Patch testing with alkyl glucosides: Concomitant reactions are common but not ubiquitous

Frequent Positive Patch Test Reactions to Glucosides in Children: A Call for Caution?

BACKGROUND

Alkyl glucosides are surfactants commonly found in cosmetics and household products. However, data on glucoside contact allergy in paediatric populations is limited.

OBJECTIVES

To determine the prevalence, relevance and clinical characteristics of contact allergy to glucosides in children.

METHODS

A retrospective review of the files of paediatric patients (≤ 16 years) who underwent patch testing for decyl glucoside (DG) and/or lauryl glucoside (LG) at the Antwerp University Hospital (UZA) in the period between January 2018 and December 2024.

RESULTS

Among 241 children tested for DG, 148 (61.4%) were also tested for LG. DG reactions were observed in 47 patients (19.5%), with 27 (11.2%) considered positive. LG reactions occurred in 17/148 (13%), but only 4 (2.7%) were positive, all with concomitant DG reactions. Most positive DG reactions were weak (+) (25/27), whereas only 2 were strong (++). The median age was 7 years (range: 2-15), with 51.9% female. Culprit sources mostly included cosmetics.

CONCLUSIONS

Patch test reactions to glucosides readily occur in children, and the positivity rate is surprisingly high. Besides many irritant and doubtful reactions, false-positive (+) reactions likely occur, particularly in young atopic children. Careful interpretation of positive results and complementary work-up may thus be necessary.

Occurrence of alkyl glucosides in rinse-off cosmetics marketed as hypoallergenic or for sensitive skin

Rinse-off cosmetic products, primarily shampoos, are frequently implicated in the onset of allergic contact dermatitis (ACD) caused by alkyl glucosides (AGs). AGs are increasingly popular surfactants and known contact allergens. Glucoside-induced ACD was most frequently observed with shampoos and skin-cleansing products in both consumer and occupational settings. Thereby, studies have shown that atopic individuals are the most susceptible to ACD. Also, several investigations have indicated that individuals with sensitive skin might be more prone to skin allergies. This is why the presence of AGs was investigated in shampoos and body cleansers marketed as hypoallergenic or for sensitive skin. For this purpose, the website of Amazon.com was surveyed. Four groups of cosmetics were obtained by using the following keywords: "hypoallergenic shampoo for adults," "sensitive skin shampoo for adults," "hypoallergenic body cleanser for adults," and "sensitive skin body cleanser for adults." The first 30 best-selling cosmetics in each group were investigated for the presence of AGs, by analyzing the product information pages. The results showed that as much as 56.7% of hypoallergenic shampoos contained AGs, as ingredients, whereas the percentage was somewhat lower for other product categories. Even though decyl and lauryl glucoside were nearly ubiquitously used AGs in cosmetics over the past decade, the most commonly present AG in our analysis was coco-glucoside. The results of this study indicated a necessity to include coco-glucoside in the baseline series of patch testing allergens. Industry, regulators, and healthcare providers should be made aware of the frequent presence of AGs in rinse-off cosmetic products marketed as hypoallergenic or for sensitive skin to ensure the safety and well-being of consumers and patients.

The European baseline series and recommended additions: 2023

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023.

Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018

BACKGROUND

Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products.

OBJECTIVE

To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018).

METHODS

Retrospective analysis of patients tested by the North American Contact Dermatitis Group.

RESULTS

Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside.

LIMITATIONS

The cohort predominantly reflects a referral population, and follow-up after testing was not captured.

CONCLUSION

Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.

Impact of trends in new and emerging contact allergens

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.

European patch test results with audit allergens as candidates for inclusion in the European Baseline Series, 2019/20 - Joint results of the ESSCAA and the EBSB working groups of the ESCD, and the GEIDACC

BACKGROUND

In 2019, a number of allergens (haptens), henceforth, 'the audit allergens,' were considered as potential additions to the European baseline series (EBS), namely, sodium metabisulfite, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5 or 5% pet), linalool hydroperoxides (lin-OOH), limonene hydroperoxides (lim-OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments, too.

OBJECTIVES

To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe.

METHODS

Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the ESSCA testing these, as well as further collaborators from the EBS working group of the ESCD, and the Spanish GEIDAC. As patch test outcome, reactions between day (D) 3 and D5 were considered.

RESULTS

Altogether n=12403 patients were tested with any of the audit allergen. Positive reactions were most common to lin-OOH 1% pet. (8.74 (8.14-9.37)), followed by lin-OOH 0.5% pet., and lim-OOH 0.3% pet (5.41 (4.95-5.89)). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72 (4.2-5.28), followed by sodium metabisulfite 1% pet. (3.75 (3.32-4.23)) and Compositae mix 5% pet. (2.31 (1.84-2.87). For some allergens, clinical relevance was frequently difficult to ascertain.

CONCLUSIONS

Despite many positive patch test reactions, it remains controversial whether lin- and lim-OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion among the ESCD members and ultimately decision on their implementation into routine testing. This article is protected by copyright. All rights reserved.

Baby wipes and nappy rash - what is the relationship? A review

Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.

Contact Dermatitis Associated With Hair Care Products: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001-2016

BACKGROUND

Hair care products (HCPs) may cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD).

OBJECTIVES

The aims of the study were to determine the prevalence of HCP-associated ICD/ACD and to characterize relevant allergens.

METHODS

This study is a retrospective analysis of North American Contact Dermatitis Group (NACDG) patch test data, 2001-2016.

RESULTS

Of 38,775 patients tested, 3481 (9.0%) had positive patch test reactions associated with HCPs. The HCP-positive patients were significantly more likely to be female (79.9% vs 66.0%) and/or have primary sites of dermatitis on the face (32.0% vs 27.8%) or scalp (15.4% vs 2.2%) compared with the HCP-negative patients (P < 0.0001). Of 4908 HCP-associated positive patch test reactions, 86.9% (n = 4263) were due to allergens on the NACDG screening series; p-phenylenediamine (35.8%), methylisothiazolinone (9.7%), methylchloroisothiazolinone/methylisothiazolinone (8.7%), and cocamidopropyl betaine (5.9%) were the most frequent. Most reactions (87.7%, 3736/4263) were currently clinically relevant. The most common job associated with 366 occupationally related NACDG HCP-associated allergens was hairdresser/cosmetologist (71.9%). Two hundred eighty-two patients (0.7%) had ICD associated with HCPs. Shampoo/conditioners were the most frequent source of NACDG HCP-associated reactions (47.3%) and HCP-associated ICD (45.0%).

CONCLUSIONS

Of the HCP-positive patients, 18.5% had HCP reactions to allergens not on the NACDG screening series, underscoring the importance of patch testing to expanded series in patients suspected of HCP allergy.

Freeze-Dried Matrices Composed of Degradable Polymers with Surfactant-Loaded Microparticles Based on Pectin and Sodium Alginate

Gelatin/polyvinylpyrrolidone/hydroxyethyl cellulose/glycerol porous matrices with microspheres made of sodium alginate or pectin and sodium alginate were produced. A surfactant was loaded into these microparticles. The microspheres were characterized using optical microscopy, scanning electron microscopy SEM, and laser diffraction particle size analyzer. For the matrices, the density, porosity, swelling capacity, dissolution in phosphate saline buffer were determined and SEM, mechanical, and thermogravimetric studies were applied. The results showed that the size of the two-component microspheres was slightly larger than that of single-ingredient microparticles. The images confirmed the spherical shape of the microparticles. The prepared matrices had high water uptake ability and porosity due to the presence of hydrophilic polymers. The presence of microparticles in the matrices caused a decrease in these parameters. Degradation of the composites with the microspheres was significantly faster than the matrix without them. The addition of microparticles increased the stiffness and toughness of the prepared materials. The efficiency of the thermal decomposition main stage was reduced in the samples with microspheres, whereas a char residue increased in these composites.

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

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. 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.

A review of contact dermatitis

OBJECTIVE

To familiarize the reader with the mechanisms and causes of contact dermatitis.

DATA SOURCES

Recent research articles, relevant review articles, and case series/reports in English from PubMed database, mostly from 2010 onwards.

STUDY SELECTIONS

Most data were in the form of retrospective studies. Efforts were made to include clinical trials; however, for newer allergens and data on biologics, case series and case reports were included. Older studies regarding the mechanism were included if they were of particular importance.

RESULTS

An understanding of this review should enable the reader to approach the patient with unknown dermatitis with a better understanding of the cause and management.

CONCLUSION

Clinical suspicion for relevant allergens combined with the interpretation of patch tests are important in the diagnosis and treatment of patients with contact dermatitis.

Developing a cosmetic series: Results from the ESSCA network, 2009-2018

BACKGROUND

There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series.

OBJECTIVES

To propose a standardized, evidence-based cosmetic series for Europe based on up-to-date analysis of relevant contact allergens.

METHODS

We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009 to 2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis.

RESULTS

Sensitization prevalences of 39 cosmetic contact allergens were tabulated. Thirty of these allergens yielded >0.3% positive reactions and are therefore included in our proposed European cosmetic series. Six were considered no longer relevant and therefore excluded. Three were included in a supplementary European cosmetic series. An additional nine allergens were included in either the core or supplemental European cosmetic series following literature review.

CONCLUSION

We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances.

Contact Allergy-Emerging Allergens and Public Health Impact

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.