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Samaran Q, Raison-Peyron N, Dereure O, Svedman C, Dahlin J. Allergic contact dermatitis to isobornyl acrylate in a hospital wristband. Contact Dermatitis 2024; 91:62-64. [PMID: 38448369 DOI: 10.1111/cod.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Quentin Samaran
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Nadia Raison-Peyron
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Olivier Dereure
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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2
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Mowitz M, Hosseini S, Siemund I, Ulriksdotter J, Svedman C. New device, 'old' allergens. Allergic contact dermatitis caused by the Dexcom G7 glucose sensor. Contact Dermatitis 2024; 90:495-500. [PMID: 38316128 DOI: 10.1111/cod.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) has been reported as an adverse effect from the use of several glucose sensors and insulin pumps from different manufacturers. Isobornyl acrylate (IBOA) has been identified as a major culprit sensitizer, but also other acrylates and (modified) colophonium have been reported as causes of ACD. OBJECTIVES To report the two first cases diagnosed with ACD caused by the Dexcom G7 (DG7) glucose sensor. PATIENTS AND METHODS Two children with suspected ACD from DG7 were patch tested with our medical device series with an addition of selected test preparations including two variants of modified colophonium - methyl hydrogenated rosinate (MHR) and glyceryl hydrogenated rosinate (GHR). Both patients were also tested with acetone extracts made from different parts of the DG7 sensor. The extracts were analysed by gas chromatography-mass spectrometry (GC-MS). RESULTS Both patients tested positive to IBOA, hydroabietyl alcohol and GHR. In addition, patient 1 had a positive reaction to MHR and patient 2 had a positive reaction to colophonium. The GC-MS analyses showed the presence of IBOA and colophonium-related substances in the DG7 extracts. CONCLUSIONS Both patients were diagnosed with contact allergy to well-known medical device-related sensitizers. The presence of IBOA and (modified) colophonium in a newly introduced (on the Swedish market in 2023) glucose sensor is remarkable and indicates an inadequate toxicological assessment of the materials used in the sensor.
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Affiliation(s)
- Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sarah Hosseini
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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3
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Ulriksdotter J, Sukakul T, Bruze M, Mowitz M, Ofenloch R, Svedman C. Contact Allergy to Allergens in the Swedish Baseline Series Overrepresented in Diabetes Patients with Skin Reactions to Medical Devices - A Retrospective Study from Southern Sweden. Acta Derm Venereol 2024; 104:adv19676. [PMID: 38551376 PMCID: PMC11000652 DOI: 10.2340/actadv.v104.19676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 04/02/2024] Open
Abstract
Allergic contact dermatitis is reported among individuals using continuous glucose monitoring systems and insulin pumps. The aim of this study was to describe contact allergy patterns for allergens in the Swedish baseline series and medical device-related allergens among users. Contact allergy to baseline series allergens and isobornyl acrylate was compared between diabetes patients and dermatitis patients patch-tested at the Department of Occupational and Environmental Dermatology during 2017 to 2020. Fifty- four diabetes patients and 2,567 dermatitis patients were included. The prevalence of contact allergy to fragrance mix II and sesquiterpene lactone mix was significantly higher in diabetes patients compared with dermatitis patients. Of the diabetes patients 13.0% and of the dermatitis patients 0.5% tested positive to sesquiterpene lactone mix (p < 0.001). Of the diabetes patients 7.4% and of the dermatitis patients 2.3% tested positive to fragrance mix II (p = 0.041). Of the diabetes patients 70.4% tested positive to medical device-related allergens. Of the diabetes patients 63.0% and of the dermatitis patients 0.2% were allergic to isobornyl acrylate (p < 0.001). In conclusion, not only medical device-related contact allergies, but also contact allergy to baseline series allergens (fragrance mix II and sesquiterpene lactone mix), is overrepresented in diabetes patients who use medical devices.
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Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden; Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden .
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Robert Ofenloch
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Velasco-Amador JP, Prados-Carmona Á, Navarro-Triviño FJ. [Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T280-T287. [PMID: 38242434 DOI: 10.1016/j.ad.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/08/2023] [Indexed: 01/21/2024] Open
Abstract
The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.
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Affiliation(s)
- J P Velasco-Amador
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - Á Prados-Carmona
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - F J Navarro-Triviño
- Unidad de Eczema de Contacto e Inmunoalergia, Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain.
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von Kobyletzki LB, Ulriksdotter J, Sukakul T, Aerts O, Agner T, Buhl T, Bruze M, Foti C, Gimenez-Arnau A, Gonçalo M, Hamnerius N, Johansen JD, Rustemeyer T, Stingeni L, Wilkinson M, Svedman C. Prevalence of dermatitis including allergic contact dermatitis from medical devices used by children and adults with Type 1 diabetes mellitus: A systematic review and questionnaire study. J Eur Acad Dermatol Venereol 2024. [PMID: 38400603 DOI: 10.1111/jdv.19908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease control. Adverse skin reactions from these MDs may however hamper compliance. The objective of this study was to systematically review and analyse studies assessing the prevalence and incidence of dermatitis, including allergic contact dermatitis (ACD) related to MDs used in patients with T1D and to compare referral routes and the clinical investigation routines between clinics being part of the European Environmental and Contact Dermatitis Research Group (EECDRG). A systematic search of PubMed, EMBASE, CINAHL and Cochrane databases of full-text studies reporting incidence and prevalence of dermatitis in persons with T1D using MDs was conducted until December 2021. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at EECRDG clinics focused on referral routes, patient numbers and the diagnostic process. Among the 3145 screened abstracts, 39 studies fulfilled the inclusion criteria. Sixteen studies included data on children only, 14 studies were on adults and nine studies reported data on both children and adults. Participants were exposed to a broad range of devices. Skin reactions were rarely specified. It was found that both the diagnostic process and referral routes differ in different centres. Further data on the prevalence of skin reactions related to MDs in individuals with T1D is needed and particularly studies where the skin reactions are correctly diagnosed. A correct diagnosis is delayed or hampered by the fact that, at present, the actual substances within the MDs are not declared, are changed without notice and the commercially available test materials are not adequately updated. Within Europe, routines for referral should be made more standardized to improve the diagnostic procedure when investigating patients with possible ACD from MDs.
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Affiliation(s)
- L B von Kobyletzki
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - J Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - O Aerts
- Contact Allergy Unit, Department of Dermatology, University Hospital Antwerp (UZA) and Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - T Agner
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - T Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - C Foti
- Section of Dermatology, DIMEPREJ Department, University "Aldo Moro", Bari, Italy
| | - A Gimenez-Arnau
- Department of Dermatology, Hospital del Mar and Research Institute de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Gonçalo
- Clinic of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - N Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - J D Johansen
- Department of Dermatology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - T Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - L Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - M Wilkinson
- Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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6
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Genève P, Adam T, Delawoevre A, Jellimann S, Legagneur C, DiPatrizio M, Renard E. High incidence of skin reactions secondary to the use of adhesives in glucose sensors or insulin pumps for the treatment of children with type 1 diabetes. Diabetes Res Clin Pract 2023; 204:110922. [PMID: 37769906 DOI: 10.1016/j.diabres.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
AIMS To evaluate the incidence of the skin reactions secondary to continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring (CGM), sensors and the characteristics of affected children with type 1 diabetes. METHODS An observational, retrospective, single-centre study included 198 children with type 1 diabetes, (46% girls, mean age 11.75 years). A standardised questionnaire was completed with the patient during current care to evaluate the skin reactions (mean and percentage), the type of reaction, their impact and the treatment) and the characteristics of affected children with univariate and multivariate analysis. RESULTS Sixty-seven children (33.8%) reported active skin reactions: 45 children with CSII (30.4%) and 46 with CGM (23.5%). Children with skin reactions were younger (mean age 10.6 yo versus 12.34 yo, p < 0.05), with a younger age at the diagnosis of diabetes (5.59 yo versus 7.08 yo, p < 0.05). Atopy was more frequent in the group with skin reactions (76.1% versus 54.1% p < 0.05). On multivariate analysis, only the personal history of atopy was associated with skin reactions: OR 2.56 [1.16-5.97] (p < 0.05). CONCLUSION This study confirms the high incidence of skin reactions to adhesive devices used in the treatment of type 1 diabetes in children.
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Affiliation(s)
- P Genève
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - T Adam
- Department of Allergology, Children's Hospital, University Hospital of Nancy, France
| | - A Delawoevre
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - S Jellimann
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - C Legagneur
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - M DiPatrizio
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - E Renard
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France; INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, University of Lorraine, Nancy, France.
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7
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Cichoń M, Trzeciak M, Sokołowska-Wojdyło M, Nowicki RJ. Contact Dermatitis to Diabetes Medical Devices. Int J Mol Sci 2023; 24:10697. [PMID: 37445875 DOI: 10.3390/ijms241310697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Skin adverse reactions to diabetes medical devices have been reported frequently over recent years. Adhesives attaching glucose sensors and continuous insulin infusion sets to the skin are proven to cause both allergic contact dermatitis and irritant contact dermatitis in patients with diabetes mellitus. Several allergens contained in adhesives and/or parts of medical devices are documented to cause allergic contact dermatitis, with acrylate chemicals being the most common culprit-especially isobornyl acrylate (IBOA), but also 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate or cyanoacrylates. Epoxy resin, colophonium and nickel were also identified as causative allergens. However, repetitive occlusion, maceration of the skin and resulting disruption of the skin barrier seem to have an impact on the development of skin lesions as well. The purpose of this study is to highlight the burden of contact dermatitis triggered by diabetes medical devices and to show possible mechanisms responsible for the development of contact dermatitis in a group of diabetic patients.
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Affiliation(s)
- Mikołaj Cichoń
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | | | - Roman J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland
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Diedisheim M, Pecquet C, Julla JB, Carlier A, Potier L, Hartemann A, Jacqueminet S, Vidal-Trecan T, Gautier JF, Dubois Laforgue D, Fagherazzi G, Roussel R, Larger E, Sola-Gazagnes A, Riveline JP. Prevalence and Description of the Skin Reactions Associated with Adhesives in Diabetes Technology Devices in an Adult Population: Results of the CUTADIAB Study. Diabetes Technol Ther 2023; 25:279-286. [PMID: 36763338 DOI: 10.1089/dia.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Objective: The use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII) devices adhering to the skin can lead to skin reactions. The objective was to determine the prevalence and consequences of skin reactions at CGM or CSII sites in a large unbiased population. Research Design and Methods: This is a cross-sectional multicenter study. All adult patients with diabetes seen in consultation over a period of 7 months and using or having used a system with skin adhesives (in the last 10 years) were included and filled out a self-assessment questionnaire. Results: Among 851 patients, skin reaction was reported in 28% with CGM and 29% with CSII. Patients reporting reactions were more frequently women using CGM and CSII, and CGM users had type 1 more often than type 2 diabetes (P < 0.001). Manifestations were similar for reactions to CGM and CSII: redness and pruritus in 70%-75% of patients with reactions, pain in 20%-25%, and vesicles and desquamation in 12%-15%. Manifestations occurred within the first 24 h of first use in 22%-24% of patients with reactions to CGM and CSII, but after more than 6 months in 38% and 47% of patients with reactions to CGM and CSII, respectively. Device use was definitively stopped in 12% of patients with reactions to CGM (3.2% of all users) and 7% with reactions to CSII (2.1% of all users). Conclusions: Skin reactions were common, with similar presentations in CGM and CSII users. Manifestations suggested skin irritation rather than allergies. These reactions rarely led to the definitive discontinuation of the use of the device.
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Affiliation(s)
- Marc Diedisheim
- Diabetology Department, Cochin Hospital, APHP, Paris, France
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
| | | | - Jean-Baptiste Julla
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Aurelie Carlier
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Louis Potier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Agnès Hartemann
- Diabetology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Tiphaine Vidal-Trecan
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Jean-François Gautier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | | | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ronan Roussel
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Etienne Larger
- Diabetology Department, Cochin Hospital, APHP, Paris, France
| | | | - Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
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Raison-Peyron N, Mowitz M, Dereure O, Svedman C. Allergic Contact Dermatitis in a Patient After Five Years of Use of Omnipod Insulin Pump. J Diabetes Sci Technol 2022; 16:1342-1343. [PMID: 36048581 PMCID: PMC9445354 DOI: 10.1177/19322968221110578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nadia Raison-Peyron
- Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, Montpellier, France
- Nadia Raison-Peyron, MD, Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France.
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Olivier Dereure
- Department of Dermatology, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, University of Lund, Malmö, Sweden
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Alves da Silva C, Bregnhøj A, Mowitz M, Bruze M, Andersen KE, Sommerlund M. Contact dermatitis in children caused by diabetes devices. Contact Dermatitis 2022; 87:406-413. [PMID: 35634681 DOI: 10.1111/cod.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insulin pump and glucose monitoring devices improve diabetes mellitus (DM) control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices has been reported. OBJECTIVE To investigate the culprits of localized contact dermatitis in pediatric patients with diabetes caused by insulin pump and glucose monitoring devices. METHODS Retrospective analysis of 15 pediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pump and glucose monitoring devices RESULTS: Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster. CONCLUSION A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to benzoyl peroxide. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Anne Bregnhøj
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Mowitz
- Department Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Klaus Ejner Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Sommerlund
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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11
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Oppel E, Högg C, Oschmann A, Summer B, Kamann S. Contact allergy to the Dexcom G6 glucose monitoring system -role of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in the new adhesive. Contact Dermatitis 2022; 87:258-264. [PMID: 35503433 DOI: 10.1111/cod.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin reactions to the glucose monitoring systems Dexcom G5 and G6 have been rare. In 2019, the components of the adhesive were exchanged for better skin fixation. Since then, more and more patients experienced severe skin reactions. A few months ago, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate (MBPA) was identified as a new component in the adhesive of the G6 model. Furthermore, it was suspected that isobornylacrylate (IBOA) was also a component of the exchanged adhesive. OBJECTIVES Our objective was to investigate if MBPA plays a major role in the increasing skin problems of patients without a history of IBOA-sensitization. Furthermore, our aim was to examine whether IBOA is contained in the newer model adhesive and may also contribute to allergic contact dermatitis (ACD). PATIENTS AND METHODS Five patients with a newly occurred ACD caused by the glucose monitoring system Dexcom G6 were investigated. Patch testing including MBPA in 3 different concentrations, as well as IBOA were performed. Gas chromatography-mass spectrometry of the newer system Dexcom G6 was carried out. RESULTS All patients were shown to be sensitized to MBPA, while MBPA 0,5% showed the strongest reaction. On the other hand, IBOA was tested negative. CONCLUSION In our study group MBPA was observed to be the triggering allergen of the recently changed adhesive.
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Affiliation(s)
- Eva Oppel
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital LMU, Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine LMU, Munich, Germany
| | - Anna Oschmann
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology, University Hospital LMU, Munich, Germany
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Dupuy E, Miller M, Harter N. What We Have Learned–Milestones in Pediatric Contact Dermatitis. CURRENT DERMATOLOGY REPORTS 2022; 11:1-12. [PMID: 35369649 PMCID: PMC8959272 DOI: 10.1007/s13671-022-00353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review This review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children. Recent Findings ACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use. Summary ACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.
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Affiliation(s)
- Elizabeth Dupuy
- Division of Pediatric Dermatology, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Melanie Miller
- Department of Dermatology, LAC+USC Keck School of Medicine, Los Angeles, CA USA
| | - Nicole Harter
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE USA
- Division Chief, Pediatric Dermatology, Children’s Hospital & Medical Center Omaha, 8534 Cass St., Omaha, NE 68114 USA
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Allergic Contact Dermatitis, an Important Skin Reaction in Diabetes Device Users: A Systematic Review. Dermatitis 2022; 33:110-115. [PMID: 35245221 DOI: 10.1097/der.0000000000000861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diabetes management has undergone many advances over the years, including the introduction of devices that allow patients to monitor blood glucose and administer insulin. Although these devices have improved patients' quality of life, they are associated with adverse reactions.A systematic literature search was performed up to May 2020 in PubMed, Cochrane, and Embase databases, with no temporal restrictions. Articles were screened by title, abstract, and full text as needed. A manual search among the references of the included articles was also performed.Two hundred sixty-five articles were identified, and 50 studies met inclusion criteria. Several cases of allergic contact dermatitis due to the use of insulin infusion systems and blood glucose monitoring have been reported. Acrylates, methacrylates, and colophonium, as well as, in particular, isobornyl acrylate, represent the main allergens responsible.Skin reactions, in particular allergic contact dermatitis, are a very common adverse event caused by insulin pumps and glucose sensors, which may lead to discontinue the usage of these devices with serious consequences for the patients. Collaboration between specialists, specifically between dermatologists and diabetologists, with patients and manufacturers is essential for the correct management of diabetes devices and potential related skin reactions.
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15
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Impact of trends in new and emerging contact allergens. Int J Womens Dermatol 2022; 8:e006. [PMID: 35620033 PMCID: PMC9112390 DOI: 10.1097/jw9.0000000000000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022] Open
Abstract
Allergic contact dermatitis represents a T cell-mediated, delayed-type hypersensitivity response to exogenous agents. While allergic contact dermatitis is one of the most common causes of skin disease encountered by dermatologists, emerging trends within the field are in constant flux, as influenced by ever-changing industry practices and evolving consumer behaviors. Although certain allergens continue to predominate, new chemicals are frequently being introduced, thus shifting the pattern of allergen exposure and sensitization. This review examines the impact of trends in new and emerging contact allergens, with particular attention to clinical contexts in which these agents may be encountered. In addition, we offer a working knowledge of these allergens’ characteristics, sources, and relevance, while outlining recommendations to accurately evaluate, diagnose, and provide appropriate counseling for these diseases.
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Passanisi S, Salzano G, Galletta F, Aramnejad S, Caminiti L, Pajno GB, Lombardo F. Technologies for Type 1 Diabetes and Contact Dermatitis: Therapeutic Tools and Clinical Outcomes in a Cohort of Pediatric Patients. Front Endocrinol (Lausanne) 2022; 13:846137. [PMID: 35370980 PMCID: PMC8965381 DOI: 10.3389/fendo.2022.846137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
The increasing use of technological devices for the management of diabetes is related to the prolonged exposure of patients' skin to chemical and mechanical agents and, consequently, to the increased risk of developing dermatological complications. Among these, contact dermatitis is the most insidious skin disorder. Despite the magnitude of the issue, no universally accepted recommendations on the management of this common complication are currently available. Our observational study aimed to describe all the solutions adopted by patients and their caregivers to treat and prevent the appearance of contact dermatitis and to describe the clinical impact of this cutaneous complication. Twenty-one pediatric patients (mean age 12.1 ± 3.7 years) with type 1 diabetes were recruited in the study. The most common treatment used to treat acute skin lesions was the application of topical corticosteroids, sometimes associated with topical antibiotics (9.5%). In order to prevent the further appearance of dermatitis, the most frequently adopted measure was the use of hydrocolloid and/or silicone-based adhesives, followed by the application of protective barrier films. One patient reported benefit from the off-label use of fluticasone propionate nasal spray. However, only 52.4% of the study participants achieved a definitive resolution of the skin issue, and 38.1% of patients were forced to discontinue insulin pump therapy and/or continuous glucose monitoring. No differences were observed in glycated hemoglobin values between the period before and after the onset of contact dermatitis. Our study confirms the severity of this dermatological complication that may hinder the spread of new technologies for the management of diabetes. Finally, our findings highlight the importance of establishing close collaboration both with pediatric allergy specialists to prescribe the most suitable treatment and with manufacturing companies to ensure that adhesives of technological devices are free of harmful well-known sensitizers.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
- *Correspondence: Stefano Passanisi,
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Francesca Galletta
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Sara Aramnejad
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Giovanni B. Pajno
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Allergy Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
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Passanisi S, Salzano G, Lombardo F. Skin Involvement in Paediatric Patients with Type 1 Diabetes. Curr Diabetes Rev 2022; 18:e030921196145. [PMID: 34477525 DOI: 10.2174/1573399817666210903153837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022]
Abstract
Skin involvement is an overlooked aspect in the management of paediatric patients with type 1 diabetes. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: "children," "pediatric/paediatric patients," "skin," "skin disorders," "type 1 diabetes." Dermatological side effects are frequently observed among diabetic children and adolescents. Insulin-induced lipodystrophies and allergic contact dermatitis caused by insulin pumps or glycaemic sensors are the most common skin reactions in these patients. Furthermore, several diabetes-associated skin diseases such as necrobiosis lipoidica, granuloma annulare, vitiligo, and bullosis diabeticorum may already be present in paediatric patients. Paediatric diabetes specialists should pay attention to their patients' skin to recognize these disorders, identify the potential causes, and choose the most suitable treatment. Finally, the evaluation of skin concentrations of advanced glycation end-products using non-invasive diagnostic techniques may be used to assess the risk of chronic complications of diabetes as early as adolescence.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
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18
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Kamann S, Wagner N, Oppel E. Moderne Sensortechnik zur kontinuierlichen Glukosemessung: Anwendungseinschränkungen durch Kontaktallergien. J Dtsch Dermatol Ges 2021; 19:1715-1722. [PMID: 34894186 DOI: 10.1111/ddg.14621_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nicola Wagner
- Hautklinik, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Eva Oppel
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
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19
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Kamann S, Wagner N, Oppel E. Modern diabetes devices for continuous blood sugar measuring: Limitations due to contact allergies. J Dtsch Dermatol Ges 2021; 19:1715-1721. [PMID: 34751512 DOI: 10.1111/ddg.14621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
During the past years, diabetes diseases have increased significantly worldwide. However, new technologies such as continuous glucose measurement using a subcutaneous sensor are developing just as rapidly. A continuous improvement in insulin pump therapy is also contributing to an improved quality of life. A common feature of these modern devices for diabetes therapy is that they remain fixed in place on the skin for several days. In recent years, skin reactions, in particular pronounced contact dermatitis due to the devices and their adhesives have been increasingly reported. In particular, isobornyl acrylate, which used to be included in a glucose measurement sensor set, was identified as a main allergen. Development of contact allergy can result both in a necessity to quit the measuring system and in allergic cross-reactions to other systems.
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Affiliation(s)
- Stefanie Kamann
- Department of Dermatology and Allergology, Feldafing, Germany
| | - Nicola Wagner
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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20
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Nivet E, Lo G, Nivot-Adamiak S, Guitteny MA, De Kerdanet M. Impact of OMNIPOD® on the quality of life of adolescents with type 1 diabetes. Arch Pediatr 2021; 29:21-26. [PMID: 34753634 DOI: 10.1016/j.arcped.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/28/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Several pediatric studies have demonstrated that therapy using a conventional insulin pump improves glycemic control and quality of life. At the beginning of this study, a new tubeless insulin pump, Omnipod®, had recently been marketed in France. OBJECTIVES Analyze the response of adolescents treated with multiple injections to the proposal to use this new medical device and compare both the quality of life and the glycemic control of adolescents according to their choice. MATERIAL AND METHODS This was a prospective, observational study of adolescents aged 10-17 years who had type 1 diabetes for more than 1 year, all treated with multi-injection insulin delivery according to a basal-bolus regimen. They were separated into three groups: group A choosing to use the Omnipod® system, group B taking the time to think before making a decision, and group C choosing to keep their multi-injection therapy. The three groups were compared according to their quality of life with validated tools and glycemic control. RESULTS Groups were formed with 30 (25%) patients in group A, 55 patients (45%) in group B, and 36 patients (30%) in group C. As to the WHO Well-Being Index, no significant difference appeared in the study for the patients in the three groups. An increased treatment satisfaction score was found, evolving from 3.79 ± 0.68 to 4.36 ± 0.56, p = 0.002 (group A) and from 3.87 ± 0.7 to 4.16 ± 0.7, p = 0.032 (group B), with no significant change for group C (from 4.39 ± 0.6 to 4.31 ± 0.62, p = 0.582). The wish to change treatment score improved for group A (from 4.14 ± 0.88 to 1.68 ± 0.9; p < 0.001) and group B (from 3.51 ± 1.05 to 1.84 ± 1; p < 0.001), with no significant change for group C (from 1.81 ± 0 0.98 to 1.61 ± 0.8; p = 0.432). There was no significant difference regarding HbA1c rates in the three groups. CONCLUSION There was no significant difference in quality-of-life scores between adolescents who chose to switch from multiple injection to the tubeless patch pump and those who retained multi-injection treatment, but increased satisfaction was observed in the former group.
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Affiliation(s)
- E Nivet
- Service endocrinologie pédiatrique, Assistante spécialiste, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France.
| | - G Lo
- PH endocrinologue et diabétologue pédiatrique, CH Libourne,70 Rue Réaux, 33500 Libourne, France
| | - S Nivot-Adamiak
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M-A Guitteny
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
| | - M De Kerdanet
- Service endocrinologie pédiatrique, PH endocrinologue et diabétologue pédiatrique, CHU Rennes, Hôpital Sud, 16 boulevard de Bulgarie, 35200 Rennes, France
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21
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Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure. Postepy Dermatol Alergol 2021; 38:555-560. [PMID: 34658693 PMCID: PMC8501444 DOI: 10.5114/ada.2020.95848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Acrylate monomers have a wide range of applications. Since the 1950s, many reports of occupational origin allergic contact dermatitis due to (meth)acrylate monomers have been published. During last decades, (meth)acrylate allergy has undergone an occupational shift from dentistry toward beauty industry and medical devices. The aim of the study was to conduct a literature review on acrylates as a cause of allergic contact dermatitis, current sources of exposure as well as identification of professional groups with an increased risk of this allergy and methods of effective prevention. Database review: Medline search (PubMed), Wiley Online Library and Web of Science base in years 1956–2019 using the following keywords: acrylates, manicurists, dentists, dental technicians, medical devices, occupational exposure, and allergic contact dermatitis. 204 346 articles containing the term ‘acrylates‘ have been found. They include 2 042 articles with the word ‘manicurists’, 169 919 – ‘dentists’, 218 236 – ‘dental technicians’, 2 427 418 – ‘medical devices’. Fifty-nine articles were chosen based on analysis of abstracts and full texts. In the past allergy to acrylates was mainly of occupational origin and dental technicians were the most often affected professional group. Since the long-lasting manicure has become popular, this problem concerns both manicurists and their customers. Moreover, the new significant trend is non-occupational allergic contact dermatitis caused by medical devices especially dedicated to diabetes patients.
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22
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Ulriksdotter J, Svedman C, Bruze M, Mowitz M. Allergic contact dermatitis caused by dipropylene glycol diacrylate in the Omnipod® insulin pump. Br J Dermatol 2021; 186:334-340. [PMID: 34510410 DOI: 10.1111/bjd.20751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cases of allergic contact dermatitis (ACD) caused by isobornyl acrylate (IBOA) in the Omnipod® insulin pump have previously been reported. OBJECTIVES To present three cases of patients with ACD caused by a new allergen in the pump, and results from chemical analyses. METHODS Omnipod pumps from different batches were analysed by gas chromatography-mass spectrometry. Aimed testing, with the department's medical device (MD) series and substances identified in the pump including dipropylene glycol diacrylate (DPGDA) at 0·01% and 0·1% in petrolatum (pet.), was performed. Patch testing also included extracts from the device, the adhesive patch as is, and allergens from baseline series. RESULTS All patients tested positive to 0·1% DPGDA in pet., and two patients additionally to a 0·01% concentration. DPGDA was found in extracts of the Omnipod pumps brought by the patients. An Omnipod pump from an earlier batch contained tripropylene glycol diacrylate, IBOA, N,N-dimethylacrylamide, di(ethylene glycol)ethyl ether acrylate (DEGEA) but no DPGDA. One of the patients reacted positively to all of these allergens except DEGEA, which was not tested. CONCLUSIONS When suspecting ACD to MDs, DPGDA at 0·1% in pet. should be tested. The contents of Omnipod have changed over time. Patch testing with updated test series and relevance assessment of positive reactions is a delicate task. Children, with lifelong use of MDs, risk contracting many allergies with potential cross-allergies. A question should be raised as to whether these low molecular weight acrylates should be used at all in devices constantly worn on the skin.
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Affiliation(s)
- J Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Bergaliden 14, 251 87, Helsingborg, Sweden
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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23
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Fink H, de Barros Fernandes NM, Weissmann J, Frey M. Extraction With Sweat-Sebum Emulsion as a New Test Method for Leachables in Patch-Based Medical Devices, Illustrated by Assessment of Isobornylacrylate (IBOA) in Diabetes Products. J Diabetes Sci Technol 2021; 15:792-800. [PMID: 32115999 PMCID: PMC8258535 DOI: 10.1177/1932296820908656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increasing offering of patch-based medical devices is accompanied by growing numbers of reported adverse skin reactions. Procedures for testing leachables according to ISO 10993 may not be optimal for lipophilic substances that can be mobilized on skin by sweat and sebum. We propose an improved extraction method for targeted analysis of leachables using low volumes of a sweat-sebum emulsion. The approach is illustrated by the analysis of isobornylacrylate (IBOA), a compound found in some devices and suspected for allergenic potential. METHOD Three patch-based products were tested: an implantable device for continuous glucose monitoring (CGM), an intermittently scanned CGM (isCGM) device, and a micro-insulin pump. Quantification of IBOA was performed by gas chromatography and allergenic potential of IBOA levels was assessed by the KeratinoSens cell assay. Different combinations were used for extraction solvent (isopropanol, 5% ethanol-water solution, and sweat-sebum emulsion), extraction volumes (complete immersion vs partial immersion in 2 mm of solvent), and extraction time (3, 5, and 14 days). RESULTS Isobornylacrylate was only found in the isCGM device. About 20 mg/L IBOA were eluted after 3 days in isopropanol but only about 1 mg/L in ethanol-water. Sweat-sebum emulsion dissolves IBOA better and gives a more stable solution than ethanol-water. Decomposition of IBOA solutions requires adjusted extraction timing or correction of results. In the sweat-sebum extract, IBOA levels were about 20 mg/L after 3 days and about 30 mg/L after 5 days, clearly above the threshold found in the KerationSens assay for keratinocyte activation (10 mg/L). CONCLUSION Extraction by low volumes of sweat-sebum emulsion can be a superior alternative for the targeted simulating-use assessment of leachables in patch-based medical devices.
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Affiliation(s)
- Herbert Fink
- Roche Diabetes Care GmbH, Mannheim, Germany
- Herbert Fink, Roche Diabetes Care GmbH, Sandhofer Str. 116, 68305 Mannheim, Baden-Württemberg, Germany.
| | | | | | - Manfred Frey
- Steinbeis Innovationszentrum für Zellkulturtechnik, Mannheim, Germany
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Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus. J Diabetes Sci Technol 2021; 15:786-791. [PMID: 32389062 PMCID: PMC8258506 DOI: 10.1177/1932296820918894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. METHODS One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. RESULTS Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were "red," "itchy," "painful," and "rash." Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. CONCLUSIONS Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.
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Affiliation(s)
- Rachel S. Rigo
- Columbia University Irving Medical Center, New York, NY, USA
| | - Laura E. Levin
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald V. Belsito
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria C. Garzon
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachelle Gandica
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kristen M. Williams
- Columbia University Irving Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Kristen M. Williams, MD, Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, 2nd Floor, New York, NY 10032, USA.
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25
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Gatica-Ortega ME, Mowitz M, Pastor-Nieto MA, Navarro-Triviño FJ, Fernández-Redondo V, Hernández-Cano N, Borrego L, Gómez-de-la-Fuente E, Torralba M, Svedman C, Giménez-Arnau A. Contact Dermatitis From Glucose Sensors In Spain: A Multicentric Approach. Contact Dermatitis 2021; 85:554-562. [PMID: 34185891 DOI: 10.1111/cod.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/06/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Allergic contact dermatitis from glucose sensors may interfere with their ongoing application. OBJECTIVE To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results and outcomes from the ongoing use of the device. METHODS A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain epidemiologic features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results. RESULTS Thirty patients were evaluated mean age: 20 .93 years. 66 .7 % were children and 66 .7 % female. 90 .0 % used Freestyle Libre FSL. 8 /26 30 .8 % reacted to isobornyl acrylate IBOA and 2 /20 10 .0 % to N,N dimethylacrylamide DMAA. The mean latency time to develop dermatitis was 9 months. 16 /29 55 .2 % patients continued using the same sensor causing the reaction. 13 /29 44 .8 % were unable to continue using the sensor due to severe reactions. Of them, 5 were positive to IBOA, one to IBOA and DMAA; one to DMAA; one to colophony and 1 to isopropyl alcohol wipes. In one patient the outcome was unknown. CONCLUSION The frequency of sensitization to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding medical devices composition and cooperate with the investigation of contact dermatitis is urgently needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Martin Mowitz
- Dept. of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - María A Pastor-Nieto
- Dermatology Dept. Hospital Universitario de Guadalajara Guadalajara, Spain.,Dept. of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, Faculty of Medicine, Alcalá University Alcalá de Henares, Madrid, Spain
| | | | | | | | - Leopoldo Borrego
- Universidad de Las Palmas de Gran Canaria. Dermatology Dept. Hospital Universitario Insular Dermatology Dept. Hospital Universitario Insular
| | | | - Miguel Torralba
- Dept. of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, Faculty of Medicine, Alcalá University Alcalá de Henares, Madrid, Spain.,Internal Medicine Dept., University Hospital of Guadalajara, Spain
| | - Cecilia Svedman
- Dept. of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ana Giménez-Arnau
- Dermatology Dept. Hospital del Mar, IMIM, Universitat Autònoma de Barcelona
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Further Evidence of Allergic Contact Dermatitis Caused by 2,2'-Methylenebis(6-tert-Butyl-4-Methylphenol) Monoacrylate, a New Sensitizer in the Dexcom G6 Glucose Sensor. Dermatitis 2021; 33:287-292. [PMID: 34115662 DOI: 10.1097/der.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the spring of 2020, we have seen several patients experiencing severe allergic contact dermatitis (ACD) from the Dexcom G6 glucose sensor after the composition of the sensor's adhesive patch had been changed. We have previously reported the finding of a new sensitizer, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate, in the Dexcom G6 adhesive patch. Three patients with ACD from Dexcom G6 tested positive to this sensitizer. They were also allergic to isobornyl acrylate, a sensitizer present both in Dexcom G6 and in other medical devices previously used by these patients. OBJECTIVE The aim of the study was to report the first 4 cases sensitized to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate without a simultaneous allergy to isobornyl acrylate. METHODS The cases were patch tested their own materials, a medical device series, and 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in several concentrations. RESULTS All 4 cases tested positive to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate at either 1.0% or 1.5% in petrolatum, whereas 20 controls tested negative to both concentrations. CONCLUSIONS The cases reported here provide further evidence of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate as a relevant culprit sensitizer in patients with ACD from Dexcom G6. However, the initially used patch test concentration (0.3%) did not suffice to elicit positive reactions in these cases, which is why patch testing at 1.5% is recommended.
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Facial Personal Protective Equipment: Materials, Resterilization Methods, and Management of Occupation-Related Dermatoses. Dermatitis 2021; 32:78-85. [PMID: 33273243 DOI: 10.1097/der.0000000000000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods. OBJECTIVES The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses. METHODS Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored. RESULTS Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed. CONCLUSIONS There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.
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Herman A, Uter W, Rustemeyer T, Matura M, Aalto-Korte K, Duus Johansen J, Gonçalo M, White IR, Balato A, Giménez Arnau AM, Brockow K, Mortz CG, Mahler V, Goossens A. Position statement: The need for EU legislation to require disclosure and labelling of the composition of medical devices. J Eur Acad Dermatol Venereol 2021; 35:1444-1448. [PMID: 33955077 PMCID: PMC8251888 DOI: 10.1111/jdv.17238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, skin reactions secondary to the use of medical devices (MD), such as allergic contact dermatitis have increasingly been observed (e.g. to continuous blood sugar monitoring systems, insulin pumps, wound dressings, medical gloves, etc.): this is regarded as a developing epidemic. Lack of labelling of the composition of MD, as well as frequent lack of cooperation of manufacturers to disclose this relevant information, even when contacted by the clinician for the individual case of an established adverse reaction, significantly impede patient care. OBJECTIVES To advocate for full ingredient labelling in the implementation of EU regulation for MD. METHODS This position paper reviews the scientific literature, the current regulatory framework adopted for MD to date, and the likely impact, including some costs data in case of the absence of such labelling. RESULTS Efforts made by several scientific teams, who are trying to identify the culprit of such adverse effects, either via asking for cooperation from companies, or using costly chemical analyses of MD, can only partly, and with considerable delay, compensate for the absence of meaningful information on the composition of MD; hence, patient management is compromised. Indeed, without knowing the chemical substances present, physicians are unable to inform patients about which substances they should avoid, and which alternative MD may be suitable/tolerated. CONCLUSION There is an urgent need for full and accurate labelling of the chemical composition of MD in contact with the human body.
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Affiliation(s)
- A Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, Univ. Erlangen/Nürnberg, Erlangen, Germany
| | - T Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Matura
- Dermatology Unit, Skaraborgs Hospital Skövde, Skövde, Sweden
| | - K Aalto-Korte
- Occupational Health Unit, Finnish Institute of Occupational Heath, Helsinki, Finland
| | - J Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - I R White
- Cutaneous Allergy Team, St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - A M Giménez Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - C G Mortz
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - V Mahler
- Med. Faculty, Univ. Erlangen/Nuremberg, Erlangen, Germany
| | - A Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
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Lee EB, Lobl M, Ford A, DeLeo V, Adler BL, Wysong A. What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic? Curr Allergy Asthma Rep 2021; 21:26. [PMID: 33779825 PMCID: PMC8006117 DOI: 10.1007/s11882-021-01000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates. Recent Findings Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home. Summary Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.
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Affiliation(s)
- Erica B Lee
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Marissa Lobl
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Aubree Ford
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA
| | - Vincent DeLeo
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, 985645 Nebraska Medical Center, Omaha, NE, 68198-5645, USA.
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30
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Weng AT, Zachariae C, Christensen KB, Svensson J, Berg AK. Five-Month Follow-up Shows No Improvement in Dermatological Complications in Children With Type 1 Diabetes Using Continuous Glucose Monitoring Systems and Insulin Pumps. J Diabetes Sci Technol 2021; 15:317-323. [PMID: 31619071 PMCID: PMC8256062 DOI: 10.1177/1932296819882425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A Danish study showed that 90% of the pediatric patients who participated had some time experienced dermatological complications due to treatment with continuous subcutaneous insulin infusion (CSII). This follow-up study describes dermatological complications due to CSII and/or continuous glucose monitoring (CGM) between the two study periods and includes health-related quality of life (HrQoL) measurements. METHODS A total of 138 patients (95%) out of 145 patients from the initial study answered an online questionnaire regarding dermatological complications related to CSII and/or CGM, five months later. A second questionnaire (DISABKIDS) regarding HrQoL was sent out to those 138 of which 111 patients completed it. The patients were aged from 2 to 20 years. Descriptive statistics, χ2 tests, and univariate and multivariate analyses were used to analyze the data. RESULTS In total, 81% of the 138 patients continued to have dermatological complications at follow-up. Itching was the most frequently reported complication. Patients using Enlite reported more dermatological complications than those using Libre. In total, 79% of the patients who used barrier cream in the initial study still had dermatological complications five months later. Age, gender, Body Mass Index (BMI), or HbA1c levels showed no significant association with dermatological complications. Patients who perceived dermatological complications as a greater problem had lower HrQoL scores. CONCLUSION Once dermatological complications start to appear, they become chronic, indicating that the treatments currently available are inadequate. Patients perceiving dermatological complications as a greater problem were associated with lower HrQoL. These findings highlight the need for additional preventive studies.
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Affiliation(s)
- Anna T. Weng
- Department of Pediatrics, Copenhagen
University Hospital, Herlev Hospital, Denmark
- Faculty of Health Science, University of
Copenhagen, Denmark
- Anna T. Weng, BSc, Department of Pediatrics,
Copenhagen University Hospital, Herlev Hospital, Herlev Ringvej 75, Herlev 2730,
Denmark.
| | - Claus Zachariae
- Department of Dermatology and Allergy,
Copenhagen University Hospital, Gentofte Hospital, Denmark
| | - Karl B. Christensen
- Department of Public Health, Section of
Biostatistics, University of Copenhagen, Denmark
| | - Jannet Svensson
- Department of Pediatrics, Copenhagen
University Hospital, Herlev Hospital, Denmark
- Faculty of Health Science, University of
Copenhagen, Denmark
| | - Anna K. Berg
- Department of Pediatrics, Copenhagen
University Hospital, Herlev Hospital, Denmark
- Faculty of Health Science, University of
Copenhagen, Denmark
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31
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Svedman C, Bruze M, Antelmi A, Hamnerius N, Hauksson I, Ulriksdotter J, Mowitz M. Continuous glucose monitoring systems give contact dermatitis in children and adults despite efforts of providing less ‘allergy‐ prone’ devices: investigation and advice hampered by insufficient material for optimized patch test investigations. J Eur Acad Dermatol Venereol 2021; 35:730-737. [DOI: 10.1111/jdv.16981] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C. Svedman
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - M. Bruze
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - A. Antelmi
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - N. Hamnerius
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - I. Hauksson
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
| | - J. Ulriksdotter
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
- Department of Dermatology Helsingborg Hospital Helsingborg Sweden
| | - M. Mowitz
- Department of Occupational and Environmental Dermatology Lund UniversitySkåne University Hospital Malmö Sweden
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32
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Svedman C, Ulriksdotter J, Lejding T, Bruze M, Mowitz M. Changes in adhesive ingredients in continuous glucose monitoring systems may induce new contact allergy pattern. Contact Dermatitis 2021; 84:439-446. [PMID: 33421157 DOI: 10.1111/cod.13781] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical devices (MD) in close skin-contact for a prolonged time, such as glucose monitoring (CGM) systems, are a risk factor for contact allergy, and there has been an increase in patients using these. Correct diagnosis demands targetted testing. OBJECTIVES We report a new allergen in a continuous CGM system in which the adhesive was changed. The allergy pattern of the patients diagnosed is reported. METHODS The three patients reported were patch tested with an MD series, own material, and possible allergens found through analysis with gas chromatography-mass spectrometry, comparing analysis from the CGM system before and after change. RESULTS The patients were sensitized to isobornyl acrylate (IBOA), found in previously used devices and the present CGM. Apart from IBOA, the culprit allergen was found to be 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate. CONCLUSION Allergic contact dermatitis due to CGM systems and insulin pumps are difficult to investigate and require chemical analysis. Because of the lack of information on substances used in the production, and when changes with MDs are initiated, it is difficult to advise patients, especially since they risk sensitization to several allergens. The use of MDs has increased and, thus, the need for collaboration between manufacturers, clinicians, and patient organizations.
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Affiliation(s)
- Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, SUS, University of Lund, Malmö, Sweden
| | - Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, SUS, University of Lund, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden University of Lund, Malmö, Sweden
| | - Tina Lejding
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, SUS, University of Lund, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, SUS, University of Lund, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, SUS, University of Lund, Malmö, Sweden
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Abstract
Novel diabetic devices are being developed to help manage diabetes and improve the quality of life of patients with diabetes. Both insulin pumps and glucose monitors are becoming increasingly convenient, long-lasting, and discrete for patients, but this often requires the use of strong external cutaneous adhesives and increased contact time with the skin. As a consequence, these devices have been associated with a variety of dermatologic reactions, namely, irritant and allergic contact dermatitis. Some of these reactions can be severe, precluding the use of these devices, which puts patients' long-term health at risk. Herein, we review the history of diabetic devices and reported cutaneous reactions to diabetic devices and commonly cited allergens.
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34
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Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol 2020; 84:235-244. [PMID: 33217510 DOI: 10.1016/j.jaad.2020.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.
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Affiliation(s)
- Holly Neale
- University of Massachusetts School of Medicine, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Cristina Garza-Mayers
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Idy Tam
- Tufts University School of Medicine, Boston, Massachusetts
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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35
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Dendooven E, Foubert K, Goossens A, Gilles P, De Borggraeve W, Pieters L, Lambert J, Aerts O. Concomitant positive patch test reactions in FreeStyle-allergic patients sensitized to isobornyl acrylate. Contact Dermatitis 2020; 84:166-174. [PMID: 32965058 DOI: 10.1111/cod.13706] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Concomitant positive patch test reactions in patients sensitized to isobornyl acrylate (IBOA) have rarely been documented. OBJECTIVES To report concomitant sensitizations in patients with allergic contact dermatitis (ACD) from the glucose sensor FreeStyle Libre and sensitized to IBOA. METHODS In 2019, 26 patients with suspected ACD from FreeStyle Libre were patch tested to a baseline series and to a (meth) acrylate series containing IBOA and 2-phenoxyethyl acrylate (PEA) 0.1% pet. Diabetes devices and patch test preparations were analyzed with gas chromatography - mass spectrometry (GC-MS) for the presence of IBOA and PEA. RESULTS Of the 26 patients, 18 (69%) were sensitized to IBOA, and eight (44%) and 11 (61%) of these were co-sensitized to sesquiterpene lactones and fragrances, respectively. Ten patients (56%) were co-sensitized to PEA, which, contrary to IBOA, could not be detected in any device. The PEA test material was shown to be contaminated with IBOA. CONCLUSIONS Contact allergy to IBOA appears to be declining and IBOA-sensitized patients are most often co-sensitized to sesquiterpene lactones and fragrances. Vigilance is required when patch testing (acrylate) materials obtained from industry, as these might be contaminated and, hence, alter the results and their interpretation.
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Affiliation(s)
- Ella Dendooven
- Department of Dermatology, University Hospital Antwerp (UZA), Antwerp, Belgium.,Research Group Immunology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Research Group Natural Products and Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Kenn Foubert
- Research Group Natural Products and Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - An Goossens
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Philippe Gilles
- Molecular Design and Synthesis, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - Wim De Borggraeve
- Molecular Design and Synthesis, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - Luc Pieters
- Research Group Natural Products and Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Julien Lambert
- Department of Dermatology, University Hospital Antwerp (UZA), Antwerp, Belgium.,Research Group Immunology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA), Antwerp, Belgium.,Research Group Immunology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
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36
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Gatica-Ortega ME, Pastor-Nieto MA. Dermatitis alérgica de contacto y otras dermatosis asociadas al uso de bombas de insulina y sensores de glucosa. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.piel.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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37
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Ahrensbøll-Friis U, Simonsen AB, Zachariae C, Thyssen JP, Johansen JD. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: Results from a 5-year period. Contact Dermatitis 2020; 84:75-81. [PMID: 32677709 DOI: 10.1111/cod.13664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of patients with contact dermatitis from glucose sensors and insulin infusion sets is increasing. Patch testing is challenging because of a lack of information concerning the constituent materials of medical devices. OBJECTIVES To report on products and causes of allergic reactions to glucose sensors or insulin infusion sets over a 5-year period and suggest a short screening series. METHODS Analysis of patch test data from consecutive patients suspected of allergic contact dermatitis (ACD) to glucose sensors and/or insulin infusion sets from 2015-2019. RESULTS Patient numbers increased from 4 to 15 per year; 30/38 (78.9%) were children. In 29 (76.3%), a diagnosis of allergic/probable ACD was established, mostly due to the tapes of the device or allergens in these tapes (n = 23) followed by allergens in the device housing (n = 10). Isobornyl acrylate, abitol, and colophonium were the most common allergens. Information from manufacturers was often difficult to obtain and, if accessible, inadequate. For this reason, the diagnosis was delayed for more than 1.5 years in 12 (31%) patients. CONCLUSIONS The increasing number of patients, mostly children, with ACD from devices used in treatment of type 1 diabetes demonstrates the importance of this problem. Allergies can easily be overlooked, due to the lack of mandatory labeling of the constituent materials of the devices.
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Affiliation(s)
- Ulrik Ahrensbøll-Friis
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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38
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Hamnerius N, Mowitz M. Intense skin reaction to a new glucose monitoring and insulin pump system. Contact Dermatitis 2020; 83:524-527. [DOI: 10.1111/cod.13663] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Nils Hamnerius
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
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39
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Ulriksdotter J, Svedman C, Bruze M, Glimsjö J, Källberg K, Sukakul T, Mowitz M. Contact dermatitis caused by glucose sensors-15 adult patients tested with a medical device patch test series. Contact Dermatitis 2020; 83:301-309. [PMID: 32608015 DOI: 10.1111/cod.13649] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported. Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens. OBJECTIVES To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications. METHODS A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series. IBOA and DMAA were tested at 0.1% and 0.3% in petrolatum (pet.). Readings were performed on day (D) 3 and D7. Background data, details on skin reactions, and associated implications were assessed using a questionnaire. RESULTS Thirteen patients were sensitized to IBOA and four to DMAA. Two positive reactions to IBOA and one to DMAA were seen only at 0.3% concentration on D7. Median duration of sensor use before dermatitis onset was 6 months. Half the number of the patients took precautions in everyday life due to sensor-related skin reactions. Six patients discontinued sensor usage. CONCLUSIONS Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA. Adding the 0.3% pet. concentration is recommended. The reading on D7 is necessary.
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Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jenny Glimsjö
- Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
| | - Kajsa Källberg
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Kamann S, Heinemann L, Oppel E. Usage of Hydrocolloid-Based Plasters in Patients Who Have Developed Allergic Contact Dermatitis to Isobornyl Acrylate While Using Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2020; 14:582-585. [PMID: 31538817 PMCID: PMC7576941 DOI: 10.1177/1932296819876964] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) systems replace more and more capillary self-monitoring of blood glucose by patients with diabetes. However, at least a subset of patients experience adverse skin reactions such as severe allergic contact dermatitis (ACD) after prolonged usage of CGM systems. A major allergen isobornyl acrylate (IBOA) has been identified recently. OBJECTIVES After developing an ACD, patients have difficulties in continuing the usage of their CGM system (and also of, eg, certain patch pumps). Most of such patients look for possibilities to continue the usage of, eg, a CGM system that requires intermittent scanning (iscCGM, Freestyle Libre). PATIENTS AND METHODS Eight patients with a known ACD were supplied with different hydrocolloid-based plasters (n = 5 with Hansaplast blister plaster, n = 2 with Cutimed Hydro B from BSN, and n = 1 with Stomahesive baseplate from Convatec). They attached these plasters to their skin underneath their iscCGM system. RESULTS All patients were able to continue the usage of this iscCGM system when using such plasters. CONCLUSION Patients with ACD benefit from the usage of such plasters; however, some limitations have to be acknowledged.
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Affiliation(s)
- Stefanie Kamann
- Dermatology and Allergology, Feldafing, Germany
- Stefanie Kamann, MD, Dermatology and Allergology, Seewiesstraße 1, 82340 Feldafing, Germany.
| | | | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Contact Allergy-Emerging Allergens and Public Health Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072404. [PMID: 32244763 PMCID: PMC7177224 DOI: 10.3390/ijerph17072404] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.
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Pyl J, Dendooven E, Van Eekelen I, den Brinker M, Dotremont H, France A, Foubert K, Pieters L, Lambert J, De Block C, Aerts O. Prevalence and Prevention of Contact Dermatitis Caused by FreeStyle Libre: A Monocentric Experience. Diabetes Care 2020; 43:918-920. [PMID: 32054722 DOI: 10.2337/dc19-1354] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cutaneous adverse events (CAE) from FreeStyle Libre include allergic contact dermatitis (ACD) caused by the allergen isobornyl acrylate (IBOA). We aim to report CAE from this glucose sensor, ACD to IBOA in particular, and the outcome of using barrier films as a prevention. RESEARCH DESIGN AND METHODS A monocentric, retrospective review of medical files from adult and pediatric patients with diabetes using Freestyle Libre, in the period between December 2016 and April 2019, was performed with a focus on CAE. RESULTS Fifty-seven of 1,036 patients with diabetes (5.5%) were referred to our dermatology department because of CAE from FreeStyle Libre. Thirty-nine of 1,036 (3.8%) had ACD due to IBOA. Only two patients, of whom one sensitized to IBOA, had a benefit from using barrier films. CONCLUSIONS CAE occurred in 5.5% of FreeStyle Libre users, and 3.8% suffered from ACD due to IBOA. Barrier films had limited value in the prevention.
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Affiliation(s)
- Jeroen Pyl
- Department of Dermatology, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Ella Dendooven
- Department of Dermatology, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Ine Van Eekelen
- Department of Dermatology, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Marieke den Brinker
- University of Antwerp, Antwerp, Belgium.,Division of Pediatric Endocrinology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Hilde Dotremont
- University of Antwerp, Antwerp, Belgium.,Division of Pediatric Endocrinology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Annick France
- University of Antwerp, Antwerp, Belgium.,Division of Pediatric Endocrinology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Kenn Foubert
- University of Antwerp, Antwerp, Belgium.,Natural Products & Food Research and Analysis, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Pieters
- University of Antwerp, Antwerp, Belgium.,Natural Products & Food Research and Analysis, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Julien Lambert
- Department of Dermatology, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Christophe De Block
- University of Antwerp, Antwerp, Belgium.,Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, Antwerp University Hospital, Antwerp, Belgium .,University of Antwerp, Antwerp, Belgium
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Abstract
Consumer use of wearable health devices has been rapidly increasing. Because of prolonged skin contact required, allergic contact dermatitis to components has been reported. Eczematous rash is the most common dermatologic adverse reaction to continuous glucose monitors, and rash from wearable activity trackers is commonly reported by consumers, suggesting that allergic contact dermatitis to wearable health devices may be vastly underreported. Acrylates, methacrylates, and colophonium are the most common allergens found on patch testing. Isobornyl acrylate has been identified as the primary allergen in many cases of allergic contact dermatitis to continuous glucose monitors. These chemicals are found in either the adhesives or the units themselves. Awareness of the presence of these chemicals in wearable devices may provide assistance for diagnostic patch testing in users who have dermatological reactions to the devices and hopefully guide dermatotoxicological evaluation guidance by government and industry.
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von Krogh F, Zink A. [Diabetes mellitus - the skin as a monitor]. MMW Fortschr Med 2020; 162:49-53. [PMID: 32124344 DOI: 10.1007/s15006-020-0219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Fakultät für Medizin, Technische Universität München, Biedersteiner Straße 29, D-80802, München, Deutschland.
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Abstract
The design and development of insulin pumps and various glucose sensor systems has an enormous impact on life quality of diabetic patients. Surveillance and therapy of diabetes has improved due to the new diabetic devices, which are affixed to the patients' skin for several days. Since their introduction, irritant and allergic contact dermatitis have been frequently reported. Patients often acquire contact sensitization to isobornyl acrylate, N,N-dimethylacrylamide or formerly to 2‑ethyl-cyanoacrylate. These contact allergens were found in the patch, in the glue to affix the box on the patch or in the casing of the system itself. Development of contact allergy to substances of these systems may result in the need to abandon modern diabetic devices.
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Lombardo F, Passanisi S, Caminiti L, Barbalace A, Marino A, Iannelli M, Messina MF, Pajno GB, Salzano G. High Prevalence of Skin Reactions Among Pediatric Patients with Type 1 Diabetes Using New Technologies: The Alarming Role of Colophonium. Diabetes Technol Ther 2020; 22:53-56. [PMID: 31464516 DOI: 10.1089/dia.2019.0236] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the past few years, the increasing use of devices for diabetes treatment, such as continuous subcutaneous insulin infusion pumps, flash glucose monitoring, continuous glucose monitoring systems, sensor-augmented pumps, and automated insulin delivery devices, has resulted in important improvements in disease management. Meanwhile, the longer a patient uses a device, the greater the likelihood of developing a skin reaction. Allergic contact dermatitis is the most frequently described skin side effect caused by adhesive tapes contained in the insulin infusion sets or glucose sensor sets and used to connect these devices to the body. We describe 18 patients, followed up at our Pediatric Diabetes Centre, who experienced dermatological complications due to diabetes device use from January 2018 to December 2018. All the patients were patch tested with allergens from a "standard" series and from a "plastics and glues" series. Patch tests resulted positive in 66.7% of patients. Colophonium was the most frequently isolated sensitizing allergen (41.1% of cases). It is a complex mixture of >100 compounds derived from pine trees. Colophonium is commonly used, in both unmodified and modified forms, as a fast-acting adhesive for industrial, medical, or other commercial uses. Its presence in the adhesive of the insulin sets and glucose sensors was confirmed by the manufacturer of some devices brand. On the basis of our results, we stress the importance of contacting manufacturers for product information. We also highlight that there should be stricter legal restrictions to label medical adhesives, even if only small amounts of colophonium are used.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Andrea Barbalace
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Alessandra Marino
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Mauro Iannelli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Allergy Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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Kamann S, Oppel E, Liu F, Reichl FX, Heinemann L, Högg C. Evaluation of Isobornyl Acrylate Content in Medical Devices for Diabetes Treatment. Diabetes Technol Ther 2019; 21:533-537. [PMID: 31287728 DOI: 10.1089/dia.2019.0163] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Along with increased usage of continuous glucose monitors, flash glucose monitors, and patch pumps by patients with diabetes, the frequency of skin reactions has also increased. Skin irritation and itching can be annoying to users. However, more serious contact allergies to one or more components of the adhesives or plastic material of the housing of the devices can become lifelong. Redness and itchiness are so strong that patients can no longer use a particular system. In August 2017, a major culprit allergen, isobornyl acrylate (IBOA), was identified for these more serious reactions. Objectives: Our objective was to evaluate IBOA content in different medical products. Methods: The plastic material used for the housing of the Freestyle Libre (n = 3), Dexcom G6 (n = 3), and Enlite (n = 4) was analyzed for IBOA content by gas chromatography-mass spectrometry. Adhesives of the different systems were also analyzed. Results: IBOA was found in the housings of Freestyle Libre and Enlite sensor, but not in the Dexcom G6. Conclusions: Patients with an IBOA allergy should consider switching to a medical product without IBOA. Furthermore, removal of IBOA from devices that contact the skin is encouraged.
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Affiliation(s)
| | - Eva Oppel
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Fangfang Liu
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
| | | | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University, Munich, Germany
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Affiliation(s)
- M. Gonçalo
- Clinic of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra University Hospital Praceta Mota Pinto P‐3000‐075 Coimbra Portugal
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