Formaldehyde-releasers: relationship to formaldehyde contact allergy. Contact allergy to formaldehyde and inventory of formaldehyde-releasers

This is one of series of review articles on formaldehyde and formaldehyde-releasers (others: formaldehyde in cosmetics, in clothes and in metalworking fluids and miscellaneous). Thirty-five chemicals were identified as being formaldehyde-releasers. Although a further seven are listed in the literature as formaldehyde-releasers, data are inadequate to consider them as such beyond doubt. Several (nomenclature) mistakes and outdated information are discussed. Formaldehyde and formaldehyde allergy are reviewed: applications, exposure scenarios, legislation, patch testing problems, frequency of sensitization, relevance of positive patch test reactions, clinical pattern of allergic contact dermatitis from formaldehyde, prognosis, threshold for elicitation of allergic contact dermatitis, analytical tests to determine formaldehyde in products and frequency of exposure to formaldehyde and releasers. The frequency of contact allergy to formaldehyde is consistently higher in the USA (8-9%) than in Europe (2-3%). Patch testing with formaldehyde is problematic; the currently used 1% solution may result in both false-positive and false-negative (up to 40%) reactions. Determining the relevance of patch test reactions is often challenging. What concentration of formaldehyde is safe for sensitive patients remains unknown. Levels of 200-300 p.p.m. free formaldehyde in cosmetic products have been shown to induce dermatitis from short-term use on normal skin

European Surveillance System on Contact Allergies (ESSCA): Characteristics of patients patch tested and diagnosed with irritant contact dermatitis

Background Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. Objectives To describe the characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; ) database. Methods Data collected by the ESSCA in consecutively patch-tested patients from January 2009 to December 2018 were analyzed. Results Of the 68 072 patients, 8702 were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry cooks, and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. Conclusions The hands were mainly involved in OICD also in the subgroup of patients with contact dermatitis, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult-to-treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered

Risk and safety requirements for diagnostic and therapeutic procedures in allergology : World Allergy Organization Statement

Peer reviewe

Patch Test Results with Metals and Meteorological Conditions

Background: Nickel, cobalt and chromium are some of the most common causes of type IV sensitizations and subsequent allergic contact dermatitis. Accurate diagnosis of contact sensitization to these metal salts is made possible through standardized patch testing; however, patch tests with metal allergens may be influenced by meteorological conditions at the time of testing. We aimed to investigate how patch test reactions to these metals relate to outdoor temperature and humidity at the time of testing. Methods: Clinical patch test results from 61,435 patients tested at Austrian and German dermatology departments participating in a contact sensitization surveillance network (www.ivdk. org) from 1993 through 2001 were evaluated with weather data measured near the testing location and at the time of testing. Test reactions and ambient temperature and humidity were examined with multinomial logistic regression models. Results: The odds of irritant and doubtful reactions to all 3 ionized metals increased during cold/arid conditions, and the odds of weak allergic (positive) reactions to nickel and cobalt also increased during cold/dry weather. Strong allergic reactions were essentially independent of weather conditions. Conclusions: The increase in irritant and doubt- ful reactions coinciding with decreasing temperature and humidity may be the result of an overall increase in skin irritation brought about by these ambient conditions. The observed increases in erythematous and infiltrated (‘weak allergic’) reactions may be due to doubtful reactions increasing in intensity and being (falsely) classified as positive during colder and drier conditions