Ian R. White’s research while affiliated with British Society for Cutaneous Allergy and other places

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Publications (144)


Flow-chart for classification of a late-appearing reaction (LAR). conc. patch test concentration, D days after the start of patch test exposure, LARps LAR in a pre-sensitized individual, ±  criterion may or may not be met
Extended fragrance ingredients surveillance study (EFISS)—protocol for a clinical surveillance study on contact allergy to 7 fragrance materials in widespread use but hitherto not systematically patch tested
  • Article
  • Full-text available

May 2025

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4 Reads

Archives of Dermatological Research

Wolfgang Uter

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Ana Carolina Figueiredo

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Contact allergy (CA) is not uncommon in the population, including to various fragrance allergens. If not diagnosed correctly, allergic contact dermatitis (ACD) may ensue, because targeted allergen avoidance is not possible. The primary objective of the study is to estimate the prevalence of CA to seven fragrance materials in patients with suspected ACD across Europe. Based on the outcome, a conclusion will be drawn as to whether present risk management regarding maximum recommended concentrations of each of these, based on quantitative risk assessment (QRA2), is adequate. The planned study is a surveillance study based on consecutive patients, patch tested in 10 European departments of dermatology with a series of allergens as indicated by their personal history, including the European baseline series, supplemented with the seven additional fragrance ingredients. The patch test procedure will follow the guideline of the European Society of Contact Dermatitis (ESCD) with additional standardization procedures. The envisaged sample size is 8100; recruitment will be in three data cycles with brief intervals allowing for descriptive interim analyses. Those patients reacting positively to any of the study allergens will be followed-up specifically to identify the source of sensitizing and/or eliciting exposure(s). Results will inform risk reassessment and subsequent risk management measures. Study results will be published in an open-access peer-reviewed scientific journal. Structured post-marketing surveillance of consumer risk of contact allergy by monitoring prevalences of positive patch test reactions in a dedicated European expert network is developed which can serve as a model for further chemicals. Important outcomes will be either a confirmation of effectiveness of risk management measures in place, or alternatively identifying aspects needing improvement (for certain cosmetic product categories). DRKS registration (DRKS00033263) 16.09.2024, mirrored at https://trialsearch.who.int Supplementary Information The online version contains supplementary material available at 10.1007/s00403-025-04286-9.

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Thresholds for ingredient labelling/identification


Examples of allergic contact dermatitis on (A) the scalp extending beyond the hairline and severe periorbital edema from hair dye. (B) On the abdomen from a metal belt buckle. (C) On the back of the hands of a construction worker due to cement allergens, that is, occupational contact allergens. (D, E) On the foot and leg from topical medicaments.
The procedure of patch testing. (A) Patch test substances (haptens dispersed in appropriate vehicles) in a tray. (B) Loading patch test chambers with patch test substances of choice. (C) Patch tests mounted on a patient's upper back (the principal patch test area) for 2 days. (D) Patient's back 4 days later with a weak (+) and strong (++) positive patch test reaction to two of the haptens tested. Readings of patch test reactions are performed on Days 2, 3, 4, and 7 according to the European Society of Contact Dermatitis (ESCD) patch test guideline.
Severely compromised supply of patch test allergens in Europe hampers adequate diagnosis of occupational and non‐occupational contact allergy. A European Society of Contact Dermatitis (ESCD), European Academy of Allergy and Clinical Immunology (EAACI), European Academy of Dermatology and Venereology (EADV) task forces ‘Contact Dermatitis’ and ‘Occupational Skin Disease’ position paper

May 2024

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93 Reads

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6 Citations

Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high‐quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.



Use of methylisothiazolinone (MI), benzisothiazolinone (BIT), octylisothiazolinone (OIT) and dichlorooctylisothiazolinone (DCOIT) in non‐cosmetic products in Sweden during 1995–2018. Graphs based on annual reports by companies to the Swedish Products Register on import and manufacture.¹ Blue line: tonnes; red dashed line: number of products.
Frequency of contact allergy to methylisothiazolinone (MI), benzisothiazolinone (BIT), and octylisothiazolinone (OIT) in various parts of Europe and North America. Consecutively patch tested general dermatitis patients, concomitantly tested with MI, BIT and OIT. Values as reported or estimated based on text and graphs in the references listed in Table 2. Horizontal lines indicate reported mean values. ES, Spain; ESSCA, European Surveillance System on Contact Allergies; IVDK, Information Network of Departments of Dermatology; NACDG, North American Contact Dermatitis Group; NL, Netherlands; UK, United Kingdom.
Increasing non‐cosmetic exposure and sensitization to isothiazolinones require action for prevention: Review

February 2024

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30 Reads

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15 Citations

Frequent use of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI in cosmetic products has been the main cause of widespread sensitization and allergic contact dermatitis to these preservatives (biocides). Their use in non‐cosmetic products is also an important source of sensitization. Less is known about sensitization rates and use of benzisothiazolinone (BIT), octylisothiazolinone (OIT), and dichlorooctylisothiazolinone (DCOIT), which have never been permitted in cosmetic products in Europe. BIT and OIT have occasionally been routinely patch‐tested. These preservatives are often used together in chemical products and articles. In this study, we review the occurrence of contact allergy to MI, BIT, OIT, and DCOIT over time, based on concomitant patch testing in large studies, and case reports. We review EU legislations, and we discuss the role of industry, regulators, and dermatology in prevention of sensitization and protection of health. The frequency of contact allergy to MI, BIT, and OIT has increased. The frequency of contact allergy to DCOIT is not known because it has seldom been patch‐tested. Label information on isothiazolinones in chemical products and articles, irrespective of concentration, is required for assessment of relevance, information to patients, and avoidance of exposure and allergic contact dermatitis.






Citations (80)


... 6 Sometimes positive tests to metabisulphite 1% in pet. that has been added to the European baseline series, 7 are incorrectly classified as irritant 2 and its relevance is not always easy to determine, 8 although often discovered if a thorough examination of possible sources (both occupational and non-occupational) is carried out. 2,3 Cinnamon (and its components cinnamal and/or cinnamic alcohol) are also causes of allergic contact cheilitis/stomatitis, for example, chewing gum as a frequent cause (see reference 9 for a review) and tea. 10 In patients with severe and/or treatment-resistant cheilitis, stomatitis, and aphthosis, 11 a comprehensive history, patch testing, avoidance of the suspected agents, and clearing of the lesions are necessary to establish the diagnosis. ...

Reference:

Allergic contact cheilitis/stomatitis due to beverages and food, an underreported diagnosis
Sodium metabisulphite: Findings on patch testing over 5‐years from a single centre

... Although BIT is currently not allowed in cosmetic products under European Union (EU) legislation, it is extensively used in non-cosmetic products such as detergents, paints, adhesives and fillers [22][23][24][25]. The usage of BIT increased significantly from 1995 to 2018, both in total weight (tonnes) and the number of products registered within the Swedish Products Register [22]. ...

Increasing non‐cosmetic exposure and sensitization to isothiazolinones require action for prevention: Review

... 14 A recent report described a patient who reacted to benzyl salicylate, ethylhexyl salicylate, and homosalate. 15 One case of recurrent dermatitis following oral exposure to aspirin (acetylsalicylic acid) in a patient with methyl salicylate contact allergy has been reported, though this has never been replicated. 16 Despite the fact that salicylates are derivatives of salicylic acid substituted at a specific site ( Figure 1), cross-reactivity with salicylic acid itself has not been previously described. ...

Allergic contact dermatitis to multiple salicylates: A case report

... These restrictions resulted in a substantial decrease in contact allergy to MI across Europe. The European Surveillance System on Contact Allergies' (ESSCA) data showed a decline from 7.6% in 2013-2014 to 4.4% in 2017-2018, and the Information Network of Departments of Dermatology (IVDK) reported a decrease from 5.4% to 3.2% during the same period [9]. However, the prevalence of contact allergy has continued to increase in the United States, where MI remains less regulated [9]. ...

Trends in the Prevalence of Methylchloroisothiazolinone/Methylisothiazolinone Contact Allergy in North America and Europe
  • Citing Article
  • January 2023

JAMA Dermatology

... Several authors are indeed more frequently reporting case reports of severe ACD in paediatric patients [37,38], which can be severely impactful on their quality of life. In fact, contact allergy to (meth)acrylates can influence future job choices (e.g., dentistry [39], beauty industry [22], manufacturing [1]), requiring strict avoidance of these compounds. Also, in patients allergic to 2-HEMA caution should be used towards medical devices, such as orthopaedic or dental prosthesis, even if not necessarily an acrylate implant causes local or systemic reactions [40]. ...

Occupational hand dermatitis secondary to methacrylates—The ‘manual tray’ sign

... Although BIT is currently not allowed in cosmetic products under European Union (EU) legislation, it is extensively used in non-cosmetic products such as detergents, paints, adhesives and fillers [22][23][24][25]. The usage of BIT increased significantly from 1995 to 2018, both in total weight (tonnes) and the number of products registered within the Swedish Products Register [22]. ...

Preservatives in non‐cosmetic products: Increasing human exposure requires action for protection of health

... GB is an effective technique for handling diverse datasets and constructing powerful predictive models by integrating multiple weak learners. GB is capable of managing imbalanced datasets but is susceptible to overfitting 50 . In addition, the training time may be relatively long owing to the iterative training of multiple models. ...

Gradient boosting approaches can outperform logistic regression for risk prediction in cutaneous allergy

... Since patients with linalool HPs contact allergy also had MCAs, genetic factors might play a role. 30 There are a few limitations in this retrospective study. According to the PT procedure, the patch test chambers that were changed from Finn chamber to Finn chamber aqua in January 2018 might affect the patch test reactions; however, reactions of most of the allergens should remain virtually the same, according to a published study. ...

Unravelling the genetic basis of contact allergy

... Its use is still permitted in a multitude of products including, but not limited to, non-EU cosmetics, veterinary products such as dog shampoo, industrial and domestic cleaning detergents and washing up liquids, fabric softeners and water-based dyes, paints and glues. The introduction of legislation resulted in a significant decrease in the prevalence of contact allergy to MDBGN [42]. Mercader-García et al reported current relevance of positive patch test to MDBGN could be ascertained in only 0.87% of cases and that exposure, whilst still possible is much scarcer than previous. ...

Reply to further response: Comment on MDBGN/DBDCB, the European baseline series, and EU legislation—Again

... 20,21 Continued testing of MDBGN may therefore be recommended in cases of high clinical suspicion. 22 This reinforces the need for individualized patient assessment in occupational dermatology since conventional diagnostic methods are not able to capture the complete allergen spectrum. 23 Although not explicitly mentioned for ACD, underreporting of occupational illnesses can be driven by a lack of awareness, fear of job loss, and inadequate workplace health surveillance, 24 leading many workers to ignore or self-treat minor symptoms. ...

Comment on MDBGN/DBDCB, the European baseline series, and EU legislation