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The fragrance mix and its constituents: a 14-year material.

Results from 14 years of patch testing with the fragrance mix and its constituents are reviewed. From 1979-1992, 8215 consecutive patients were patch tested with the fragrance mix and 449 (5.5%) had a positive reaction. An increase in the frequency of reactions to fragrance mix was seen from the first 5-year period to the last. Only 54.4% of the patients tested in the last 5-year period with the individual constituents of the mix had at least 1 positive reaction. The results of testing with the constituents are the basis for a discussion of methodological problems. A significant decrease in the frequency of reaction to cinnamic aldehyde was registered, at the same time as the test concentration was reduced from 2% to 1% pet. However, no significant variations in the frequency of reactions to oak moss were seen, notwithstanding a similar reduction in test concentration.

Administration, Cutaneous↗

Is the European standard series suitable for patch testing in Riyadh, Saudi Arabia?

Due to the lack of a regional patch test series in our geographical area, the suitability of the European standard series was evaluated by patch testing dermatitis patients in Riyadh, Saudi Arabia. Of 240 consecutive patients with various forms of dermatitis, 136 (57%) showed 1 or more positive patch tests, women, 74 (54%), slightly outnumbering men, 62 (46%). Positive reactions were found to 21 of the 22 items in the test series. Sensitization was most common to nickel sulfate (51 = 37.5%), potassium dichromate (48 = 35%) and cobalt chloride (43 = 32%) The frequency of sensitization to nickel was higher in women (41 = 30%) while that to dichromate was higher in men (39 = 29%). Less reactions were found to fragrance mix (21 = 15%), formaldehyde (15 = 11%) and neomycin sulfate (15 = 11%). Sensitization to other allergens ranged between 10 and 1%. Less than 1% of patients (0.7%) reacted to benzocaine and none to primin. The frequency of occurrence of multiple sensitivities is also presented. We conclude that the European standard series is suitable for patch testing dermatitis patients in our region, with the exception of benzocaine and primin. The addition of 3 allergens that could be of local relevance is discussed.

Adolescent↗

A clinical and patch test study of contact dermatitis from traditional Chinese medicinal materials.

Putative allergens in, clinical manifestations of, and patch tests with traditional Chinese medicinal materials (CMM) causing contact dermatitis (CD) were studied. 14 patients with CMM CD and 351 controls were patch tested with the standard series of allergens of Beijing Medical University and the suspected drug, as is. It was found that most CMM CD was caused by the CMM frequently used topically for analgesic and anti-inflammatory effect. All patients patch tested with the suspected drug gave positive results. Some patients also reacted to fragrance mix, colophony, rubber mix and ammoniated mercury. The positivity rates of fragrance mix and colophony in CMM CD patients were significantly higher than in controls (55.6% versus 16.5% for fragrance mix, chi 2 = 11.86, p < 0.01; and 55.6% versus 5.1% for colophony, chi 2 = 29.35, p < 0.01), while not those of rubber mix and ammoniated mercury. Results indicated that the topical analgesic and anti-inflammatory CMM, especially those containing fragrance, may cause contact sensitization. Clinical findings in CMM CD included cutaneous irritation, allergic contact dermatitis, immediate contact reactions and systemic contact dermatitis. CMM CD can be diagnosed by patch testing the putative drug, as is.

Administration, Cutaneous↗

Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei.

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

Academic Medical Centers↗

Threshold responses in cinnamic-aldehyde-sensitive subjects: results and methodological aspects.

Cinnamic aldehyde is an important fragrance material and contact allergen. The present study was performed to provide quantitative data on the eliciting capacity of cinnamic aldehyde, to be considered in assessment of clinical relevance and health hazard. The skin response to serial dilution patch tests and 6-week graded use tests with 0.02, 0.1 and 0.8% cinnamic aldehyde in ethanol was studied in a group of cinnamic-aldehyde-sensitive eczema patients. The minimum effect level demonstrated was 0.02% cinnamic aldehyde on patch testing and 0.1% cinnamic aldehyde on use testing, which are allowed usage concentrations in different kind of cosmetics. 72% (13/18) developed eczema in the use test performed with an alcoholic solution of cinnamic aldehyde on healthy upper arm skin. 6 of the 13 use-test-positive subjects (46%) reacted later than day 7, indicating that the standard exposure period of 7 days in use testing may not be sufficient, if low concentrations or volatile substances are used. A significant correlation between patch test sensitivity and the outcome of use testing was found (1,<0.001), which should be considered in designing future use test studies and advising patients. Detailed exposure information is needed to evaluate more fully the consequences of cinnamic aldehyde sensitivity.

Acrolein↗

Patch testing of 490 patients in Hong Kong.

Patch testing, using European standard allergens and suspected causative substances brought in by patients, was carried out in 490 patients with eczema in Hong Kong and 437 completed the test. Before patch testing, 244, 141 and 105 patients were diagnosed as having contact dermatitis, endogenous eczema and unclassified eczema, respectively. After patch testing, the diagnosis of the causal agent was changed in 54 contact dermatitis patients, and 18% of endogenous eczema patients and 34% of unclassified eczema patients were re-diagnosed as contact dermatitis. In the patients with a final diagnosis of contact dermatitis, 19.5% were positive to fragrance mix, followed by nickel sulfate (16.4%) and cobalt chloride (11.3%). The commonest causative agents for contact dermatitis were soap or detergent (22.0%) and traditional Chinese medicine (17.3%); the latter was a more common cause of contact dermatitis than Western medicine (9.0%) or metals (13.4%). The prevalence of allergic reaction to fragrance in Hong Kong was higher than among Chinese in Beijing, Shanghai, Taipei or Singapore (78% ethnic Chinese). Dermatologists should have a high index of suspicion about traditional medications and should patch test with the suspected substance when patients give a history of use.

Dermatitis, Allergic Contact↗

Patch test results in schoolchildren. Results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG)

Our aim was to explore the current spectrum of contact allergens in schoolchildren, as a basis for diagnosis and prevention of allergic contact dermatitis. Results of patch tests in children 6-15 years old, performed in the years 1990-1995 by 22 centres of the German Contact Dermatitis Research Group and filed by the Information Network of Departments of Dermatology, were analysed and evaluated retrospectively, including epidemiologic data. Children with positive tests (62 out of 156 boys and 108 out of 260 girls tested) had a higher frequency of allergic contact dermatitis and a lower frequency of atopic dermatitis than patch test negative ones. 16 distinct allergens elicited positive reactions in > or = 1% of the children tested. Reactions to nickel sulfate occurred in 15.9% of all children tested, but in 25.0% of girls 14/15 years old, and in only 4.5% of boys 6-13 years old. Double-sensitizations with cobalt salts, potassium dichromate and palladium were seen. Mercury compounds were found in 2nd place (thimerosal: all children: 11.3%; 6-13 years old: 14.3%; 14/15 years old: 8.0%), followed by fragrance allergens. We conclude that contact allergy in children is related to their sex and age. Prophylaxis against nickel, mercury, and fragrance allergy needs to be improved. A shortened standard series may be sufficient for testing children.

Adolescent↗

Deodorants: a clinical provocation study in fragrance-sensitive individuals.

Deodorants are one of the most marketed types of cosmetics and are frequently reported as a cause of dermatitis, particularly among fragrance-sensitive persons. The aim of this study was to investigate the ability of deodorants, which had previously caused axillary dermatitis in fragrance-mix-sensitive eczema patients, to provoke reactions on repeated open application tests on the upper arm and in the axillae, and to relate the findings to the content of fragrance-mix constituents in those deodorants. 14 eczema patients performed a 7-day use test with 1 or 2 deodorants that had caused a rash within the last 12 months. 2 applications per day were made in the axilla and simultaneously on a 25 cm2 area on the upper arm. A total of 20 deodorants were tested among the 14 patients. Afterwards, the deodorants were subjected to quantitative chemical analysis identifying constituents of the fragrance mix. 12/20 (60%) deodorants elicited eczema on use testing in the axilla. 8/12 deodorants were positive in the axilla on day (D) 7 and 4 both in the axilla and on the upper arm. 2 of the 4 developed a reaction in the axilla before it developed on the upper arm. Chemical analysis revealed that 18/19 deodorants contained between 1 and 6 of the fragrance-mix constituents, on average 3 being found. The mean concentration of fragrance-mix constituents was generally higher in the deodorants causing a positive use test, as compared with those giving a negative reaction, indicating that the differences between the deodorants in terms of elicitation potential were more related to quantitative aspects of allergen content than of a qualitative nature. It is recommended that deodorants are tested in the axilla in the case of a negative use test on the upper arm and a strong clinical suspicion.

Allergens↗

Fragrances and other materials in deodorants: search for potentially sensitizing molecules using combined GC-MS and structure activity relationship (SAR) analysis.

Deodorants are one of the most frequently-used types of cosmetics and are a source of allergic contact dermatitis. Therefore, a gas chromatography - mass spectrometric analysis of 71 deodorants was performed for identification of fragrance and non-fragrance materials present in marketed deodorants. Futhermore, the sensitizing potential of these molecules was evaluated using structure activity relationships (SARs) analysis. This was based on the presence of 1 or more chemically reactive site(s), in the chemical structure, associated with sensitizing potential. Among the many different substances used to formulate cosmetic products (over 3500), 226 chemicals were identified in a sample of 71 deodorants. 84 molecules were found to contain at least 1 structural alert, and 70 to belong to, or be susceptible to being metabolized into, the chemical group of aldehydes, ketones and alpha,beta-unsaturated aldehydes, ketone or esters. The combination of GC-MS and SARs analysis could be helpful in the selection of substances for supplementary investigations regarding sensitizing properties. Thus, it may be a valuable tool in the management of contact allergy to deodorants and for producing new deodorants with decreased propensity to cause contact allergy.

Aerosols↗

Usefulness of the European standard series for patch testing in children. A 3-year single-centre study of 337 patients.

Results of patch tests in 337 children aged 1 to 15 performed in our paediatric unit during the past 3 years have been analysed retrospectively in order to optimize the patch test series and to assess their relevance. This study represents the most important single-centre study reported so far over a short period. We found a positive patch test rate of 66%, with a peak incidence among children less than 3 years of age (88% versus 58.9%). The most common allergens were metals, especially nickel, fragrances and, less frequently, rubber chemicals. Concerning nickel, positive reactions rarely correlated with a relevant exposure and were difficult to interpret, especially in patients with atopic dermatitis, who are probably more likely to have irritant or false-positive reactions to metals. Based on the results and their relevance, we propose a shortened standard series of patch tests for paediatric patients.

Adolescent↗