Occupational methacrylate and acrylate allergy – cross‐reactions and possible screening allergens

Background. Acrylic resin monomers, especially acrylates and methacrylates, are important occupational allergens. Aims. To analyse patterns of concomitant patch test reactions to acrylic monomers in relation to exposure, and to suggest possible screening allergens. Patients/methods. We reviewed the patch test files for the years 1994–2009 at the Finnish Institute of Occupational Health for allergic reactions to acrylic monomers, and analysed the clinical records of sensitized patients. Results. In a group of 66 patients allergic to an acrylic monomer, the most commonly positive allergens were three methacrylates, namely ethyleneglycol dimethacrylate (EGDMA), 2‐hydroxyethyl methacrylate (2‐HEMA) and 2‐hydroxypropyl methacrylate (2‐HPMA), and an acrylate, namely diethyleneglycol diacrylate (DEGDA). The patterns of concomitant reactions imply that exposure to methacrylates may induce cross‐reactivity to acrylates, whereas exposure to acrylates usually does not lead to cross‐allergy to methacrylates. Screening for triethyleneglycol diacrylate (TREGDA) in the baseline series was found to be useful, as 3 of 8 patients with diagnosed occupational acrylate allergy might have been missed without the screening. Conclusions. A short screening series of four allergens, EGDMA, DEGDA, 2‐HPMA and pentaerythritol triacrylate (PETA), would have screened 93% of our 66 patients; each of the remaining 5 patients reacted to different acrylic monomer(s).     

Screening for acrylate/methacrylate allergy in the baseline series: our experience in Sweden and Singapore

Background: No studies to specifically determine the prevalence of contact allergy to acrylates/methacrylates in patch tested populations have been published. Objectives: To determine the prevalence of acrylate/methacrylate allergy in all patients tested to the baseline patch test series. Methods: Five acrylate/methacrylate allergens (2‐hydroxyethyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate, triethylene glycol diacrylate, and 2‐hydroxypropyl acrylate) were included in the baseline series for at least 2 years in Malmö and Singapore. Results: Thirty‐eight patients in total had reacted to acrylate/methacrylate allergens in the baseline series during the study period in both populations. In Malmö, there were 26 (1.4%) patients with positive patch tests to acrylate/methacrylate allergens, 14 of whom had relevant reactions. In Singapore, there were 12 (1.0%) patients with positive patch tests to acrylate/methacrylate allergens, but only 1 had relevant reactions. If we had not added acrylate/methacrylate allergens to the baseline series, we would not have patch tested 13/26 (50%) of the positive reactors in Malmö and 11/12 (92%) of the positive reactors in Singapore. The overall proportion of missed positive reactors would have been 24/38 (63%). Conclusions: The prevalence of acrylate/methacrylate allergy in our patch tested dermatitis populations is 1.4% in Malmö and 1.0% in Singapore.     

The rising trend in allergic contact dermatitis to acrylic nail products

Shellac is a newly available type of long‐wearing nail polish, which is becoming increasingly popular. We describe four cases of allergic contact dermatitis (ACD) to acrylates found in Shellac nail products, involving three beauticians and one consumer who purchased the product over the internet. Increasing use of these new acrylic nail products means that dermatologists need to be aware of the possibility of ACD occurring. Testing with hydroxyethyl methacrylate alone, which is included in the Australian Baseline Series, is adequate for screening for acrylate allergy.     

Sensitization to dimethyl fumarate with multiple concurrent patch test reactions

Background: Chairs and sofas imported from China to Europe were shown to contain dimethyl fumarate (DMF), a sensitizing, volatile chemical. Many of the sensitized patients also had positive patch test reactions to acrylates. Objectives: To analyse the occurrence and strength of DMF sensitization and the appearance of concomitant reactions. Methods: Patch testing with DMF in concentrations of 0.1–0.00001% was carried out in 37 patients. Diethyl fumarate (DEF), diethyl maleate (DEM), dimethyl maleate (DMM), ethyl acrylate (EA), methyl acrylate (MA), and methyl methacrylate (MMA) were also tested with a dilution series at equimolar concentrations. Results: The lowest concentration of DMF eliciting a reaction varied between 0.0001% and 0.1% and all but four patients reacted concurrently to DEF. DEM elicited positive patch test reactions in 21/37 patients and DMM reactions were seen in all 9 patients tested. EA elicited positive reactions in 13/37 patients and a positive MA reaction was seen in 7/37 patients, 2 of whom also reacted to MMA. Conclusions: The strength of the sensitization to DMF showed variation and concurrent reactions were common. Concurrent reactions to (meth)acrylates were seen in patients, who reacted to lower (0.001% or less) DMF concentration probably elicited by cross‐reactivity.     

Occupational allergic contact dermatitis caused by epoxy diacrylate in ultraviolet-light-cured paint, and bisphenol A in dental composite resin

Allergic contact dermatitis (ACD) caused by epoxy di(meth)acrylates or bisphenol A is rare. Here 2 such cases are reported. A dental assistant had allergic contact dermatitis (ACD) caused by bisphenol A contained in denial composite resin (DCR) products based on epoxy dimethacrylate. The contact allergy was verified by allergic patch lest reactions to bisphenol A and 2 DCRs. The OCRs giving allergic reactions were analyzed, and 0.014–0.015% of bisphenol A was detected. Occupational ACD caused by bisphenol A in dental composite resins has not been described before. The other patient was a male process worker in a paint factory. He was sensitized by an epoxy diacrylate, 2.2-bis[4-(2-hydroxy-3-acryloxypropoxy)pheny]-propane (BIS-GA), and other acrylate compounds contained in raw materials of ultraviolet-light-curable paint. The epoxy diacrylate gave an allergic patch test reaction down to 0.016% in pet. He also had an allergic patch lest reaction to several other acrylate compounds. 2-hydroxypropyl acrylate, 2-hydroxypropyl acrylate, 1,4-butanediol diacrylate, 1,6-hexanediol diacrylate, diethyleneglycol diacrylate, triethylene glycol diacrylate, and tripropylene glycol diacrylate, indicating cross and/or concomitant sensitization.     

Variation in allergen content over time of acrylates/methacrylates in patch test preparations

Background Acrylates/methacrylates are volatile substances. There might be a gradual decrease in acrylate/methacrylate allergen content over time in patch test preparations but this has not yet been documented. Objectives To determine the allergen content of acrylates/methacrylates in patch test preparations over time under different storage conditions. Methods Five acrylate/methacrylate allergens [2‐hydroxyethyl methacrylate (2‐HEMA), methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), triethylene glycol diacrylate (TREGDA) and 2‐hydroxypropyl acrylate (2‐HPA)] in syringes and IQ? chambers (Chemotechnique Diagnostics, Vellinge, Sweden) were analysed using gel permeation chromatography and high‐performance liquid chromatography to measure the allergen content over time in samples stored in the freezer, refrigerator and under room temperature. Results The concentration of allergens in syringes decreased with time. Those stored at room temperature had the fastest rate of decrease, followed by those in the refrigerator and freezer. In most cases, in syringes or IQ? chambers under all storage conditions, the MMA decreased most rapidly, followed by 2‐HPA, 2‐HEMA, EGDMA and TREGDA. The allergens in the IQ? chambers rapidly disappeared, with almost all samples reaching nondetectable levels by day 8. MMA was the first to reach a nondetectable level – at day 2. Conclusions Acrylate/methacrylate allergens are lost rapidly from IQ? chambers especially if stored at room temperature. Allergens in syringes remain above 80% of their initial concentrations for longer periods compared with IQ? chambers. In syringes and IQ? chambers there is a slower rate of decrease in concentration when the storage temperature is lower. Allergens should be stored refrigerated, replaced regularly, and freshly applied on to test patches on the day of use.     

Sensibilización a acrilatos por uñas artificiales acrílicas. Revisión de 15 casos

BackgroundAllergic contact dermatitis due to acrylates present in the workplace is a disease frequently reported among dentists, printers, and fiberglass workers. Recently, the number of cases of contact allergic dermatitis among beauticians specialized in sculpting artificial nails has increased.ObjectiveOur objective was to study the clinical characteristics and allergens implicated in allergic contact dermatitis due to acrylates in beauticians and users of sculpted nails.Material and methodsThis was an observational, retrospective study of patients diagnosed with allergic contact dermatitis due to acrylates used in sculpting artificial nails over the last 26 years in the Hospital General Universitario, Valencia, Spain.ResultsIn total, 15 patients were diagnosed: 14 beauticians and 1 client. Most cases were diagnosed in the past 2 years. All were women, their mean age was 32.2 years, and 26.7 % had a personal or family history of atopy. The sensitization time varied between 1 month and 15 years. The most frequently affected areas were the fleshy parts of the fingers and hands. Three patients —2 beauticians and 1 client— presented allergic asthma due to acrylates. All patients underwent patch testing with a standard battery of allergens and a battery of acrylates. The most frequent allergens were ethylene glycol dimethacrylate (13/15, 86.7%), hydroxyethyl methacrylate (13/15, 86.7%), triethylene glycol dimethacrylate (7/15, 46.7%), 2-hydroxypropyl methacrylate (5/15, 33.3%), and methyl methacrylate (5/15, 33.3%).ConclusionsAcrylate monomers used for sculpting artificial nails are important sensitizers for contact and occupational dermatitis. The most important consideration is primary and secondary prevention.     

10 years of patch testing with the (meth)acrylate series

Statistics on 10 years of patch testing with 30 (meth)acrylates were compiled. Altogether 275 patients were patch tested and 48 patients (17.5%) had an allergic reaction to at least 1 (meth)acrylate. The (meth)acrylates most often provoking an allergic patch test reaction were 2-hydroxyethyl acrylate (2-HEA; 12.1%), 2-hydroxypropyl methacrylate (2-HPMA; 12.0%) and 2-hydroxyethyl methacrylate (2-HEMA; 11.4%). No allergic reactions were caused by 2-ethylhexyl acrylate (2-EHA), 2,2-bis[4-(methacryloxy)phenyl]propane (BIS-MA), trimethylolpropane triacrylate (TMPTA), oligotriacrylate 480 (OTA 480), N,N-methylenebisacrylamide (MBAA), or ethyl cyanoacrylate (ECA). The frequency of allergic patch test reactions presented cannot be considered as a "ranking" list of the most sensitizing (meth)acrylate compounds. In order to be able to judge the sensitization capacity of various (meth)acrylate compounds in humans, it would be necessary to have detailed information on the exposure history of the patients studied, including the purity of the (meth)acrylate compounds. Currently, this is not possible because (meth)acrylate-containing products regularly contain undeclared (meth)acrylate compounds.     

Contact allergy to acrylates/methacrylates in the acrylate and nail acrylics series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens

In a recent study we showed that all our dental personnel/patients were detected with 2-hydroxyethyl methacrylate (2-HEMA) and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (bis-GMA). We studied 90 patients tested to the acrylate and nail acrylics series at our department over a 10 year period to see whether screening allergens could be found. Patch testing with an acrylate and nail acrylics series was performed. Among the 10 acrylate/methacrylate-allergic occupational dermatitis patients tested to the acrylate series, the most common allergens were triethyleneglycol diacrylate (TREGDA, 8), diethyleneglycol diacrylate (5), and 1,4-butanediol diacrylate (BUDA, 5). All 10 of these patients would have been picked up by a short screening series combining TREGDA, 2-hydroxypropyl methacrylate (2-HPMA), and BUDA or 1,6-hexanediol diacrylate (HDDA). Among the 14 acrylate/methacrylate-allergic nail patients, the most common allergens were ethylene glycol dimethacrylate (EGDMA, 11), 2-HEMA, (9), and triethyleneglycol dimethacrylate (9). Screening for 3 allergens i.e. 2-HEMA plus EGDMA plus TREGDA, would have detected all 14 nail patients. A short screening series combining 2-HEMA, EGDMA, TREGDA, 2-HPMA, bis-GMA, and BUDA or HDDA would have picked up all our past study patients (dental, industrial, and nail) with suspected allergy to acrylate/methacrylate allergens.     

P67Hand eczema, skin exposure and glove use in dental technicians

Objective:  Exposure to adhesives and glues is common in occupation. We here analyse the data of patients with suspected contact dermatitis (CD) from glues recorded within the Information Network of Departments of Dermatology (IVDK).
Methods:  Data recorded between 1996 and 2001 within the IVDK were searched for patients who underwent patch testing because of suspected contact dermatitis from glues.
Results:  Overall data of 829 patients were found, among them 336 with occupational skin disease. Allergic CD was diagnosed in 171/336 patients (50.9%), irritant CD in 24.7%. CD was mostly localized on the hands (72.6%), followed by the face (13.4%) and arms (3.9%). By far the most common cause of an allergic patch‐test reaction was epoxy resin (EP): 18.2%(age‐ and sex‐standardized proportion of sensitization) reacted to the standard EP based on diglycidylether of bisphenol A. reactive diluents and hardeners which elicited a positive patch‐test reaction in > 5% of the patients were phenyl glycidylether and 4,4'diamino diphenylmethane respectively. Cresyl glycidylether was positive in 4.9%. (Meth‐)acrylates which showed an allergic patch‐test reaction in >= 5% of the patients were 2‐hydroxypropyl methacrylate, hydroxyethyl acrylate, 2‐hydroxyethyl methacrylate, ethyleneglycol dimethacrylate, BIS GMA and triethyleneglycol dimethacrylate. Colophony was positive in 8.3% and p‐tert‐butylphenol formaldehyde resin in 4.1% of the patients respectively.
Conclusion:  In our collective allergic CD was nearly 2‐fold more frequent than irritant CD in patients with occupational CD from glues, epoxy resin components being the most important allergens.     

Active sensitization caused by 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethyleneglycol dimethacrylate and N,N-dimethylaminoethyl methacrylate

A 45-year-old orthodontist became sensitized during patch tests with (meth)acrylates. Retesting showed that the sensitizing acrylics were methacrylates, namely 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethylene glycol dimethacrylate and N,N -dimethylaminoethyl methacrylate. Acrylates are stronger sensitizers than methacrylates, but the present report indicates that also methacrylates may sensitize at the patch test concentrations used. Accordingly, it may be necessary to use lower (meth)acrylate concentrations for patch testing.     

Contact allergy to (meth)acrylates in the dental series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens

Contact allergy to dental allergens is a well‐studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2‐hydroxyethyl methacrylate (2‐HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2‐HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2‐HEMA. One dental patient reacted only to 2,2‐bis[4‐(2‐hydroxy‐3‐methacryloxypropoxy) phenyl]propane (bis‐GMA). From our data, screening for (meth)acrylate contact allergy with 2‐HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate‐allergic dental patients and 100% (18/18) of our (meth)acrylate‐allergic dental personnel. The addition of bis‐GMA in dental patients would increase the pick‐up rate to 100%.     

Methacrylate and acrylate allergy in dental personnel

BACKGROUND: Methacrylates are important allergens in dentistry. OBJECTIVE: The study aimed to analyse patch test reactivity to 36 acrylic monomers in dental personnel in relation to exposure. METHODS: We reviewed the test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions to acrylic monomers in dental personnel and analysed the clinical records of the sensitized patients. RESULTS: 32 patients had allergic reactions to acrylic monomers: 15 dental nurses, 9 dentists, and 8 dental technicians. The dentists and dental nurses were most commonly exposed to 2-hydroxyethyl methacrylate (2-HEMA), triethyleneglycol dimethacrylate (TREGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). 8 dentists and 12 dental nurses were allergic to 2-HEMA. The remaining dentist was positive to bis-GMA and other epoxy acrylates. The remaining 3 dental nurses reacted to diethyleneglycol diacrylate (DEGDA) or triethyleneglycol diacrylate (TREGDA), but not to monofunctional and multifunctional methacrylates. Our dental technicians were mainly exposed and sensitized to methyl methacrylate (MMA) and ethyleneglycol dimethacrylate (EGDMA). 1 technician reacted only to 2-HEMA, and another to ethyl methacrylate (EMA) and ethyl acrylate (EA). CONCLUSIONS: 2-HEMA was the most important allergen in dentists and dental nurses, and MMA and EGDMA in dental technicians. Reactions to bis-GMA, DEGDA, TREGDA, EMA and EA were relevant in some patients.     

Late patch test reaction to acrylates in a dental worker.

A dental technician developed eyelid and hand dermatitis. She had been previously patch-tested elsewhere with a sample of an acrylic material from a nail salon that reportedly was positive only after 1 month. Repeat testing with ethyl acrylate and methyl methacrylate gave no reaction at 48 or 96 hours, but became positive 5 weeks later. This very late reaction is probably a true allergic manifestation and not a case of active sensitization.     

Occupational contact dermatitis in 2 dental technicians

2 dental technicians, both with chronic hand eczema, reported worsening from the use of 2 products containing methyl methacrylate, employed in manufacturing acrylic prostheses. Patch tests in both patients gave positive reactions to methyl methacrylate, ethylene glycol dimethacrylate and products employed in manufacturing acrylic prostheses (2% and 5% pet.). On the basis of results subsequently obtained from patch tests carried out with pieces of glove interposed between the skin and the allergens (methyl methacrylate and products employed), we advised our patients still to use latex gloves during work. Follow-up after 1 year showed complete regression of the dermatitis in 1 case and considerable improvement in the other.     

Occupational allergic contact dermatitis due to acrylates in Lodz

Among 1619 patients suspected of occupational contacT dermatitis examined during the years 1990 1994, sensitivity to acrylates was diagnosed in 9 persons 14 dental technicians. 4 dentists. 1 textile printer). Ethyleoeglycol dimethacrylate (5 positive patch tests), methyl methacrylate (4). 2-hydroxyethyl methacrylate (4) and triethyleneglycol dimethacrylate (4) were the most common sensitizers, Comparison of patch test results in dental technicians and dentists indicated that dentists were sensitive to a greater number of (meth)acrylate (aerylate and methacrylate) allergens and also to certain other allergens (metals and rubber additives). Dental technicians were sensitive almost exclusively to methaerylates, while the textile printer only to acrylates.     

Cross-sensitization patterns in acrylate allergies

Five subjects developed allergic contact dermatitis to one or more acrylate components used in a commercial adhesive tape. Patch testing to acrylic monomers was performed to examine their cross-reaction patterns. Two subjects with broad cross-reactions to acrylates did not react to methyl methacrylate or the alkyl methacrylate that corresponded to the acrylate which induced the sensitization. Methyl methacrylate may not be adequate as a screen for many acrylates used commercially.     

Occupational allergic contact dermatitis from 2-hydroxyethyl methacrylate and ethylene glycol dimethacrylate in a modified acrylic structural adhesive

Acrylates have a broad area of application in various products including glues, sealants and adhesives. Whereas anaerobic acrylic sealants arc well-known sensitizers, acrylate glues that cure in air have only seldom been reported as allergens. Here a patient sensitized to such a glue, and developing hand dermatitis that spread to the lower arms, chest, neck and face, is presented. Her glue was analyzed by gas chroma tography/mass spectrometry (GC/MS) and contained 24,6% 2-hydroxyethyl methacrylate (2-HEMA) and 0.4% ethylene glyol dimethacrylate (EGDMA). These 2 acrylate compounds, as well as her glue, provoked an allergic patch test reaction. Also many other acrylate compounds, e.g., tetrahydrofurfuryl methacrylate, gave an allergic reaction indicating cross-allergy. The patient could not continue in her previous workplace because of severely-relapsing skin symptoms.     

High frequency of false-positive reactions in attempted patch testing with acrylate/methacrylate mixes

Background. Although acrylate/methacrylate allergy has been frequently reported, until now patch testing with this group of allergens has been unwieldy, requiring the application of large supplementary series in most centres. Objectives. To formulate and evaluate two mixes of acrylate/methacrylate allergens in three centres (Malmö, Singapore, and Leuven). Patients/materials/methods. All patients tested with the baseline series during the study period were also patch tested with the mixes. Mix 1 consisted of: triethyleneglycol diacrylate (TREGDA) 0.1% wt/wt, 2‐hydroxyethyl methacrylate (2‐HEMA) 1.0% wt/wt and ethyleneglycol dimethacrylate 1.0% wt/wt in petrolatum. Mix 2 consisted of: TREGDA 0.1% wt/wt and 2‐HEMA 2.0% wt/wt in pet. The separate components of the two mixes were also tested simultaneously. Results. There were 25 (5 males; 20 females) positive reactions to mix 1 with 16 in Malmö, 8 in Singapore, and 1 in Leuven. Positive reactions to mix 2 were seen only in Malmö, in 8 female patients. Thus, the positive reaction rate for mix 1 was 8.3% overall (Malmö 7.7%, Singapore 18.6%, and Leuven 2.1%), and that for mix 2 was 2.7% overall (Malmö 3.8%, Singapore 0%, and Leuven 0%). Of the 16 positive reactions to mix 1 in Malmö, only 4 were considered to be true allergic reactions, as the component allergen testing gave totally negative results in 12/16. For mix 2, only 3/8 positive reactions were considered to be true allergic reactions, as the component testing was negative in 5/8. Many doubtful (10–20%) and positive but non‐allergic reactions were recorded, leading to early termination of the study. Conclusions. Although this was an unsuccessful attempt to formulate an acrylate/methacrylate mix, our experience will be useful for those embarking on future attempts to do this.     

Allergic contact dermatitis from dental composite resins due to aromatic epoxy acrylates mid aliphatic acrylates

7 patients were occupationally sensitized to dental composite resin products (DCR): 6 dental nurses and 1 dentist. All had a positive patch test to their DCR. 2 independent types of allergy were seen; (a) aromatic epoxy acrylate, and/or (b) aliphatic acrylates. 4 out of 5 patients reacted to BIS-GMA, the most widely used aromatic epoxy acrylate in DCR, but not the dentist. She and 2 dental nurses were allergic to aliphatic acrylates, including triethylene glycol dimethacrylate (TREGDMA) and triethylene diglycol diacrylate (TREGDA). 4 patients were allergic to epoxy resin (ER) (containing mainly MW 340), possibly an impurity in some DCR. 2 patients were also allergic to methyl methacrylate (MMA): the dentist, had been exposed to MMA, but the nurse's exposure was uncertain. 1 patient was also allergic to rubber gloves, 2 to rubber chemicals but not their gloves, and 5 to disinfectants used. diagnosis was delayed as long as 13 years in spite of previous patch testing. Dermatologists need to use the patients' own DCR and the (meth)acrylate series for patch testing. No dental nurses could continue their occupation, but the dentist could occasionally handle DCR if wearing PVC gloves. Dental personnel need to know about the risks of DCR, and use no-touch techniques and protective gloves.