Recommendation to include fragrance mix 2 and hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral®) in the European baseline patch test series

Fragrance chemicals lyral and lilial decrease viability of HaCat cells' by increasing free radical production and lowering intracellular ATP level: protection by antioxidants

We investigate in this study the biochemical effects on cells in culture of two commonly used fragrance chemicals: lyral and lilial. Whereas both chemicals exerted a significant effect on primary keratinocyte(s), HaCat cells, no effect was obtained with any of HepG2, Hek293, Caco2, NIH3T3, and MCF7 cells. Lyral and lilial: (a) decreased the viability of HaCat cells with a 50% cell death at 100 and 60 nM respectively; (b) decreased significantly in a dose dependant manner the intracellular ATP level following 12-h of treatment; (c) inhibited complexes I and II of electron transport chain in liver sub-mitochondrial particles; and (d) increased reactive oxygen species generation that was reversed by N-acetyl cysteine and trolox and the natural antioxidant lipoic acid, without influencing the level of free and/or oxidized glutathione. Lipoic acid protected HaCat cells against the decrease in viability induced by either compound. Dehydrogenation of lyral and lilial produce α,β-unsaturated aldehydes, that reacts with lipoic acid requiring proteins resulting in their inhibition. We propose lyral and lilial as toxic to mitochondria that have a direct effect on electron transport chain, increase ROS production, derange mitochondrial membrane potential, and decrease cellular ATP level, leading thus to cell death.

Patch testing with fragrance mix II: results of the IVDK 2005-2008

BACKGROUND

The fragrance mix (FM I), established in 1977, detects the majority, but not all cases of contact allergy to fragrances. Based on European research 2002/2003, fragrance mix II (FM II) was developed to supplement FM I. In 2005, the German Contact Dermatitis Research Group (DKG) added FM II to their baseline series.

OBJECTIVES

To evaluate reactions to FM II and its constituents in routine patch testing.

METHODS

Retrospective data analysis of the Information Network of Departments of Dermatology (IVDK), 2005-2008, of patch test results with FM II and its constituents.

RESULTS

A total of 35 633 patients were patch tested with FM II as part of the DKG baseline series. Of these, 1742 (4.9%) reacted positively. Concomitant reactions to FM I were observed in 41.9% of the patients reacting to FM II. In 367 FM II-positive patients, a full breakdown test of the mix was performed. Of these, 47.7% reacted to hydroxyisohexyl 3-cyclohexene carboxaldehyde, 16.1% to citral, 11.4% to farnesol, 3.8% to hexyl cinnamal, 2.7% to coumarin, and 2.5% to citronellol.

CONCLUSIONS

FM II is an important screening and diagnostic tool to detect fragrance allergy. Hydroxyisohexyl 3-cyclohexene carboxaldehyde is the most important fragrance allergen in FM II.

The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the extended European Baseline Series

The differential diagnostic work-up of children with chronic eczema should involve patch testing, also in cases with confirmed atopy. In our previous study, contact allergy was detected in every second child with chronic eczema. The aim of the present study was to identify the most important sensitizers in atopic children with eczema. During an allergy screening program, 103 consecutive children aged 7-8 and 93 adolescents aged 16-17 were enrolled. The inclusion criterion was chronic recurrent eczema as detected with the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and atopy, defined as positive skin prick test to one or more common airborne or food allergens. The children were patch-tested with the newly extended European Baseline Series (EBS, 28 test substances) supplemented with propolis, thimerosal, benzalkonium chloride, and 2-phenoxyethanol. In total, 67.0% children and 58.1% adolescents were found patch test positive. Among children, 35.9% reacted to nickel, 16.5% propolis, 11.7% thimerosal, 9.7% cobalt, each 6.8% fragrance mix (FM) I and chromium, and 5.8% to FM II. Among adolescents, 37.6% reacted to thimerosal, 19.4% to nickel, 6.5% to cobalt, and 5.4% to propolis. We demonstrate the advantage of using FM II - a new addition to the EBS that detects a relatively high proportion of contact hypersensitivity among children. An important sensitizer from outside EBS is propolis, which according to the frequency of sensitization occupies rank 2 in children and rank 4 in adolescents. These data show that propolis should be included into routine patch testing in children.

Contact-allergic reactions to cosmetics

Contact-allergic reactions to cosmetics may be delayed-type reactions such as allergic and photo-allergic contact dermatitis, and more exceptionally also immediate-type reactions, that is, contact urticaria. Fragrances and preservative agents are the most important contact allergens, but reactions also occur to category-specific products such as hair dyes and other hair-care products, nail cosmetics, sunscreens, as well as to antioxidants, vehicles, emulsifiers, and, in fact, any possible cosmetic ingredient. Patch and prick testing to detect the respective culprits remains the golden standard for diagnosis, although additional tests might be useful as well. Once the specific allergens are identified, the patients should be informed of which products can be safely used in the future.

Allergic contact dermatitis caused by farnesol: clinical relevance

CONTEXT

The fragrance material farnesol is cited as an infrequent but important cause of allergic contact dermatitis (ACD). It is included in the fragrance mix II patch series and requires labeling in the European Union if it is used in a consumer product.

OBJECTIVE

To review the existing literature to determine the causative role of farnesol in clinical contact allergy.

MATERIALS AND METHODS

Survey of the literature on farnesol studies; predictive and clinical elicitation tests in case reports, reviews, and abstracts.

RESULTS

Predictive animal studies demonstrated in most cases that farnesol was a nonsensitizer. However, 2 local lymph node assays (LLNAs) indicated strong sensitization potential. Predictive human test data indicated a low potential, if any, for sensitization in human tests with farnesol at 10% or 12%. A few clinical reports indicated low-level allergy or questionable reactions to farnesol, with 5% being the most commonly used. There were also reports in which no reactions were seen.

DISCUSSION

Predictive testing on farnesol in animals shows conflicting results depending on the study methodology used. Human predictive patch-test data also had gaps that prevented it from being definitive in pointing to a causative relationship between farnesol and contact dermatitis. The real sensitizing potential of a material can best be determined by evaluating the clinical and epidemiological data so as to help resolve the conflicting animal and human predictive test data.

CONCLUSIONS

This literature and scoring exercise showed that predictive and clinical elicitation data do not document a clear causative determination that farnesol is a frequent contact allergen. Detailed clinical relevance and patient studies should clarify the clinical problem farnesol represents.

Integrated, multidisciplinary care for hand eczema: design of a randomized controlled trial and cost-effectiveness study

Background

The individual and societal burden of hand eczema is high. Literature indicates that moderate to severe hand eczema is a disease with a poor prognosis. Many patients are hampered in their daily activities, including work. High costs are related to high medical consumption, productivity loss and sick leave. Usual care is suboptimal, due to a lack of optimal instruction and coordination of care, and communication with the general practitioner/occupational physician and people involved at the workplace. Therefore, an integrated, multidisciplinary intervention involving a dermatologist, a care manager, a specialized nurse and a clinical occupational physician was developed. This paper describes the design of a study to investigate the effectiveness and cost-effectiveness of integrated care for hand eczema by a multidisciplinary team, coordinated by a care manager, consisting of instruction on avoiding relevant contact factors, both in the occupational and in the private environment, optimal skin care and treatment, compared to usual, dermatologist-led care.

Methods

The study is a multicentre, randomized, controlled trial with an economic evaluation alongside. The study population consists of patients with chronic, moderate to severe hand eczema, who visit an outpatient clinic of one of the participating 5 (three university and two general) hospitals. Integrated, multidisciplinary care, coordinated by a care manager, including allergo-dermatological evaluation by a dermatologist, occupational intervention by a clinical occupational physician, and counselling by a specialized nurse on optimizing topical treatment and skin care will be compared with usual care by a dermatologist. The primary outcome measure is the cumulative difference in reduction of the clinical severity score HECSI between the groups. Secondary outcome measures are the patient's global assessment, specific quality of life with regard to the hands, generic quality of life, sick leave and patient satisfaction. An economic evaluation will be conducted alongside the RCT. Direct and indirect costs will be measured. Outcome measures will be assessed at baseline and after 4, 12, 26 and 52 weeks. All statistical analyses will be performed on the intention-to-treat principle. In addition, per protocol analyses will be carried out.

Discussion

To improve societal participation of patients with moderate to severe hand eczema, an integrated care intervention was developed involving both person-related and environmental factors. Such integrated care is expected to improve the patients' clinical signs, quality of life and to reduce sick leave and medical costs. Results will become available in 2011.

Trends of contact allergy to fragrance mix I and Myroxylon pereirae among Danish eczema patients tested between 1985 and 2007

BACKGROUND

Fragrance contact allergy has for long been recognized as an important health issue. In Denmark, the frequency of fragrance mix (FM) I contact allergy increased between 1985-1986 and 1997-1998 among male and female dermatitis patients.

OBJECTIVES

To investigate the development of FM I and Myroxylon pereirae (MP) contact allergy between 1985 and 2007 with an emphasis on recent years.

METHODS

A retrospective analysis of all patch test data from our database was performed. Comparison of sensitivity rates was made using a chi-squared test for trend. Logistic regression analyses were used to test for associations.

RESULTS

Of 16,173 patients, 7.2% were sensitized to FM I and 4% to MP. FM I contact allergy was associated with female sex [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.33-1.74] and age between 41 and 60 years (OR = 3.20; 95% CI = 1.98-5.21). Significant declines of FM I and MP reactions among women but not men were observed between 1999 and 2007.

CONCLUSIONS

Although the frequency of FM I contact allergy has decreased in Denmark in recent years, it is still high. Furthermore, fragrance contact allergy is caused by other important allergens not included in this analysis. Allergic contact reactions to the ingredients of FM I remain a problem in European consumers.