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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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2
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Denis S, Villa A, Lehucher-Michel MP. Occupational allergic contact dermatitis caused by tripropylene glycol diacrylate in a professional casino dealer. Contact Dermatitis 2024. [PMID: 38676369 DOI: 10.1111/cod.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Simon Denis
- Occupational and Environmental Pathologies Department, Aix-Marseille University, La Timone Hospital, Marseille, France
| | - Antoine Villa
- Occupational and Environmental Pathologies Department, Aix-Marseille University, La Timone Hospital, Marseille, France
| | - Marie-Pascale Lehucher-Michel
- Occupational and Environmental Pathologies Department, Aix-Marseille University, La Timone Hospital, Marseille, France
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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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4
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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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Alkhatib EH, Grundman JB, Adamusiak AM, Bellin MD, Brooks JP, Buckley KS, Janssen EM, Kitcharoensakkul M, McNerney KP, Pfeifer TL, Polk BI, Marks BE. Case Report: Insulin hypersensitivity in youth with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1226231. [PMID: 37929017 PMCID: PMC10624121 DOI: 10.3389/fendo.2023.1226231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Immediate type I, type III, and delayed type IV hypersensitivity reactions to insulin are rare, but potentially serious complications of exogenous insulin administration required for the treatment of type 1 diabetes (T1D). Methods We present four cases of insulin hypersensitivity reactions occurring in youth with T1D and a literature review of this topic. Results Insulin hypersensitivity reactions included types I, III, and IV with presentations ranging from localized urticaria, erythematous nodules, and eczematous plaques to anaphylaxis with respiratory distress. Reactions occurred in youth with newly diagnosed T1D and in those with long-standing T1D who were using both injection and insulin pump therapy. Multidisciplinary care involving pediatric endocrinology and allergy/immunology utilizing trials of many adjunct therapies yielded minimal improvement. Despite the use of various treatments, including antihistamines, topical therapies, immunosuppressant medications, desensitization trials, and intravenous immune globulin, cutaneous reactions, elevated hemoglobin A1c levels, and negative effects on quality of life remain persistent challenges. One patient became one of the youngest pancreas transplant recipients in the world at age 12 years due to uncontrollable symptoms and intolerable adverse effects of attempted therapies. Conclusion Although rare, insulin hypersensitivity reactions negatively affect glycemic control and quality of life. These cases demonstrate the varying severity and presentation of insulin hypersensitivity reactions along with the limited success of various treatment approaches. Given the life-sustaining nature of insulin therapy, further studies are needed to better understand the underlying pathophysiology of insulin hypersensitivity and to develop targeted treatment approaches.
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Affiliation(s)
- Einas H. Alkhatib
- Department of Pediatric Endocrinology, Children’s National Hospital, Washington, DC, United States
| | - Jody B. Grundman
- Department of Pediatric Endocrinology, Children’s National Hospital, Washington, DC, United States
| | - Anna M. Adamusiak
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Melena D. Bellin
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, MN, United States
| | - Joel P. Brooks
- Department of Allergy and Immunology, Columbia University/New York-Presbyterian, New York, NY, United States
| | - Kevin S. Buckley
- Departments of Hematology/Oncology and Infectious Disease, Atrium Health Levine Children’s Hospital, Concord, NC, United States
| | - Erin M. Janssen
- Department of Rheumatology, Mott Children’s Hospital/University of Michigan, Ann Arbor, MI, United States
| | - Maleewan Kitcharoensakkul
- Departments of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Kyle P. McNerney
- Department of Pediatric Endocrinology, Washington University School of Medicine, St. Louis, MO, United States
| | - Thea L. Pfeifer
- Department of Pediatric Endocrinology, Atrium Health Levine Children’s Hospital, Concord, NC, United States
| | - Brooke I. Polk
- Departments of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Brynn E. Marks
- Department of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Lyngstadaas AV, Holm J, Krogvold L, Måløy AK, Ingvaldsen CA. A toddler with systemic contact dermatitis caused by diabetes devices. SKIN HEALTH AND DISEASE 2023; 3:e234. [PMID: 37538326 PMCID: PMC10395622 DOI: 10.1002/ski2.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 08/05/2023]
Abstract
Continuous glucose monitors (CGM) and insulin pumps have become the preferred treatment option for most young children and adolescents with type 1 diabetes (T1D), by avoiding fingerstick testing and providing real-time glucose measurements. These medical devices and their adhesives contain substances which have been identified as being responsible for allergic contact dermatitis. We describe the case of a toddler who developed severe contact dermatitis from her diabetes devices, leading to secondary infections and hospital admissions. This was followed by the development of a symmetrical exanthema with retroauricular and glutaeal distribution. Patch tests were positive for isobornyl acrylate (IBOA) and 4-tert-butylcatechol (PTBC). Her symmetrical exanthema was interpreted as systemic contact dermatitis due to IBOA and PTBC in her diabetes devices. We suspect that systemic contact dermatitis is an underreported complication in diabetic patients.
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Affiliation(s)
| | - Jan‐Øivind Holm
- Department of DermatologyRikshospitaletOslo University HospitalOsloNorway
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
| | - Lars Krogvold
- Division of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
| | - Anne Karin Måløy
- Division of Pediatric and Adolescent MedicineOslo University HospitalOsloNorway
| | - Christoffer Aam Ingvaldsen
- Department of DermatologyRikshospitaletOslo University HospitalOsloNorway
- Department of MicrobiologyAkershus University HospitalLørenskogNorway
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8
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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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10
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Ahmadian N, Manickavasagan A, Ali A. Comparative assessment of blood glucose monitoring techniques: a review. J Med Eng Technol 2023; 47:121-130. [PMID: 35895023 DOI: 10.1080/03091902.2022.2100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring blood glucose levels is a vital indicator of diabetes mellitus management. The mainstream techniques of glucometers are invasive, painful, expensive, intermittent, and time-consuming. The ever-increasing number of global diabetic patients urges the development of alternative non-invasive glucose monitoring techniques. Recent advances in electrochemical biosensors, biomaterials, wearable sensors, biomedical signal processing, and microfabrication technologies have led to significant research and ideas in elevating the patient's life quality. This review provides up-to-date information about the available technologies and compares the advantages and limitations of invasive and non-invasive monitoring techniques. The scope of measuring glucose concentration in other bio-fluids such as interstitial fluid (ISF), tears, saliva, and sweat are also discussed. The high accuracy level of invasive methods in measuring blood glucose concentrations gives them superiority over other methods due to lower average absolute error between the detected glucose concentration and reference values. Whereas minimally invasive, and non-invasive techniques have the advantages of continuous and pain-free monitoring. Various blood glucose monitoring techniques have been evaluated based on their correlation to blood, patient-friendly, time efficiency, cost efficiency, and accuracy. Finally, this review also compares the currently available glucose monitoring devices in the market.
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Affiliation(s)
- Nivad Ahmadian
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Annamalai Manickavasagan
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Amanat Ali
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
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11
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Alves VM, Borba JVB, Braga RC, Korn DR, Kleinstreuer N, Causey K, Tropsha A, Rua D, Muratov EN. PreS/MD: Predictor of Sensitization hazard for chemical substances released from Medical Devices. Toxicol Sci 2022; 189:250-259. [PMID: 35916740 PMCID: PMC9516038 DOI: 10.1093/toxsci/kfac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the United States, a pre-market regulatory submission for any medical device that comes into contact with either a patient or the clinical practitioner must include an adequate toxicity evaluation of chemical substances that can be released from the device during its intended use. These substances, also referred to as extractables and leachables, must be evaluated for their potential to induce sensitization/allergenicity, which traditionally has been done in animal assays such as the guinea pig maximization test (GPMT). However, advances in basic and applied science are continuously presenting opportunities to employ New Approach Methodologies (NAMs), including computational methods which, when qualified, could replace animal testing methods to support regulatory submissions. Herein, we developed a new computational tool for rapid and accurate prediction of the GPMT outcome that we have named PreS/MD (Predictor of Sensitization for Medical Devices). To enable model development, we (i) collected, curated, and integrated the largest publicly available dataset for GPMT results; (ii) succeeded in developing externally predictive (balanced accuracy of 70-74% as evaluated by both 5-fold external cross-validation and testing of novel compounds) Quantitative Structure-Activity Relationships (QSAR) models for GPMT using machine learning algorithms, including Deep Learning; and (iii) developed a publicly accessible web portal integrating PreS/MD models that can predict GPMT outcomes for any molecule of interest. We expect that PreS/MD will be used by both industry and regulatory scientists in medical device safety assessments and help replace, reduce, or refine the use of animals in toxicity testing. PreS/MD is freely available at https://presmd.mml.unc.edu/.
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Affiliation(s)
- Vinicius M Alves
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Joyce V B Borba
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
| | | | - Daniel R Korn
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Nicole Kleinstreuer
- National Toxicology Program, Interagency Center for the Evaluation of Alternative Toxicological Methods, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kevin Causey
- Predictive, LLC, Research Triangle Park, NC, USA
| | - Alexander Tropsha
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA.,Predictive, LLC, Research Triangle Park, NC, USA
| | - Diego Rua
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, 20993, USA
| | - Eugene N Muratov
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
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12
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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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13
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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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14
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15
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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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16
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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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17
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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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18
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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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19
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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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20
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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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21
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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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22
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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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23
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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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24
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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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25
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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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26
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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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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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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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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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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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Ulriksdotter J, Mowitz M, Svedman C, Bruze M. Patch testing and diagnosis when suspecting allergic contact dermatitis from medical devices. Contact Dermatitis 2020; 83:333-335. [DOI: 10.1111/cod.13650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
- Department of Dermatology Helsingborg Hospital Helsingborg Sweden
| | - Martin Mowitz
- 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
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology Lund University, Skåne University Hospital Malmö Sweden
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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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Malinauskiene L, Šlekyte G, Mowitz M, Isaksson M, Zablockis R. Allergic contact dermatitis caused by isobornyl acrylate in two patients treated for idiopathic pulmonary arterial hypertension. Contact Dermatitis 2020; 83:170-171. [DOI: 10.1111/cod.13617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Malinauskiene
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and AllergologyVilnius University Vilnius Lithuania
| | - Goda Šlekyte
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and AllergologyVilnius University Vilnius Lithuania
| | - Martin Mowitz
- Department of Occupational and Environmental DermatologySkåne University Hospital, Lund University Malmö Sweden
| | - Marléne Isaksson
- Department of Occupational and Environmental DermatologySkåne University Hospital, Lund University Malmö Sweden
| | - Rolandas Zablockis
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and AllergologyVilnius University Vilnius Lithuania
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Herman A, Montjoye L, Baeck M. Adverse cutaneous reaction to diabetic glucose sensors and insulin pumps: Irritant contact dermatitis or allergic contact dermatitis? Contact Dermatitis 2020; 83:25-30. [DOI: 10.1111/cod.13529] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | - Laurence Montjoye
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
| | - Marie Baeck
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
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Vidal‐Albareda C, Yelmo‐Valverde R, Solórzano‐Zepeda C, Rodríguez‐Muñoz N, de‐la‐Hoz‐Caballer B, González‐de‐Olano D. Prevalence of contact dermatitis to glucose sensors in pediatric population and the main allergens involved. Contact Dermatitis 2020; 83:47-49. [DOI: 10.1111/cod.13511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | | | - Belén de‐la‐Hoz‐Caballer
- Department of AllergologyRamón y Cajal University Hospital, IRYCIS Madrid Spain
- Spanish Thematic Network and Co‐operative Research Centres, ARADyAL Instituto de Salud Carlos III, Madrid Spain
| | - David González‐de‐Olano
- Department of AllergologyRamón y Cajal University Hospital, IRYCIS Madrid Spain
- Spanish Thematic Network and Co‐operative Research Centres, ARADyAL Instituto de Salud Carlos III, Madrid Spain
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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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38
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Herman A, Darrigade A, Montjoye L, Baeck M. Contact dermatitis caused by glucose sensors in diabetic children. Contact Dermatitis 2019; 82:105-111. [DOI: 10.1111/cod.13429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Herman
- Department of DermatologyCliniques Universitaires Saint‐Luc, Université Catholique de Louvain Brussels Belgium
| | - Anne‐Sophie Darrigade
- Department of DermatologyCliniques Universitaires Saint‐Luc, Université Catholique de Louvain Brussels Belgium
| | - Laurence Montjoye
- Department of DermatologyCliniques Universitaires Saint‐Luc, Université Catholique de Louvain Brussels Belgium
| | - Marie Baeck
- Department of DermatologyCliniques Universitaires Saint‐Luc, Université Catholique de Louvain Brussels Belgium
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