Textile contact dermatitis: how fabrics can induce dermatitis

Purpose of the review Textile dermatitis can sometimes be difficult to diagnose due to the fact that it is difficult to clinically suspect, and when allergic, patch test correctly and advice the patient as to what garments to avoid. Recent findings The textile fibres as such are rarely the causative agent. Allergic contact dermatitis due to textiles is primarily caused by substances that are used to give the material certain qualities or performances. The textile dye mix, now in the baseline series, has proven to be a useful tool in diagnosing allergic contact dermatitis but additional patch testing with own material is advocated. Future research will hopefully facilitate the diagnostic procedure. Summary This review is a short update on textile dermatitis, both irritant and allergic, the present recommendations regarding patch testing when suspecting contact allergy and the advice to give to those allergic that will hopefully help the clinician in daily work

Contact allergy to cosmetic allergens: a five-year study

Background. One fifth of cosmetics users experience adverse reactions and up to 10% of them are of allergic origin. The aim of this study is to analyze cosmetic allergy trends in 2014-2018. Materials and methods. Study included 1425 patients patch-tested with European baseline and 463 – with cosmetic series (Chemotechnique Diagnostics). The incidence of cosmetic allergy in five years increased from 36,84% in 2014 to 46,21% 2018; peaking in 2016 (57,61%). Female and atopic patients had higher rates of cosmetic allergy, with atopic patients being more prone to allergic reactions to emulsifiers, emollients, solvents, surfactants and conditioning agents, p<0,05. The most common cosmetic allergens in European baseline series were methylisothiazolinone (13,19%), its mix with methylchloroisothiazolinone (10,04%), formaldehyde (8,14%) and Balsam of Peru (6,95%). Other prevalent allergens from cosmetic series were Shellac (16,59%), thimerosal (7,51%) and oleamidopropyl dimethylamine (4,96%). Methylisothiazolinone was mostly causing hand skin lesions (p=0,025). Conslusions. Patients with suspected allergic contact dermatitis and patch tested positive to the European baseline series should undergo cosmetic series or personal products patch testing for more detailed investigation. It is essential to track the trends of cosmetic allergy and take precautions in order to maximize the safety of cosmetics users

Metals Are Important Contact Sensitizers: An Experience from Lithuania

Background. Metals are very frequent sensitizers causing contact allergy and allergic contact dermatitis worldwide; up-to-date data based on patch test results has proved useful for the identification of a problem. Objectives. In this retrospective study prevalence of contact allergy to metals (nickel, chromium, palladium, gold, cobalt, and titanium) in Lithuania is analysed. Patients/Methods. Clinical and patch test data of 546 patients patch tested in 2014–2016, in Vilnius University Hospital Santariskiu Klinikos, was analysed and compared with previously published data. Results. Almost third of tested patients (29.56%) were sensitized to nickel. Younger women were more often sensitized to nickel than older ones (36% versus 22.8%, p=0.0011). Women were significantly more often sensitized to nickel than men (33% versus 6.1%, p<0.0001). Younger patients were more often sensitized to cobalt (11.6% versus 5.7%, p=0.0183). Sensitization to cobalt was related to sensitization to nickel (p<0.0001). Face dermatitis and oral discomfort were related to gold allergy (28% versus 6.9% dermatitis of other parts, p<0.0001). Older patients were patch test positive to gold(I) sodium thiosulfate statistically significantly more often than younger ones (44.44% versus 21.21%, p=0.0281). Conclusions. Nickel, gold, cobalt, and chromium are leading metal sensitizers in Lithuania. Cobalt sensitization is often accompanied by sensitization to nickel. Sensitivity rate to palladium and nickel indicates possible cross-reactivity. No sensitization to titanium was found

Formaldehyde may be found in cosmetic products even when unlabelled

Concomitant contact allergy to formaldehyde and formaldehyde-releasers remains common among patients with allergic contact dermatitis. Concentration of free formaldehyde in cosmetic products within allowed limits have been shown to induce dermatitis from shortterm use on normal skin. The aim of this study was to investigate the formaldehyde content of cosmetic products made in Lithuania. 42 samples were analysed with the chromotropic acid (CA) method for semi-quantitative formaldehyde determination. These included 24 leave-on (e. g., creams, lotions) and 18 rinse-off (e. g., shampoos, soaps) products. Formaldehyde releasers were declared on the labels of 10 products. No formaldehyde releaser was declared on the label of the only face cream investigated, but levels of free formaldehyde with the CA method was > 40 mg/ml and when analysed with a high-performance liquid chromatographic method -532 ppm. According to the EU Cosmetic directive, if the concentration of formaldehyde is above 0.05% a cosmetic product must be labelled \"contains formaldehyde\". It could be difficult for patients allergic to formaldehyde to avoid contact with products containing it as its presence cannot be determined from the ingredient labelling with certainty. The CA method is a simple and reliable method for detecting formaldehyde presence in cosmetic products

Severe anaphylactic reaction to cisatracurium during anesthesia with cross-reactivity to atracurium

A case of a severe anaphylactic reaction during general anesthesia was reported. Despite the high suspicion for cefuroxime as a trigger of the anaphylactic reaction, cisatracurium emerged being the culprit drug. This case illustrates the importance of testing all drugs used during procedures/operations, trying to find a culprit of anaphylaxis

Skin testing with bendamustine: what concentration should be used?

We present a case of the patient, who developed hypersensitivity reaction during the treatment of chronic lymphocytic leukemia. Bendamustine was suspected as a culprit agent. The patient as well as 3 controls underwent skin testing with the concentrations of the bendamustine described in earlier studies. We doubted the testing recommendations as all the controls developed serious local reactions. The clinical meaning of the positive skin test reaction in the patient remained unclear and questioned the safeness of recommended testing concentrations as in certain situations wrong diagnosis could be made or even harm could be done. Future investigations are needed when allergy to bendamustine is suspected