Wolfgang Uter’s research while affiliated with Friedrich-Alexander-University Erlangen-Nürnberg and other places

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Publications (77)


Scientific advice – children’s exposure to Methyl salicylate (methyl 2-hydroxybenzoate) - Revision of SCCS/1654/23 - SCCS/1676/25 - Preliminary version
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January 2025

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Natalie Von Goetz

Scientific advice – children’s exposure to Methyl salicylate (methyl 2-hydroxybenzoate) - Revision of SCCS/1654/23 - SCCS/1676/25 - Preliminary version Preliminary Opinion open for comments - Deadline for comments: 17 February 2025 The SCCS adopted this Opinion during the plenary meeting on 25 October 2024 (21 pages) Mise en ligne 20 Janvier 2025 U. Bernauer, L. Bodin, Q. Chaudhry, P.J. Coenraads, J. Ezendam, E. Gaffet, C. L. Galli, E. Panteri, V. Rogiers, Ch. Rousselle, M. Stepnik, T. Vanhaecke, S. Wijnhoven, E. Benfentati, N. Cabaton, E. Corsini, A. Koutsodimou, H. Louro, W. Uter, N. von Goetz https://health.ec.europa.eu/publications/scientific-advice-childrens-exposure-methyl-salicylate-methyl-2-hydroxybenzoate-revision-sccs165423_en https://health.ec.europa.eu/document/download/c0d2bb4f-87c2-4fff-978d-1ed3af73de1a_en?filename=sccs_o_298.pdf


The ‘ MOAHLFA (P) Index’: An Attempt to Standardise a Widely Used Array of Descriptors of Patch‐Tested Patients

January 2025

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Contact Dermatitis

Background Since its inception in 1980, the MOHL index (% patients who are male, have occupational, hand, or leg dermatitis, respectively) and its later evolutions until the presently used MOAHLFA(P) index (adding % patients with atopic dermatitis, face dermatitis, age 40+ years and positive reaction(s) to ≥ 1 baseline series allergen) have been intended to convey important demographic and clinical information on the patients patch tested in a certain area and time, aiding the interpretation of the observed spectrum of sensitisation. Objectives To examine the current usage of the MOAHLFA(P) index and suggest consolidated definitions for its single items. Methods A title/abstract search in Medline identified publications mentioning the evolving acronyms. A Delphi‐like survey among contact dermatitis experts collected agreement with suggested definitions. Results The search term ‘MOAHLFA’ was used in 35 publications from a broad geographical origin. More than 80% of the 24 participants of the survey (65% response) agreed on maintaining to use (i) sex for the ‘M’ criterion, (ii) occupation‐related dermatitis irrespective of medicolegal definitions for the ‘O’, (iii) atopic dermatitis (but not rhinitis or asthma) for the ‘A’. The possibility to use more than one site among ‘H’, ‘L’ and ‘F’ and a more detailed description of age distribution were favoured, and the difficult interpretability of the ‘P’ measure was highlighted. Conclusions The ‘classical’ MOAHLFA(P) index may be extended. Some aspects, notably atopic dermatitis, need further standardisation.



The extent of public awareness and use of the Global Solar UV Index as a worldwide health promotion instrument to improve sun protection: A systematic review and meta-analysis

October 2024

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Photochemistry and Photobiology

Thirty years ago, the Global Solar UV Index (UVI) has been introduced as a health promotion instrument to improve sun protection. We assessed systematically global levels of awareness and use of the UVI as a prerequisite for the preventive effectiveness of this public health tool. We conducted a comprehensive literature search across 10 databases, including PubMed, Scopus and Web of Science Core Collection, as well as clinical trial registries and gray literature databases. The risk of bias of studies was evaluated using the Joanna Briggs Institute checklist for prevalence studies. In addition to narrative and descriptive analysis, we performed meta‐analyses with geographical subgroup analyses to statistically summarize the results. In total, we identified 40 publications from 39 different studies across multiple global regions. However, the number of studies in the analyses varies depending on the outcome. The results, especially the awareness of the UVI, were largely dependent on the specific geographical location of the studies. While the prevalence of awareness of the UVI is high among Australian populations, there is considerable variability in levels of awareness across other global regions. At the same time, the use of the UVI is at a low level across all regions, demonstrating the need for enhanced dissemination of knowledge about the perils associated with ultraviolet radiation and the advantages of using the UVI.


Current frequency of contact allergy to isothiazolinones (methyl‐, benz‐ and octylisothiazolinone) across Europe

July 2024

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25 Reads

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3 Citations

Contact Dermatitis

Background The use of methylisothiazolinone (MI) as a preservative in cosmetic products caused an alarming increase in MI contact allergy across Europe in the 2010s. This was followed by regulations of use with a total ban on leave‐on (implemented in 2017) and reduced use concentrations in rinse‐off cosmetics (2018). Objective To follow‐up on the prevalence of contact allergy to MI and the related benzisothiazolinone (BIT) and octylisothiazolinone (OIT) in consecutively patch‐tested patients in Europe. Methods A cross‐sectional audit following the design of two previous audits on MI contact allergy from 1 May 2022 to 31 October 2022 included all patients patch tested with the European baseline series, including or supplemented with MI, BIT and OIT across 10 departments in eight European countries. Results A total of 2554 patients were consecutively patch tested with the three isothiazolinones during the study period. The prevalence of MI and BIT contact allergy was 2.9% (95% confidence interval [CI]: 2.3%–3.7%; range 1.1%–5.8%) and 3.1% (95% CI: 2.4%–3.9%; range 0.0%–6.6%), respectively; that of OIT was 0.7% (95% CI: 0.4%–1.1%; range 0%–3.2%). Rinse‐off cosmetic (73.3%) and leave‐on cosmetic products (13.3%) were still associated with eliciting allergic contact dermatitis to MI. Conclusion We confirmed a positive impact of regulatory measures on the prevalence of MI contact allergy in Europe, which halved compared to 2015. However, our data suggest that consumers may still be exposed to older cosmetic products containing MI. BIT has superseded MI in causing contact allergy, despite not being allowed for use in cosmetic products.


Contact sensitization to fragrance mix I and fragrance mix II among European dermatitis patients: A systematic review

June 2024

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3 Citations

Contact Dermatitis

Background Fragrance substances are a frequent cause of contact allergy worldwide. Fragrance exposure varies by sex, age and possibly country, influenced by cosmetic availability, environmental conditions and cultural practices. Objectives To systematically review and gather prevalence of sensitization to fragrance mix I (FM I) and fragrance mix II (FM II) in consecutively patch‐tested European dermatitis patients. Method A total of 4134 publications on patch test results of European dermatitis patients, published from 1981 to 2022, were systematically reviewed according to a previously registered and published PROSPERO protocol. Results Eighty‐four eligible original articles were analysed. Overall prevalence of sensitization to fragrance mix I (FM I) was 6.81% (95% CI: 6.37–7.28), and FM II was 3.64% (95% CI: 3.3–4.01). Sensitization to FM I was most prevalent in Central and Eastern Europe and to FM II in Western Europe. No clear time trends were observed. Among paediatric dermatitis patients, sensitization prevalence for FM I and FM II was 4.09% (95% CI: 3.37–4.96) and 2.17% (95% CI: 1.53–3.07). Conclusion The frequency of positive patch test results for both FMI and FMII remains high. Sensitization is also prevalent among children. Enhanced regulation and labelling of cosmetic products play a vital role in averting exposure and sensitization to fragrance allergens.


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
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May 2024

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4 Citations

Contact Dermatitis

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.

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Agreement between self-assessed and examiner-assessed nevi counts in subgroups defined by sociodemographic and phenotype variables. Observed agreement (in %) and weighted kappa, both accompanied by 95% confidence intervals (CI), for the subgroups and result of the statistical evaluation of heterogeneity of subgroup estimates per variable.
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The Level of Agreement between Self-Assessments and Examiner Assessments of Melanocytic Nevus Counts: Findings from an Evaluation of 4548 Double Assessments

April 2024

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17 Reads

Current Oncology

Cutaneous melanoma (CM) is a candidate for screening programs because its prognosis is excellent when diagnosed at an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and examiner assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a “nevometer” to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels, defining a nevus score. Cohen’s weighted kappa coefficient (κ) was estimated to measure the level of agreement. In the total sample, the agreement between self-assessments and examiner assessments was moderate (weighted κ = 0.596). Self-assessed nevus counts were higher than those determined by trained examiners (mean difference: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants’ eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and examiner-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.


Distribution of phenotype variables in the study sample (n=4548).
Joint distribution of the five-level nevus score based on self-assessment (row variable) and expert assessments (column variable) for all 4548 double-counting results.
The level of agreement between self-assessments and expert assessments of melanocytic nevus counts: Findings from an evaluation of 4548 blinded double assessments

February 2024

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12 Reads

Cutaneous melanoma (CM) is a candidate for screening programs, since its prognosis is excellent when diagnosed in an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and expert assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a “nevometer” to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels defining a nevus score. Cohen’s weighted kappa-coefficient was estimated to measure the level of agreement. In the total sample, agreement between self-assessments and expert-assessments was moderate (raw agreement: 50.29%, weighted κ=0.596). Self-assessed nevus counts were higher than those determined by experts (mean differ-ence: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants’ eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and expert-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.


Citations (37)


... We observed a notable geographical difference in the pooled prevalence of MI and MCI/MI between Europe and the United States, with prevalences more than double for the United States compared to Europe (MI: 6.7% vs. 2.9%; MCI/ MI: 6.9% vs. 1.4%). This aligns with a recently published study by Schwensen et al., which investigated the prevalence of CA to MI in Europe and reported a prevalence of 2.9% [45], highlighting a decrease in the prevalence of CA to MI compared to its two predecessors [46,47]. However, our findings mark an increase compared to the pooled prevalence of MCI/MI of 1.2% in the study by Bonitsis et al. [5]. ...

Reference:

Allergens Responsible for Contact Allergy in Children From 2010 to 2024: A Systematic Review and Meta‐Analysis
Current frequency of contact allergy to isothiazolinones (methyl‐, benz‐ and octylisothiazolinone) across Europe
  • Citing Article
  • July 2024

Contact Dermatitis

... Regarding fragrances, we found increased pooled prevalences of FM I (6.6% vs. 4.8%) and FM II (3.6% vs. 3.0%) in children with AD compared to all children. This is a slight difference compared to a recent systematic review in European paediatric dermatitis patients, revealing a prevalence of 4.1% and 2.2% for FM I and FM II, respectively [66]. CA to fragrances was also found to increase in persons with AD in a general population study, which was thought to be due to the increased exposure of persons with AD to moisturisers many of which would contain fragrance ingredients [67]. ...

Contact sensitization to fragrance mix I and fragrance mix II among European dermatitis patients: A systematic review
  • Citing Article
  • June 2024

Contact Dermatitis

... Asking if the patient has any allergies and clarifying the type of reaction they had, such as a mild rash or anaphylaxis, helps assess the severity and manage the risk of allergic reactions. Documenting drug allergies, including skin contact allergies caused by lanolin or rubber, is important for treatment decisions (Fonacier et al, 2024). ACPs should exercise caution regarding reported penicillin allergies, as studies indicate that a significant proportion of these reports are inaccurate. ...

Recognizing and Managing Allergic Contact Dermatitis: Focus on Major Allergens
  • Citing Article
  • May 2024

... To reach this goal, proposals for quantitative risk assessments of fragrance materials have been published to set concentration limits for fragrance materials in consumer products to reduce the risk of induction of sensitization (75)(76)(77). Theoretically, patch testing in Europe will deliver a very low rate of contact allergy to these fragrance materials (78). However, this measurement will take several years until the outcomes can be established. ...

Results of patch testing with five fragrance materials hitherto not tested: A dose-finding study in the clinical population
  • Citing Article
  • February 2024

Contact Dermatitis

... These classifications are used for appropriate labelling for safe transport, handling, and use (Corvaro et al., 2017). More recently, an assessment of the potency for risk assessment purposes might be requested on a case-by-case basis (UK HSE, 2018;Sanvido et al., 2018Sanvido et al., , 2023Corea et al., 2023), though this request is typically rare. ...

Quantitative risk assessment of skin sensitising pesticides: Clinical and toxicological considerations

Regulatory Toxicology and Pharmacology

... Apart from hairdressers, the less mentioned nail beauticians are exposed to the frequent common allergen methacrylate [2]. Ammonia sulphate is used as bleach and phenylenediamines and toluene are used as dyes to which both hairdressers and people in salons are exposed [3], [4], [5]. ...

Contact allergy to ingredients of hair cosmetics in female hairdressers and female consumers—An update based on IVDK data 2013–2020
  • Citing Article
  • June 2023

Contact Dermatitis

... Certainly, it stands out as one of the prevalent occupations encountered in contact dermatitis consultations. Exposure to the different allergens discussed throughout the manuscript is potentially relevant to hairdressing professionals [11]. PPD, nickel, isothiazolinones, fragrances, and formaldehyde/formaldehyde releasers are the most common haptens. ...

Diagnostics and Prevention of Occupational Allergy in Hairdressers

Current Allergy and Asthma Reports

... agreement with previous reviews using the PROBAST [55][56][57], the PROBAST has been criticized because of poor inter-rater agreement [56,57]. Moreover, it is not possible to distinguish domains with a high ROB based on one single signaling question answered with 'no' from domains with all signaling questions answered with 'no'. ...

Inter-Rater Agreement in Assessing Risk of Bias in Melanoma Prediction Studies Using the Prediction Model Risk of Bias Assessment Tool (PROBAST): Results from a Controlled Experiment on the Effect of Specific Rater Training

... Die Antwortmöglichkeiten waren "ja", "nein" und "weiß nicht". Die Auswahl der abgefragten Anzeichen basierte auf einer qualitativen Vorstudie zum Wissen über NMSC bei Personen über 55 Jahren [4,22], wurde mit der Fachliteratur abgeglichen und mit zwei Dermatologen diskutiert. ...

“Well, to Be Honest, I Don’t Have an Idea of What It Might Be”—A Qualitative Study on Knowledge and Awareness Regarding Nonmelanoma Skin Cancer

Current Oncology

... Zamieszczona w pierwszej publikacji zapowiedź, że aktualizacje będą raz w roku ogłaszane w British Journal of Dermatology nie została spełniona, za to grupa ICDRG w kolejnych latach opublikowała w różnych czasopismach szereg ważnych prac na temat alergicznego wyprysku kontaktowego (najnowsze w 2021 roku) [ . Regularnie publikowane są analizy wyników zebranych w ramach grupy, zarówno w zakresie kolejnych wersji serii podstawowej, jak i w odniesieniu do specyficznych grup i narażeń (dzieci, alergia kontaktowa na leki zewnętrzne, wyprysk z podrażnienia, wyprysk zawodowy itd.) [14][15][16][17]. W tabeli 1 przedstawiono historię zmian w Polskiej Serii Podstawowej (PSP) oraz Europejskiej Serii Podstawowej (ESP) [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. ...

Occupational contact allergy: The European perspective – analysis of patch test data from ESSCA between 2011‐2020
  • Citing Article
  • January 2023

Contact Dermatitis