (p = 0.02 at 72 h). Conclusion: MAS063D demonstrated benefits over vehicle in three clinically meaningful outcomes of SLS-induced ICD.
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Routine care of a newborn may be an intimidating task for new parents. This routine care includes tending to the skin of the infant. Maintaining a healthy, intact cutaneous barrier is important psychologically for the parent and medically for the child. Clinicians should be able to offer guidance concerning the basics of skin care, to dispel any misconceptions concerning baby products, and to optimize cutaneous integrity for the comfort and well being of the infant.
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Advanced cleaning formulations, such as liquid laundry packages, consist of many components that require a complex mixture of interfacial actives including silicones for foam control, bleach for brightening, and enzymes for stain removal. Many of these ingredients are mutually incompatible, particularly in liquid formulations where they can be in intimate contact over extended periods of time. Solid dispersions of a prototypical bleach, NaBO3, in silicone polyether surfactants were shown to be very stable over time, even in the presence of water-in-silicone (D(4)) emulsions containing the enzyme alpha-chymotrypsin. Normally, perborates undergo rapid decomposition on contact with water. The rate of denaturation of the enzyme in the emulsion was similarly unaffected by the presence of the bleach until the emulsion was broken, unlike the case where the polyether surfactant was not present. The polyether surfactant thus protects the perborate from hydration and the enzyme from denaturing on contact with silicone oil until excess water and high shear are applied to the emulsion; protective mechanisms are discussed.
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Nonaccidental injury is always a concern when children present with unusual injuries. The case of a child who presented with a partial thickness burn secondary to prolonged contact with a liquid biological laundry detergent is described. Initially there was some doubt as to whether the agent in question could cause this injury but a small experiment on a volunteer confirmed it was possible.
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In their raw state, enzymes of bacterial/fungal origin cause allergic reactions in the lung. Proteolytic enzymes also cause irritation to skin, eyes and the respiratory tract. For 40 years, encapsulated enzymes have been used worldwide in detergent products, especially laundry formulations, and have increasing importance due to biodegradability and functionality at low temperatures, offering environmental benefits. Uniquely to the U.K., for years it has been suggested that the inclusion of enzymes in such products leads to adverse skin reactions, including erythema, pruritus and exacerbation of eczema. In this review, we look at the facts, asking whether there is evidence that the hazards identified for enzymes translate into any risk for consumer health. By considering the actual exposures in consumer use and exaggerated product usage, it is concluded that the irritating and allergenic hazards of enzyme raw materials do not translate into a risk of skin reactions, either irritant or allergic. Investigations of numerous individuals with skin complaints attributed to laundry products demonstrate convincingly that enzymes were not responsible. Indeed, enzyme-containing laundry products have an extensive history of safe use. Thus, the supposed adverse effects of enzymes on skin seem to be a consequence of a mythology. The important practical lesson is that when primary or secondary care practitioners are presented with a skin complaint, it should not be dismissed as a result of using an enzyme-containing laundry product as the diagnosis will certainly lie elsewhere. Education for healthcare professionals could usefully be enhanced to take this on board.
Article
Les batteries commerciales pour tests épicutanés (batterie standard et batteries complémentaires) sont la base des investigations visant à confirmer une allergie de contact. Néanmoins, de nombreuses études ont montré que cela n’était pas suffisant. Ainsi, lors d’une étude multicentrique, Menné et al. [20] ont trouvé que la batterie standard européenne ne détectait, chez les patients présentant une allergie de contact, que de 37 à 73 % des allergènes responsables. Les allergènes supplémentaires et/ou testés séparément n’étant positifs que dans 5 à 23 % des cas, les auteurs mettent l’accent sur la nécessité de tester le patient avec les produits avec lesquels il a été réellement en contact. En Italie, une analyse des dossiers de 230 patients adressés pour suspicion d’allergie de contact professionnelle a montré que la batterie standard seule détectait 69,9 % des cas de nature allergique ; 26,3 % de ces cas étant positifs uniquement pour les tests supplémentaires
Article
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an autoimmune etiology, underlying systemic disease, or in association with an identifiable causative agent, such as a medication, food product, or dental material. OLLs commonly present with striae, erythema, and/or ulceration on affected oral mucosa and can be symptomatic. The aim of this report is to describe a case of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral occlusal appliance.
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Patch testing is essential for identification of culprit allergens responsible for allergic contact dermatitis. This manuscript reviews how to perform patch testing and how to read and interpret the results.
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Some proteins, including enzymes, can induce allergic sensitization of various types, including allergic sensitization of the respiratory tract. There is now an increased understanding of the role that the skin plays in the development of IgE-mediated allergy and this prompts the question whether topical exposure to enzymes used widely in consumer cleaning products could result in allergic sensitization. Here, the evidence that proteins can interact with the skin immune system and the way they do so is reviewed, together with a consideration of the experience gained over decades of the use of enzymes in laundry and cleaning products. The conclusion drawn is that although transcutaneous sensitization to proteins can occur (typically through compromised skin) resulting in IgE antibody-mediated allergy, in practice such skin contact with enzymes used in laundry and cleaning products does not appear to pose a significant risk of allergic disease. Further, the evidence summarized in this publication support the view that proteins do not pose a risk of allergic contact dermatitis.
Article
Background: The European Surveillance System on Contact Allergies (ESSCA) began in 2001 as project funded by a European Union grant to monitor and evaluate contact sensitization (CS) based on clinical data collected by participating European dermatology departments. Objectives: ESSCA aims to detect trends in CS in an international patch test population, monitoring the frequency of CS to (standard series) allergens, evaluating the effectiveness of intervention (e.g. governmental regulations) and improving standardization of the patch test procedure on an international level. Methods: In 2004, 31 ESSCA dermatology departments in 11 European countries collected patch test results and medical histories of patients tested with the European Standard Series (ESS) or a local standard allergen series using the multilingual Winalldat/ESSCA database, the German Winalldat/Information Network of Departments of Dermatology (IVDK) database or a locally created database including the items of the ESSCA 'minimal data set'. Data were sent to the ESSCA data centre where they were imported, pooled, examined for quality and subsequently analysed. Results: The departments patch tested 11 643 patients with a standard series, and 44% of the patients tested positive to one or more substances of the ESS. Nickel sulphate, the fragrance mix, Myroxylon pereirae resin, cobalt chloride, potassium dichromate, methyldibromoglutaronitrile and paraphenylenediamine are (still) the most important allergens detected. Several additional substances tested on consecutive patients in some clinics were also examined. Among these allergens, propolis and Compositae mix had a relatively high CS prevalence. Conclusions: The expanding ESSCA network continues to provide up-to-date information regarding the pattern of CS diagnosed in participating departments across Europe. © 2007 The Authors Journal compilation
Article
Background: Contact dermatitis (CD) has been assessed by numerous disease severity indices resulting in heterogeneity across published research. Objective: This study aims to evaluate published CD severity scales and identify a criterion standard for assessment. Methods: Scopus and Ovid MEDLINE were searched for human randomized controlled trials (RCTs) on CD severity measures published during a 10-year period. Eligible studies were English-language RCTs reporting disease severity outcome measures for CD in humans. Studies were excluded if they were duplicates, not available in English, not related to CD, not RCTs, not conducted on human subjects, or did not report relevant outcome measures. Results: A total of 22 disease outcome measures were used in 81 included RCTs. Instrument-based measures were used in 40 (49.4%) studies, and visual assessments were used in 66 (81.5%) RCTs. Only 5 (6.2%) studies reported quality of life (QoL) outcomes. Two (2.5%) studies used a clinical severity scale, which combined both QoL and visual assessments. Limitations: This study was limited by the exclusion of non-RCTs and gray literature. Conclusions: Wide variation in CD outcome measures exists including instrument-based measures, visual assessments, and QoL outcomes. A standardized outcome measure must be generated to reduce heterogeneity.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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Household, personal, and industrial products contain detergents which play an important role in everyday life. The term “detergency” is used to describe the process of cleaning by a surface-active agent (surfactant). The most important ingredients of detergents are surfactants which display surface-tension-lowering properties so water can expand to wet surface, increasing washing effectiveness. Chemically, surfactants are amphiphilic molecules with a lipophilic tail and a hydrophilic head. They are categorized into four primary groups according to the charge present in the hydrophilic head: anionic, cationic, amphoteric, and nonionic. In the current market of cleaners and cleansers, anionic surfactants are the most common ones. Surfactants may be irritating to the skin. The order of irritant potential of surfactants is the following: cationic = anionic > amphoteric > nonionic; however, mixtures of surfactants may elicit unexpected reactions. Considering the widespread use and applications of household and personal detergents, the frequency of side effects to the skin is relatively low in an occupational as well in a personal exposure.
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Background: Household cleaning products are widely used by the public, but limited data have been obtained on whether their use induces allergic dermatitis in children. Objective: This study investigated the association between exposure to household cleaning products and allergic dermatitis in primary-school children. Methods: A prospective cohort study of Hong Kong primary-school children was conducted between 2012 and 2014. A baseline survey was administered to 1,812 students who did not have allergic dermatitis. Information on respiratory symptoms, exposure to household chemical cleaning products and other topics was collected using a self-designed questionnaire. A cumulative chemical burden (CCB) score was calculated for each student by summing the duration of exposure to 14 chemical cleaning products. Principal component analysis was used to identify patterns in the use of these cleaning products. Logistic regression was performed to calculate relative risk (RR) with 95% confidence intervals (CIs) after adjusting for potential confounders. Results: Eighty-nine (4.9%) of the students surveyed had dermatitis during the follow-up. However, exposure to individual chemical cleaning products was not found to be associated with the children's allergic dermatitis (all P > 0.05). In contrast to those in the lowest tertile, neither CCB scores in the middle tertile (RR: 1.16, 95% CI: 0.67 to 2.00) nor those in the highest tertile (RR: 1.24, 95% CI: 0.73 to 2.14) were significantly associated with the risk of allergic dermatitis. The adjusted RR for every 5-unit increment in CCB score was 1.01 (95% CI: 0.98 to 1.03). Four patterns of cleaning-product use were derived, but none were found to be associated with the risk of dermatitis (all P > 0.05). Conclusion: The use of household chemical cleaning products is not associated with the risk of dermatitis in primary-school children. This article is protected by copyright. All rights reserved.
Article
Background: Chemicals in textile manufacturing and laundering products are important sources of allergens triggering allergic contact dermatitis. Allergens corresponding to the textile production process have been well recognized. However, there is limited information regarding potential allergens in laundering products. Objective: The aim is to investigate the presence and prevalence of potential allergens in commonly used laundering products. Methods: An Internet-based search was performed to identify the current best-selling laundering products in the United States. Subsequent inquiry of common allergens for each product was collected through a review of ingredients listed by manufacturers. Results: Sixty-five laundering products were examined: 30 laundry detergents, 10 fabric softeners, 8 dryer sheets, and 17 stain removers. Ten common allergens were identified: benzisothiazolinone, benzyl benzoate, cocamidopropyl betaine, decyl glucoside, "fragrances," lauryl glucoside, methylisothiazolinone, methylchloroisothiazolinone, phenoxyethanol, and propylene glycol. Fragrances and essential oils are the top allergens in laundry detergents (66.7%), fabric softeners (90%), dryer sheets (75%), and stain removers (58.8%). Laundry detergents labeled as "baby safe" and "free and gentle" contained common allergens, with methylisothiazolinone being the most prevalent, in 80% and 57.1%, respectively. Conclusions: Textile dermatitis can negatively impact quality of life and function. Aside from textile dyes and finishing resins, laundering products should also be considered.
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Many industrial microbial enzymes produced currently are used in the food industry. Enzymes are proteins and do not typically represent a hazard. Those that do are well defined and include, bacterial, plant and animal toxins, allergens, and antinutrients. Enzymes are not acutely toxic, genotoxic, or toxic by repeated dose administration. The enzyme industry has performed many genotoxicity studies. Greater than 230 and > 240 mutagenicity studies on bacterial and mammalian cells, respectively have been conducted. Further > 200, 90-day oral gavage or feeding studies have been performed with no adverse findings observed. Except for the potential skin and eye irritating effects of some proteases and the potential for occupational respiratory sensitization, enzymes are safe for human exposure. These studies also confirm that any remaining fermentation materials in the product also lack toxicity. The safety of enzyme production strains continues to be the key consideration in evaluating enzyme safety. The conduct of repeated toxicological testing with enzymes derived from the same strain lineage with no adverse effects allows for the establishment of a Safe Strain Lineage (SSL). The lack of general toxicological concern on enzymes and the use of the SSL concept support the consideration of reduced Toxicology testing packages. Safety assessment requirements for food enzymes are complicated by differences in global regulations. This includes differences in the conditions under which premarket approval is required, and differences in sensitivities to perceived risks of the use of biotechnology in developing new enzyme products, resulting in discrepancies in the type of safety data manufacturers must provide. Additional research and data into the etiology of how enzymes act as respiratory allergens are also needed to differentiate between nonallergenic/weakly allergenic enzymes and those moderate/strongly allergenic enzymes via the respiratory route of exposure.
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The increasing demand of emulsifying and demulsifying agents applied in petrochemical industries shifting the global attention from chemically synthesised surfactants toward biosurfactants in past decades. Petroleum industries significantly employed a large volume of surface-active agents for application in several fields related to crude oil extraction, recovery, transportation, and cleaning of oil carrying tanks. Besides direct application in oil field, biosurfactants possess some other applications in the formulation of petroleum products like biofuel preparation and cosmetic industries. Owing to widespread acceptability and extensive stability within a broad range of temperature, pH, and salinity, biosurfactants furnished a potential importance as emulsifier and demulsifier in the formulation of petrochemical and its related product. This article discusses only those biosurfactants that are applied in the formulation of petrochemical products as emulsifying and demulsifying agents.
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Ethoxylated alcohols are non-ionic surfactants. The majority are used in household cleaners, laundry products, toiletries and in industrial and institutional cleaners. In previous studies, an ethoxylated non-ionic surfactant of technical quality showed allergenic activity in guinea pig experiments. Chemical analysis revealed a content of formaldehyde, a well-known contact allergen, and peroxides in the surfactant. Most cases of occupational contact dermatitis are considered to be of irritant origin, caused by contact with water and surfactants, but if allergenic autoxidation products can be formed, allergic contact dermatitis cannot be excluded. The sensitizing potential of a chemically defined high purity ethoxylated alcohol was investigated and oxidation under various storage and handling conditions was studied for this and a homologous product. The pure surfactant showed no significant allergenic activity on predictive testing in guinea pigs. When ethoxylated alcohols were stored in the refrigerator, their deterioration was limited. At room temperature, their content of peroxides and formaldehyde increased with time. Levels of formaldehyde above those capable of causing positive patch test reactions were found. Since such surfactants have wide applications, resulting exposure to formaldehyde could be more frequent than is generally realized, contributing to persistence of dermatitis in individuals allergic to formaldehyde.
Article
Detergent residues are often accused to cause efflorescences of the skin. In the present studies different textiles were washed under standardized conditions and the residues analized. Textile probes were patch tested for 48 h on seborrhoic and sebostatic volunteers. A second series of textiles was given to babies and small children. In all cases no reactions were observed. According to these results and further literature the contribution of detergent residues as a releaser of skin reactions is rather insignificant.
Article
Background and Design: Past observations have shown increased irritancy in patients with ''conditioned hyperirritability'' due to active dermatitis, including atopic dermatitis (AD). In less active atopic conditions, irritancy levels are less certain. We have utilized 48-hour Finn Chamber testing with graded dilutions of sodium lauryl sulfate to detect irritancy thresholds in well-defined groups of patients with AD, inactive AD, and allergic respiratory disease with no dermatitis and in normal nonatopic subjects.Results: Significantly greater frequency of response to sodium lauryl sulfate in both AD groups and also in patients with allergic rhinitis with no dermatitis was seen. Effective concentrations of sodium lauryl sulfate causing irritation in 50% or more of subjects (ED50) ranged from 0.0625% to 0.31% in all atopic groups, percentages that were significantly lower than the normal ED50 of 0.60%. Response intensity was also significantly greater in each atopic group.Conclusions: Our results showed significantly greater irritant responses in atopic subjects with no skin disease or in subjects with inactive AD and confirmed past findings that showed greatly increased irritancy in patients with active AD. We hypothesize that abnormal intrinsic hyperreactivity in inflammatory cells, rather than in skin cells, in atopic individuals predisposes to a lowered threshold of irritant responsiveness.(Arch Dermatol. 1994;130:1402-1407)
Article
: Between August 1, 1985 and July 30, 1989 patch tests were performed on 4,055 patients with suspect contact dermatitis in 14 clinics in North America. Twenty-eight screening chemicals were used for these tests. The most common locations for the presenting dermatitis were hands, face, generalized, arms, and feet. The peak decanal age group was 21 to 30 years. Nearly half of the tested patients were found to have allergic contact dermatitis. Photodermatitis accounted for only 0.4% of the population. The proportion of responses to the various test chemicals is discussed. (C)1991American Contact Dermatitis Society, All Right Reserved
Article
As part of an Agricultural Experiment Station U.S. Western regional project, this article reports consumer perceptions of dermatological and other health problems resulting from contact with laundry products or laundered textiles. The objectives are to (a) assess the percentage of the population who perceive these health problems and analyze the relationship between these problems and the respondents' demographics, (b) identify laundry products implicated by afflicted individuals, and (c) assess the specific health problems and how consumers seek relief from these problems. Information from a self-administered questionnaire mailed to a disproportionate stratified random sample of households in five Western U.S. states provided baseline data on the existence of dermatological and other health problems perceived to be attributed to laundry product use. Skin irritation perceived to be caused by laundry products was reported by 26% of 3,841 respondents, and perceptions of allergies to laundry products were reported by 21% of the respondents. These problems were experienced more often by females than males and more often by children, age 1 through 20, than other age groups. In follow-up telephone interviews with afflicted consumers, detergents caused the most health problems. Skin irritation, especially on the arms, was the most common health problem. Individuals typically discontinued use of laundry products that they suspected caused their problems.
Article
An outbreak of severe allergic contact dermatitis occurred in Norway in 1966 in women who had used a new dish-washing product containing an alkyl ethoxysulphate. The dermatitis was sometimes accompanied by adverse systemic effects. Subsequent investigations revealed the presence of unsaturated sultone and chlorosultone contaminants in the alkyl ethoxysulphate component of a particular batch of the detergent. Their presence was attributed to abnormal manufacturing conditions. These sultones were shown to be potent skin sensitizers and the allergic contact dermatitis was attributed to them. The various clinical, toxicological and analytical aspects of this occurrence are reviewed and discussed here. The work represents a model study of this type of problem, in which an occasional contaminant in a commercial product gives rise to untoward skin reactions.
Article
The 6 most common fluid and powder detergent brands in use in Austria were analyzed as to their nickel and chromium content. The analysis was carried out by means of atomic absorption spectroscopy. 1. The above-mentioned metals were found to be present in each of the products analysed. On average, the fluid detergents contained ten times less nickel and chromium than the powders. 2. Repeated investigations revealed a considerable variation in metal ion content in different batches of the same detergent. Thus, presumably the raw products already contain nickel and chromium and it is unlikely that these ions get into the products during the manufacturing process. 3. In the appropriately diluted detergent powder solutions, as recommended by the producer, the content of nickel was found to lie between 0.4 ppm and 0.717 ppm and the chromium content ranged from 0.733 to 0.917 ppm. Since powder detergents also contain complex-producing agents, it can be assumed that these concentrations of metal ions do not suffice for sensitization. In the fluid detergents the nickel and chromium contents were found to be below the safety limit for the elicitation of an excematous reaction.
Article
Patients who are sensitive to fragrances should either use fragrance-free cosmetics or undergo a repeat open application test to the cosmetic or perfume to determine sensitivity. Unusual reactions include systemic contact dermatitis due to balsam of Peru, benzyl alcohol, and menthol. Some responses involve pigmented eruptions due to phototoxic or photoallergic agents in perfumes and incense. Other reactions include consort dermatitis and reactions to toothpastes, gum and perfumes in paper products, sanitary napkins, ostomy pastes, and detergents.
Article
The frequency of raised levels of IgE antibodies against a detergent enzyme—subtilisin-A—was investigated in adult Swedish consumers. Of 1132 patient sera which were sent to the laboratory for routine RAST testing against various allergens a positive RAST to subtilisin was found in twenty-one (1.9%). Of 391 blood donors two had a positive RAST and one a doubtfully positive reaction. A positive prick test to subtilisin was obtained in four out of 122 patients with symptoms of allergic airways disease. Sensitization occured more often among patients with an atopic constitution. About four out of five of the patients in whom IgE antibodies to the enzyme was found were women. Thirty-five patients (seventeen with a positive and eighteen with a negative RAST to subtilisin) were further investigated in order to see if results of RAST and skin test with subtilisin were correlated with clinical symptoms. Eight patients with positive RAST and skin test reported symptoms of an immediate allergic type in connection with exposure to enzyme detergents. Three patients had symptoms which could be attributed to residues of subtilisin in the laundry after washing. In six patients the sensitization did not seem to have any clinical significance. Taking into account the general use of enzyme detergents, sensitization has not been found to be a major clinical problem.
Article
Twenty-five per cent of 353 highly and moderately sensitive patients attending allergy clinics in Cincinnati and Middletown, Ohio, exhibited positive skin tests to either one or both of the 2 major types of commercial detergent enzymes, Alcalase (ALC) and Amylase Protease (AP). Positive passive transfer results were obtained in 5 of 10 patients who exhibited direct skin reactivity. Nasal and bronchial challenge tests were performed in 14 patients, all of whom related the onset of respiratory symptoms to prior exposure to enzyme-containing products. Positive nasal tests were observed in 7 patients with histories of upper respiratory symptoms, and positive bronchial responses were obtained in 7 patients with antecedent complaints of lower airways obstruction. Eleven of these patients were atopic; 3 were nonatopic. All patients noted significant improvement in causally related symptoms after enzyme products were eliminated.
Article
— In 16 months contact dermatitis from an optical whitener, Tinopal CH 3566, was diagnosed in 167 patients at the Finsen Institute. The dermatitis presented as a textile dermatitis. Since “Tinopal” covers a wide range of chemically unrelated optical whiteners, the designation “CPY” is introduced for the particular pyrazoline derivative implicated in this dermatitis. This product sensitized 16 of 20 animals in the guinea-pig maximization test: this rates this optical whitener as a strong sensitizer. The result of patch testing in some of the patients with a number of pyrazoline derivatives points to the 4-position in the pyrazoline ring and the para-position in the l-benzyl-ring as key positions. Benzylsalicylate evoked a positive reaction in 16 of 88 patients. Seven of 13 patients showed a positive patch test to “Nylon” washed in a detergent containing the brightener.
Article
Past observations have shown increased irritancy in patients with "conditioned hyperirritability" due to active dermatitis, including atopic dermatitis (AD). In less active atopic conditions, irritancy levels are less certain. We have utilized 48-hour Finn Chamber testing with graded dilutions of sodium lauryl sulfate to detect irritancy thresholds in well-defined groups of patients with AD, inactive AD, and allergic respiratory disease with no dermatitis and in normal nonatopic subjects. Significantly greater frequency of response to sodium lauryl sulfate in both AD groups and also in patients with allergic rhinitis with no dermatitis was seen. Effective concentrations of sodium lauryl sulfate causing irritation in 50% or more of subjects (ED50) ranged from 0.0625% to 0.31% in all atopic groups, percentages that were significantly lower than the normal ED50 of 0.60%. Response intensity was also significantly greater in each atopic group. Our results showed significantly greater irritant responses in atopic subjects with no skin disease or in subjects with inactive AD and confirmed past findings that showed greatly increased irritancy in patients with active AD. We hypothesize that abnormal intrinsic hyperreactivity in inflammatory cells, rather than in skin cells, in atopic individuals predisposes to a lowered threshold of irritant responsiveness.
Article
Since finding that all subjects with contact allergy to cocamidopropylbetaine give positive reactions to 3-dimethylaminopropylamine (DMPA), we wished to verify whether sensitization to other industrially-used tensioactives might also be due to content of DMPA as an impurity. We also investigated the possible "carrier action" that tensioactives might exert on minimal quantities of DMPA. Finally, we analyzed the relationship between the structure of DMPA and other chemically-correlated molecules and their sensitizing potential, with particular reference to the structure of alkylamidopropylbetaines. For this purpose, in 34 patients with contact allergy to DMPA, we tested: (i) DMPA in concentrations below the threshold limit in water and in different tensioactives; (ii) substances that employ DMPA as a reagent in their synthesis; (iii) substances similar to DMPA as regards chemically reactive groups. The study showed that: (i) DMPA remains as a quantitatively detectable impurity in all tensioactives employing it in their synthesis; (ii) some common anionic (SLES) and non-ionic (polysorbate 20) tensioactives enhance the risk of sensitization from very low doses of DMPA, presumably due to a "carrier effect;" (iii) the sensitizing chemical structures in DMPA and related molecules are the primary amine and the tertiary (dimethyl-substituted) amine groups, when separated by either 2 or 3 carbon atoms; (iv) no sensitizing action can be attributed to the functional groups present in alkylamidopropylbetaine molecules.
Article
Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals. Patch testing, when used properly, often provides support for the diagnosis of allergic contact dermatitis. This article reports patch testing results from July 1, 1994, to June 30, 1996, by the North American Contact Dermatitis Group (NACDG). Patients evaluated in our patch test clinics were tested with the same screening series of allergens by the use of a standardized patch testing technique. The data from these patients were recorded on a standard computer entry form and analyzed. Forty-nine allergens were tested on 3120 patients. Budesonide was added to the series in July 1995 and tested on 1678 patients. Of these patients, 66.5% had positive allergic patch test reactions, and 57% had at least one allergic reaction that was felt to be clinically relevant to the present or past dermatitis. The 20 screening allergens commercially available to United States dermatologists in the Allergen Patch Test Kit, accounted for only 54.1% of the patients with positive allergic reactions. The additional 30 allergens on the NACDG screening series accounted for 47% of patients with positive allergic reactions. Had the Allergen Patch Test Kit alone been used, 12.4% of all patients tested may have had their disease misclassified as a nonallergic disorder, and an additional 34.4% of all tested patients would not have had their allergies fully defined. Among those patients with positive responses to the supplemental allergens, 81% of the responses were of present or past relevance. The 12 most frequent contact allergens were nickel sulfate, fragrance mix, thimerosal, quaternium-15, neomycin sulfate, formaldehyde, bacitracin, thiuram mix, balsam of Peru, cobalt chloride, para-phenylenediamine, and carba mix. The present relevance varied with the specific allergen from 10.7% (thimerosal) to 85.7% (quaternium-15). Among newer allergens, methyldibromoglutaronitrile/phenoxyethanol (cosmetic preservative) caused positive allergic reactions in 2% of the patients; tixocortol-21-pivalate and budesonide (corticosteroids), in 2.0% and 1.1% of the patients, respectively; and ethylene urea/melamine formaldehyde mix (textile resin), in 5% of the patients. The usefulness of patch testing is enhanced with the number of allergens tested, because allergens not found on the commercially available screening series in the United States frequently give relevant allergic reactions.
Bedeutung von ruckstanden von textilwaschmitteln aus dermatotoxikologischer sicht. [Importance of detergent residues from the dermatologic point of view
  • Matthies Vw A Lohr
  • Ippen
Matthies VW, Lohr A, Ippen H. Bedeutung von ruckstanden von textilwaschmitteln aus dermatotoxikologischer sicht. [Importance of detergent residues from the dermatologic point of view.] Dermatosen 1990;38:184-9.
Patch testing with a routine screening tray in North America, 1985 through 1989, I: frequency of response
  • Nethercott
Bedeutung von ruckstanden von textilwaschmitteln aus dermatotoxikologischer sicht.
  • Matthies