Contact allergy to methyldibromoglutaronitrile and certain other preservatives

Vehicle effects on skin sensitizing potency of four chemicals: assessment using the local lymph node assay

The murine local lymph node assay (LLNA) can be used to determine the relative skin sensitizing potency of chemicals via interpolation of the quantitative dose response data generated. Using this approach we have demonstrated previously that the vehicle matrix in which a chemical allergen is encountered on the skin can have a significant influence on sensitizing potency. Estimates of relative potency are calculated from LLNA dose responses as a function of the mathematically derived EC3 value, this being the concentration estimated to induce a stimulation index (SI) of 3. To investigate further the influence of application vehicle on sensitizing potency, the LLNA has been used to examine the activity of four recognized human contact allergens: isoeugenol and cinnamic aldehyde, two fragrance chemicals; 3-dimethylaminopropylamine (a sensitizing impurity of cocamidopropyl betaine, a surfactant used in shower gel) and dibromodicyanobutane (the sensitizing component of Euxyl K 400, a preservative used in cosmetics). The four chemicals were applied in each of seven different vehicles (acetone: olive oil [4 : 1]; dimethylsulphoxide; methylethylketone; dimethyl formamide; propylene glycol; and both 50 : 50 and 90 : 10 mixtures of ethanol and water). It was found that the vehicle in which a chemical is presented to the epidermis can have a marked effect on sensitizing activity. EC3 values ranged from 0.9 to 4.9% for isoeugenol, from 0.5 to 1.7% for cinnamic aldehyde, from 1.7 to > 10% for dimethylaminopropylamine and from 0.4 to 6.4% for dibromodicyanobutane. These data confirm that the vehicle in which a chemical is encountered on the skin has an important influence on the relative skin sensitizing potency of chemicals and may have a significant impact on the acquisition of allergic contact dermatitis. The data also demonstrate the utility of the LLNA as a method for the prediction of these effects and thus for the development of more accurate risk assessments.

Contact sensitivity to preservatives in Turkey

This study was designed to evaluate the frequency of contact sensitivity to 14 common preservatives among patients with contact dermatitis in Turkey. From 2000 to 2004, 308 patients with the diagnosis of contact dermatitis were patch tested in the Department of Dermatology, Ankara University School of Medicine. All patients were patch tested with European standard series. In addition to the four preservatives included in the standard series, patients were also tested with DMDM hydantoin, imidazolidinyl urea, bromonitropropane diol, diazolidinyl urea, thimerosal, propylene glycol, chlorocresol, chloroxylenol, methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) and benzalkonium chloride. Out of the 308 patients suspected of having contact dermatitis, 23 patients were found to have positive reactions to one or more preservatives. Preservatives that were the most frequent cause of positive reactions were thimerosal (1.6%), benzalkonium chloride (1.6%), formaldehyde (1.3%) and MDBGN/PE (0.9%). In our study, 65% of the positive reactions were caused by allergens not present in the standard series, such as thimerosal, benzalkonium chloride and MDBGN/PE. Although thimerosal caused a high rate of contact sensitivity, it may not be considered as an important allergen, because clinical relevance could not be found in any of the patients.

Recommendation to include methyldibromo glutaronitrile in the European standard patch test series

The preservative methyldibromo glutaronitrilc (MDBGN) is used non-occupationally and occupationally. High contact allergy rates have been reported when tested in consecutive dermatitis patients as well as clinical cases with allergic contact dermatitis. Up till now there has been no agreement on which patch test preparation to use to trace contact allergy to MDBGN. From the year 2005 on, MDBGN at 0.5% w/w in petrolatum is recommended for the European standard patch test series. The choice of 0.5% is based on consideration of rates of contact allergy, doubtful and irritant reactions, as well as on information on clinical relevance represented by results of a repeated open application test, and patch test concentrations to diagnose allergic contact dermatitis from MDBGN in individual cases.

Face dermatitis from contaminants on a mask for anaesthesia

Allergic and irritant contact reactions to face masks for anaesthesia have rarely been reported. We present a 55-year-old female patient who developed facial allergic contact dermatitis after an operation requiring general anaesthesia. Patch tests showed positive reactions to cocospropylenediamin-guanidinium-diacetate (trivial name Dodigen 3558), a preservative used in disinfectants for medical instruments. It could be proven that residues of the causative allergen in the disinfectant adhered to the mask. This is the first report of a clinically relevant sensitization to this increasingly widely used agent.

Sensitizing potential in mice, guinea pig and man of the preservative Euxyl K 400 and its ingredient methyldibromo glutaronitrile

The allergenicity of the preservative Euxyl K 400 and its principal allergen methyldibromo glutaronitrile (MDBGN) (1,2-dibromo-2,4-dicyanobutane) was investigated using 3 animal models; in mice, the local lymph node assay (LLNA) and in guinea pigs, the guinea pig maximization test (GPMT) and the cumulative contact enhancement test (CCET) with a dose-response protocol included. Previous attempts to define the sensitization capacity of these chemicals have given conflicting results. For comparison, the frequency and causes of positive patch test reactions to Euxyl K 400 and MDBGN were studied in patients referred to an occupational dermatology clinic. This investigation showed that Euxyl K 400 and MDBGN can give rise to contact allergy in man and that the relevant cases found mainly had similar exposure as non-occupational cases. A contact allergenic potential could be detected for MDBGN in 2 animal models, i.e., the CCET and the LLNA, and also for Euxyl K 400 in the LLNA. However, statistical analysis of the results from the GPMT with MDBGN failed to detect the sensitizing potential of this particular allergen. The results indicate that to be able to detect the allergenic potential of Euxyl K 400 and MDBGN, a predictive test method with multiple topical applications at induction is required. It is therefore important that an investigator is aware of the possibility of using various predictive test models for investigation of potential contact allergens.

Patch testing with preservatives, antimicrobials and industrial biocides. Results from a multicentre study

Preservatives are biologically reactive substances, and their allergenic potential has been known for a long time. This study examined the role of different preservatives in a large number of patients with suspected allergic contact dermatitis. Patch test data and data from the patients' history were collected from the 24 departments participating in the Information Network of Departments of Dermatology from 1 January 1990 to 31 December 1994. Patch test data from 28,349 patients tested with preservatives of the standard series (SS), from 11,485 patients tested additionally with a preservative series (PS), and from 1787 patients tested with an industrial biocide tray (IB) were evaluated. Sensitization rates (standardized) of the SS preservatives were all > 1%, with thiomersal rating highest (5.3%), the parabens lowest (1.6%), and the remainder (chlormethylisothiazolinone/methylisothiazolinone, formaldehyde and methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE)) in the range of 2%. The most important allergens of the PS were, in women, alkylaminobenzoate (contained in milking fat) (2.5%), MDBGN/PE (2.2%), benzalkonium chloride (1.8%), chloracetamide (1.4%), diazolidinyl urea (1.3%), octylgallate (1.2%) and Bronopol (1.1%). In men rates differed only with regard to alkylaminobenzoate (0.9%). Patients tested with the IB series reacted most often to methylene-bis-thiocyanate (5%), but with a reaction index of -0.7, many reactions were most probably false positives. A further seven preservatives, mostly formaldehyde-releasers used in cutting fluids, gave sensitization rates of between 1% and 3%. Glutaraldehyde, not contained in the series but often tested additionally, showed a remarkable increase in sensitization during the study period. Health care personnel were frequently affected. Altogether, this study identified areas of concern within the different groups of preservatives. The overall impact of most of the preservatives on public health seems to be low, but for diagnostic reasons preservatives must be included in patch test series.