Contact allergy to textile dyes in southern Sweden

Patch test results to extracts of synthetic garments in textile dye positive patients

BACKGROUND

Disperse dyes (DDs) are the most prevalent causes of textile-related allergic contact dermatitis and are used for coloring synthetic textile materials based on fibers such as polyester, acrylic, acetate and polyamide. Eight DDs are included in a textile dye mix (TDM) 6.6% petrolatum (pet.) in the European baseline patch test series.

OBJECTIVES

The aim of this study was to patch test TDM 6.6% pet. Positive individuals with the extracts of synthetic fiber clothes that do not contain any of the pure DDs present in the TDM 6.6% to study the reactivity pattern.

METHODS

Seventy-three TDM-positive former patients tested between 2012-2017 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were invited to join the study, 10 participated. Twenty-four textile items (collected in 9 countries in Europe, Asia and North America in 2012) were extracted in dichloromethane. The TDM 6.6% was patch tested simultaneously with the 24 textile item preparations in petrolatum made from the extracts. Prior to patch testing the participants filled the 7-question questionnaire regarding possible symptoms from textile exposure.

RESULTS

Ten individuals, agreed to join the study. Eight of them reacted to TDM 6.6%. Nine participants reacted to 20 of 24 extracts. One reacted to 19 extracts, another to 14, 3 to 5 extracts, 1 to 4, 1 to 3 extracts and 2 to 2 extracts. One was negative to all tested preparations including TDM 6.6%. The participants mainly reacted to 6 textile extracts. All controls tested negatively to tested extracts. Four individuals of the 10 TDM-allergic individuals previously had had problems after wearing clothes. Four out of the 10 participants had had atopic eczema in childhood. All women had dyed their hair with permanent hair dyes but none of the males.

CONCLUSION

TDM - positive patients react to textile extracts made from synthetic garments, even if they do not contain any of the pure DDs present in TDM 6.6%. More studies are needed to pin-point the culprit haptens in these extracts.

Environmental Causes of Dermatitis

Environmental, or exogenous, dermatitis is comprised of irritant and allergic contact dermatitis, which account for 80% and 20% of cases of contact dermatitis, respectively. Contact dermatitis is extremely common, and failure to diagnose this entity may result in overlooking a potentially curable driver of disease. In this review, we describe how clinical features, such as morphology or history, can assist in distinguishing exogenous from endogenous causes of dermatitis, and allergic from irritant contact dermatitis. Additionally, we provide an overview of common contact allergens and how dermatitis distribution can suggest possible culprit allergens. Patch testing is needed to confirm contact allergy.

Human health risks due to exposure to inorganic and organic chemicals from textiles: A review

It is well known that a number of substances used in the textile industry can mean not only environmental, but also health problems. The scientific literature regarding potential adverse health effects of chemical substances in that industry is mainly related with human exposure during textile production. However, information about exposure of consumers is much more limited. Although most research on the health effects of chemicals in textiles concern allergic skin reactions, contact allergy is not the only potential human health problem. In this paper, we have reviewed the current scientific information regarding human exposure to chemicals through skin-contact clothes. The review has been focused mainly on those chemicals whose probabilities of being detected in clothes were rather higher. Thus, we have revised the presence of flame retardants, trace elements, aromatic amines, quinoline, bisphenols, benzothiazoles/benzotriazoles, phthalates, formaldehyde, and also metal nanoparticles. Human dermal exposure to potentially toxic chemicals through skin-contact textiles/clothes shows a non-negligible presence in some textiles, which might lead to potential systemic risks. Under specific circumstances of exposure, the presence of some chemicals might mean non-assumable cancer risks for the consumers.

Evaluation of cytotoxicity and inflammatory activity of wastewater collected from a textile factory before and after treatment by coagulation-flocculation methods

Effective treatment of textile effluent prior to discharge is necessary in order to avert the associated adverse health impacts on human and aquatic life. In the present investigation, coagulation/flocculation processes were evaluated for the effectiveness of the individual treatment. Effectiveness of the treatment was evaluated based on the physicochemical characteristics. The quality of the pre-treated and post-flocculation treated effluent was further evaluated by determination of cytotoxicity and inflammatory activity using RAW264.7 cell cultures. Cytotoxicity was determined using WST-1 assay. Nitric oxide (NO) and interleukin 6 (IL-6) were used as biomarkers of inflammation. NO was determined in cell culture supernatant using the Griess reaction assay. The IL-6 secretion was determined using double antibody sandwich enzyme linked immunoassay (DAS ELISA). Cytotoxicity results show that raw effluent reduced the cell viability significantly (P < 0.001) compared to the negative control. All effluent samples treated by coagulation/flocculation processes at 1 in 100 dilutions had no cytotoxic effects on RAW264.7 cells. The results on inflammatory activities show that the raw effluent and effluent treated with 1.6 g/L of Fe-Mn oxide induced significantly (P < 0.001) higher NO production than the negative control. The inflammatory results further show that the raw effluent induced significantly (P < 0.001) higher production of IL-6 than the negative control. Among the coagulants/flocculants evaluated Al2(SO4)3.14H2O at a dosage of 1.6 g/L was the most effective to remove both toxic and inflammatory pollutants. In conclusion, the inflammatory responses in RAW264.7 cells can be used as sensitive biomarkers for monitoring the effectiveness of coagulation/flocculation processes used for textile effluent treatment.

Contact Dermatitis for the Practicing Allergist

This article provides an overview of important practice recommendations from the recently updated Contact Dermatitis Practice Parameter. This updated parameter provides essential recommendations pertaining to clinical history, physical examination, and patch testing evaluation of patients suspected of allergic contact dermatitis. In addition to providing guidance for performing and interpreting closed patch testing, the updated parameter provides concrete recommendations for assessing metal hypersensitivity in patients receiving prosthetic devices, for evaluating workers with occupational contact dermatitis, and also for addressing allergic contact dermatitis in children. Finally, the document provides practical recommendations useful for educating patients regarding avoidance of exposure to known contact sensitizers in the home and at work. The Contact Dermatitis Parameter is designed as a practical, evidence-based clinical tool to be used by allergists and dermatologists who routinely are called upon to evaluate patients with skin disorders.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Two sensitizing oxidation products of p-phenylenediamine patch tested in patients allergic to p-phenylenediamine

BACKGROUND

The results from a previous study indicated the presence of several possible sensitizers formed during oxidation of the potent sensitizer p-phenylenediamine (PPD) to which PPD-sensitized patients might react, in various patterns.

OBJECTIVES

To extract and analyse a yellow spot from a thin-layer chromatogram with oxidized PPD, to which 6 of 14 (43%) PPD-positive patients had reacted in a previous study, in order to identify potential sensitizer(s) and to patch test this/these substance(s) in the 14 PPD-positive patients.

METHODS

The yellow spot was extracted from a thin-layer chromatogram of oxidized PPD, and two substances, suspected to be allergens, were identified by analysis with gas chromatography mass spectrometry (GCMS). The 14 PPD-positive patients, who had been previously tested with the thin-layer chromatogram of oxidized PPD, participated in the investigation, and were tested with dilutions of the two substances.

RESULTS

GCMS analysis identified 4-nitroaniline and 4,4'-azodianiline in the yellow spot. Of the 14 PPD-positive test patients, 5 (36%) reacted to 4-nitroaniline and 9 (64%) reacted to 4,4'-azodianiline.

CONCLUSION

The results show that 4-nitroaniline and 4,4'-azodianiline, formed during oxidation of PPD, are potent sensitizers. PPD-sensitized patients react to a high extent to concentrations equimolar to PPD of 4-nitroaniline and 4,4'-azodianiline.

Human exposure to trace elements through the skin by direct contact with clothing: Risk assessment

Metals in textile products and clothing are used for many purposes, such as metal complex dyes, pigments, mordant, catalyst in synthetic fabrics manufacture, synergists of flame retardants, antimicrobials, or as water repellents and odour-preventive agents. When present in textile materials, heavy metals may mean a potential danger to human health. In the present study, the concentrations of a number of elements (Al, As, B, Ba, Be, Bi, Cd, Co, Cr, Cu, Fe, Hg, Mg, Mn, Mo, Ni, Pb, Sb, Sc, Se, Sm, Sn, Sr, Tl, V, and Zn) were determined in skin-contact clothes. Analysed clothes were made of different materials, colours, and brands. Interestingly, we found high levels of Cr in polyamide dark clothes (605 mg/kg), high Sb concentrations in polyester clothes (141 mg/kg), and great Cu levels in some green cotton fabrics (around 280 mg/kg). Dermal contact exposure and human health risks for adult males, adult females, and for <1-year-old children were assessed. Non-carcinogenic and carcinogenic risks were below safe (HQ<1) and acceptable (<10(-6)) limits, respectively, according to international standards. However, for Sb, non-carcinogenic risk was above 10% of the safety limit (HQ>0.1) for dermal contact with clothes.

Allergic contact dermatitis induced by textile necklace

Allergic contact dermatitis to textile dyes is considered to be a rare phenomenon. A recent review reported a prevalence of contact allergy to disperse dyes between 0.4 and 6.7%. The relevance of positive patch testing was not reported in all studies. Textile dye allergy is easily overlooked and is furthermore challenging to investigate as textile dyes are not labelled on clothing. In this report, we present a case of allergic contact dermatitis to a textile necklace. The patch test showed strong reactions to the necklace and the azo dyes Disperse Orange 1 and Disperse Yellow 3. Despite the European legislation and the reduced use of disperse dyes in Third World countries, disperse azo dyes still induce new cases of allergic contact dermatitis.

Allergic contact dermatitis in children: which factors are relevant? (review of the literature)

Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children.

Disperse Yellow Dye: An Emerging Professional Sensitizer in Contact Allergy Dermatitis

Disperse dyes are well known as common sensitizers in contact allergy dermatitis. Disperse yellow 3 is usually adopted in the textile industry for dying synthetic fibers, but is also used in hair dyes and for colouring plastic materials. We describe three cases of two males and one female patient, respectively a painter, an actor and a nursery-school teacher, who presented contact allergy dermatitis to disperse yellow 3 dye.

‘New’ contact allergens

PURPOSE OF REVIEW

Due to the continuously changing environmental conditions, it is necessary to regularly monitor and update the spectrum of contact allergens that elicit contact dermatitis. New contact allergens and known contact allergens with currently increasing importance need to be identified for diagnostic and preventive purposes.

RECENT FINDINGS

Within the last few years, allergic contact allergy to a number of substances derived from plants and other materials was reported for the first time. Furthermore, it has become obvious that dyes, especially paraphenylenediamine-related dyes, and fragrances are sources of contact allergens with increasing frequency. It is likely that within these groups of substances some as yet unidentified agents are relevant allergens.

SUMMARY

It is an ongoing challenge for clinicians to meticulously explore the exposure of eczema patients to possible new allergens. Dyes and fragrances, in particular, are of increasing significance not only because of their known ingredients but also because of new allergenic compounds.