Results of routine patch testing of 542 patients in Saskatoon, Canada

Patch Testing to Paraphenylenediamine: The North American Contact Dermatitis Group Experience (1994-2018)

Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018). Demographics and dermatitis site(s) were compared between PPD-allergic and PPD-negative patients. PPD reactions were analyzed by reaction strength, clinical relevance, occupational relatedness, and source as well as coreactivity with structurally related compounds. Results: Of 54,917 patients tested to PPD, 3095 (5.6%) had an allergic patch test reaction. Compared with PPD-negative patients, PPD-allergic patients had significantly greater odds of age >40 years (odds ratio [OR] 1.55 [95% confidence interval; CI 1.43-1.69]) and female gender (OR 1.52 [95% CI 1.41-1.66]), but lower odds of being White (OR 0.66 [95% CI 0.60-0.71]). The most common primary anatomic sites of dermatitis were face (25.5%), hands (21.9%), and scattered/generalized pattern (15.5%). Over half (55.3%) of PPD reactions were ++ or +++ at the final reading and 60.9% were currently relevant. Common exposure sources included hair dye (73.5%) and clothing/shoes/apparel (3.9%). Occupationally related reactions occurred in 8.3%, most commonly in hairdressers/cosmetologists (72.8%). The most common coreactions were benzocaine (11.3%), N-isopropyl-N'-phenyl-p-phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). Conclusions: The 24-year percentage of allergic reactions to PPD was 5.6%. PPD allergy was associated with female gender and age >40 years. PPD allergic patients were less likely to be White. Allergic reactions were usually clinically relevant and hair dye was the most frequently identified source.

Epidemiological data on consumer allergy to p-phenylenediamine

Many women and men now dye their hair. p-Phenylenediamine (PPD) is a frequent and important component of permanent hair dye products; exposure to it may cause allergic contact sensitization, acute dermatitis, and severe facial oedema. To increase our understanding of PPD allergy, we reviewed published literature containing PPD patch test data from dermatitis patients and individuals in the general population. This was performed to estimate the median prevalence and the weighted average of PPD sensitization and thereby assess the burden of PPD-containing hair care products on health. Literature was examined using PubMed-MEDLINE, Biosis, and Science Citation Index. The median prevalence among dermatitis patients was 4.3% in Asia, 4% in Europe, and 6.2% in North America. A widespread increase in the prevalence of PPD sensitization was observed among Asian dermatitis patients. In Europe, a decrease in the 1970s was replaced by a plateau with steady, high prevalences ranging between 2% and 6%. The prevalence remained high in North America, although a decreasing tendency was observed. Contact allergy to PPD is an important health issue for both women and men. More stringent regulation and enforcement are required as public health measures to reduce the burden of disease that exposure to PPD has brought to populations.

Common contact sensitizers in Delhi

Seventy-five patients of both sexes with clinically suspected contact dermatitis were patch tested with the Indian Standard Series and indigenous antigens. The results were compared with the data from other centers. Most of these patients were young adults between 20 and 39 yrs old with the mean age of 36.63 +/- 5.6 yrs. Their occupational profiles included household workers (17.33%), masons (10.66%), farmers (6.66%), factory workers (4%), medical personnel (4%), lab workers (2.66%), and miscellaneous (17.33%). Itching and burning were two of the most common complaints, and chronic dermatitis was the predominant morphologic pattern of the lesions observed. Frequent sites involved included the hands (40.83%), airborne type (22.44%), hands and feet (12.24%), feet (12.24%), face (10.2%), and neck (2.04%). Patch test analysis of these patients revealed that, out of 75 subjects tested, 49 (65.3%) reacted to one or more allergens. Parthenium (20%) is the most common contact sensitizer followed by potassium dichromate (16%), xanthium (13.33%), nickel sulphate (12%), chrysanthemum (8%), mercaptobenzothiazole, and garlic (6.66% each). These findings are in broad conformity with those in other reports. We concluded that the Indian Standard Series of antigens with the addition of a few more (such as garlic, onion and chlorheximide of local relevance) is suitable for detecting the allergens responsible for the contact dermatitis prevailing in this region.

Colophony allergy: a review

Colophony is a complex mixture of over 100 compounds derived from pine trees. It has countless applications at home and at work and exposure to colophony and modified-colophony is universal. It is the oxidation products of unmodified and modified colophony and some of the new resin acids synthesized during modification that are the principle allergens in colophony. The neutral fraction may account for a small % of positive reactions. When screening for allergy using unmodified gum rosin, allergy to modified rosin will not be revealed. When patients react to both materials, it is probably due to unmodified colophony present in both, rather than a cross-reaction. Relevant positive reactions may be missed if only colophony 20% pet is relied upon as the screening material.

The prevalence of chromium allergy in the United States and its implications for setting soil cleanup: a cost-effectiveness case study

Hexavalent chromium [Cr(VI)] elicits allergic contact dermatitis (ACD) among previously sensitized individuals, and some regulatory agencies have suggested the need for Cr(VI) soil standards that are protective of this health end point. To assess the cost effectiveness of implementing ACD-based standards, it is necessary to understand the prevalence of Cr(VI) sensitivity in the general population. More than 30 published studies from 1950 to 1997 were reviewed to determine the prevalence of Cr(VI) sensitivity. No random survey of the general United States (U.S.) population has been performed to date, but the prevalence of Cr(VI) sensitization among North American clinical cohorts (e.g., patients of dermatological clinics) was reported to be 1% in 1996. The prevalence of Cr(VI) sensitivity among the general U.S. population is estimated to be 0.08%. This estimate was calculated by dividing the current U.S. clinical prevalence estimate (1%) by the ratio of Cr(VI) sensitization in clinical vs general populations in The Netherlands (12). A retrospective cost/benefit analysis for sites in Jersey City, New Jersey, suggests that remediation of soils to protect against elicitation of ACD in sensitized individuals is not a cost-effective use of public health resources.

Results of routine patch testing of 834 patients in Turin

834 consecutive patients (630 female), aged between 26 and 46 years, who were suspected of having allergic contact dermatitis were patch tested with the GIRDCA standard series during 1989-1990. The most frequent sensitizers observed included nickel sulphate, cobalt, Kathon CG, perfumes, potassium dichromate and balsam of Peru. We have evaluated the influence of individual factors such as sex, age and occupation on the patch test results, and the coexistence of 2 or more unrelated but statistically significant sensitivities.

Colophony (rosin) in newspapers may contribute to hand eczema

Two groups of patients were studied, one with known contact allergy to colophony and hand eczema, 'colophony patients', and the other consisted of patients who suspected that their eczema was caused by contact with paper, 'paper patients'. The 'colophony patients' were patch tested with samples of newsprint paper, while the 'paper patients' were tested with samples of their own paper. Extracts of the paper and paper were applied. Testing with paper caused no reactions. All 'colophony patients' showed strong reactions to the tested extracts of newsprint paper. None of the 'paper patients' reacted to the extracts of their own paper, except those patch-test positive to colophony or maleopimaric acid, the main component of one type of modified colophony in paper size and shown experimentally to be a potent sensitizer. Colophony in paper may contribute to hand eczema in sensitized patients and the use of cotton gloves when in contact with paper might alleviate the dermatitis.

Formaldehyde is a significant allergen in women with hand eczema

Among patients consecutively patch tested at St John's from 1984-1989, the prevalence rate of formaldehyde sensitivity was 2.2% for men and 3.7% for women. During these 6 years, 117 women were primarily sensitized by formaldehyde, of whom 61 (52%) had hand eczema. Exposure was occupational in 12% and domestic in 88%. Cleaning products were the main source of exposure in the domestic group. 20 women with hand eczema avoided formaldehyde and their hands healed in 2, greatly improved in 11 and were better in 7.

Patch testing in cases of eczema and dermatitis in Beijing, China

Of 124 patients with eczema and dermatitis patch tested by the European standard series of allergens in the period from April to October 1989, 59 cases showed sensitivity to 1 or more allergens. Potassium dichromate, nickel sulphate and cobalt chloride were the 3 major sensitizers, with a frequency of 17.9%, 13.8% and 10.6%, respectively. The office and factory workers showed a higher incidence of positive reactions than the student group. The environment of the office and the factory seems to be the potential source of exacerbating factors of eczematous skin disease.

The health hazards posed by chromium-contaminated soils in residential and industrial areas: conclusions of an expert panel

Between 1905 and 1971, over 2 million tons of residue from chromite ore processing was generated in Hudson County, New Jersey, of which substantial amounts were used as fill and tank diking. A panel of medical, toxicology, and risk assessment experts was convened in early 1990 to evaluate the potential health hazards posed by the resulting chromium contaminated soil. The Panel concluded that soils containing concentrations of 75 ppm hexavalent chromium [Cr(VI)] and 1000 ppm total chromium compounds (about 95% was trivalent chromium [Cr(III)]) did not pose a significant health hazard to nearby residents and workers. They also determined that exposure to chromium from Hudson County sites posed a negligible cancer hazard to residents. Using risk assessment methods, the Panel estimated that the plausible incremental cancer risk to individuals at residential sites would be substantially less than 1 in 1,000,000. The average measured levels of airborne Cr(VI) at typical industrial sites were more than 1000-fold lower than the current OSHA Permissible Exposure Limit (PEL). The maximum plausible increased cancer risk for an average worker at a dusty industrial site was estimated to be less than 1 in 100,000. The Panel also concluded that chromium-containing crystals, which have occasionally been found in Hudson County buildings, do not pose a significant hazard. However, they suggested that were the concentration to exceed 5000 ppm Cr(VI) in the crystals, site-specific health risk assessments would be conducted and remediation considered. The Panel evaluated the dermal hazard posed by chromium-contaminated soil and acknowledged that there is a small group of persons (approximately 0.1% of the United States population) who currently have a dermal sensitization to Cr(VI) primarily through occupational exposure. Based on published studies of human volunteers, the Panel concluded that a small percentage (less than 5%) of persons already sensitized may respond to Cr(VI) in solution at concentrations above 35 ppm. They decided that a much higher concentration in soil, perhaps 350 ppm Cr(VI), would be necessary to elicit dermatitis because only a fraction of the chromium in soil is soluble. The Panel concluded that it was highly unlikely (if not impossible) for a person to become dermally sensitized to Cr(VI) or Cr(III) at the soil concentrations found in most areas in Hudson County.(ABSTRACT TRUNCATED AT 400 WORDS)

The prognosis of contact dermatitis

This article reviews the prognosis of contact dermatitis, particularly of occupational contact dermatitis. Most studies document a poor prognosis for occupational and nonoccupational contact dermatitis. The prognoses of occupational and nonoccupational contact dermatitis, irritant contact dermatitis, and allergic contact dermatitis are similar. Only a minority of studies on the prognosis of occupational contact dermatitis have found that a job change by the affected worker leads to clearing of the dermatitis. Dermatologic and nondermatologic factors associated with a poor prognosis are discussed.