Chemical investigations of disperse dyes in patch test preparations

Background:  Contact allergy to textile dyes is not uncommon. The allergy is detected by patch testing patients with commercial patch test preparations.
Objective:  To investigate 8 disperse dyes (DDs) used for patch testing in the departments in Malmö and in Leuven and to compare them with test preparations used at various dermatology departments.
Materials/Methods:  The investigated DDs were Disperse Blue (DB) 35, 106, and 124, Disperse Yellow (DY) 3, Disperse Orange (DO) 1 and 3, and Disperse Red (DR) 1 and 17. From 13 clinics, 107 petrolatum preparations were analysed using high-performance liquid chromatography and thin-layer chromatography (TLC), and compared with reference substances obtained at the Malmö laboratory. Concerning DB 35, no reference substance could be identified.
Results:  TLC visualized impurities in all DDs. For each DD, except DB 35, the mean concentration in the preparations labelled to contain 1.0% (w/w) were DB 106: 0.30%, DB 124: 0.25%, DY 3: 0.44%, DO 1: 0.40%, DO 3: 0.68%, DR 1: 0.49%, and DR 17: 0.35%; there were variations between the samples also with regard to the number of impurities. DO 3 could not be demonstrated in 4/15 preparations labelled DO 3.
Conclusion:  The results may have implications for individual diagnosis and prevention and when comparing test results from various centres.     

Cross-sensitizations between azo dyes and para-amino compound

Combined sensitizations to different azo dyes, probably based both on true cross-sensitization and on simultaneous positive reactions, have frequently been described. However, since azo dyes are included in the standard series in a minority of countries, the case studies considered comprise, with few exceptions, a small number of subjects. The aim of our study was to investigate cross-reactions between different azo dyes and para-amino compounds in azo-dye-sensitive subjects, to study the clinical aspects of azo dye dermatitis, to assess the relevance of sensitization to azo dyes, and to relate the pattern of cross-sensitizations to the chemical structure of the different dyes. Out of 6203 consecutively tested patients, 236 were sensitized to at least 1 of 6 azo compounds employed as textile dyes, included in our standard series. 107 subjects reacted to Disperse Orange 3 (DO3), 104 to Disperse Blue 124 (DB124), 76 to p -aminoazobenzene (PAB), 67 to Disperse Red 1 (DR1), 42 to Disperse Yellow 3 (DY3), and 31 to p -dimethylaminoazobenzene (PDAAB). Co-sensitizations to para-phenylenediamine were present in most subjects sensitized to DO3 (66%) and PAAB (75%), in 27% and 36% of DR1 and DY3-sensitive subjects, and only in 16% of subjects sensitized to DB124. Apart from the hands and the face, the neck and the axillae were the most frequently involved skin sites. Whereas the involvement of flexural areas was mainly connected with sensitization to DB124, in patients with hand dermatitis and in those working as hairdressers, sensitization to DO3 and PAAB was more frequent. Moreover, in the former patient group, a history of textile dye allergy was most frequently obtained. Out of 33 patients tested with an additional textile dye series, only 5 subjects reacted to anthraquinone dyes. Cross-sensitizations between azo dyes and para-amino compounds can partially be explained on the basis of structural affinities.     

Chronic generalized eczema caused by multiple dye sensitization

Textile dye sensitization is rare; its low incidence (1.4% to 5.8%) is most likely because dye contact allergy is not suspected and therefore not tested. The greatest number of positive test results are obtained for disperse dyes. We report an uncommon observation of severe and chronic textile dye dermatitis with positive patch test results to Disperse Blue 106, Disperse Blue 124, Disperse Brown 1, Disperse Yellow 3, and p-aminophenol. p-aminophenol, Disperse Blue 124, and Disperse Blue 106 are derived from p-phenylenediamine, but this allergen seems to be unreliable as a detector of textile dye allergy. The admittedly allergic capacity of disperse dyes and the increasing fabrication of synthetic fibers (acrylics and polyesters) usually colored with this group of dyes could induce more frequent textile sensitization.     

Contact sensitization to textile dyes: description of 100 subjects

We have described 100 subjects sensitized to textile dyes. Of these, 16 had clinically been suspected of having a textile dermatitis from among 1145 patients referred for patch testing. 41 patients were identified from among 861 consecutive subjects tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series supplemented with 4 disperse dyes (Disperse Blue 124, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3). The remaining 43 patients were identified from among 746 subjects tested with the GIRDCA standard series, supplemented with the 4 disperse dyes mentioned above and a further series of 12 other textile dyes. The clinical picture was extremely variable: most patients had a typical eczematous dermatitis, but we also observed persistent erythematous-wheal-type reactions, a transient urticarial dermatitis and an erythema-multiforme-like eruption. Among these textile dyes, Disperse Blue 124 caused most reactions. With the addition of the 4 disperse dyes to the GIRDCA standard series, we identified 4.8% sensitized to textile dyes, a much higher figure than the 1.4% observed among patients being patch tested on the basis of their history and the clinical findings; the addition of a further 12 textile dyes to the series further increased the detection rate to 5.8%. We stress the importance of routinely patch testing with textile dyes, which can help to elucidate the cause of certain kinds of atypical dermatitis.     

Contact allergy from disperse dyes in textiles–a review

Several disperse dyes (DDs) are still considered to be the most important allergens in textile dermatitis, but there are sparse data about their current use in textiles. The aim of this review was to evaluate published studies and reports on contact allergy to DDs published in PubMed during the last 22 years (1990–2012). Prevalence data are provided by study and by dye, as well as by the described clinical peculiarities of DD dermatitis. We reviewed 54 studies. In total, 26 DDs were tested. The average prevalence in screening studies was >1% for Disperse Blue 106, Disperse Blue 124, and Disperse Orange 3. There is a lack of data on patch testing with Disperse Blue 26, Disperse Blue 102, Disperse Orange 37, Disperse Orange 149, Disperse Yellow 23 and Disperse Yellow 49, which are listed as allergens by the EU Commission. It is necessary to check the purity and identity of dyes used for patch testing, confirm the clinical relevance of positive reactions by patch testing with suspected textiles, and, if the results are positive, determine the culprit dye.     

Are allergenic disperse dyes used for dyeing textiles?

Background. There are no data showing that disperse dyes, used to patch test patients, are currently being used for dyeing synthetic garments. It is unknown whether disperse dyes, which are currently routinely patch tested, are in fact present in synthetic textiles on the market. Objectives. To determine whether eight disperse dyes, hitherto most widely cited as allergenic, are still used in textiles that are sold in various countries. Methods. Textiles from 13 countries in Europe, Asia and the United States were analysed. The procedure used for dye identification was thin-layer chromatography. When there were matching spots from the textile extract and reference dye, high-performance liquid chromatography was performed. Results. Of 121 analysed items, three showed positive results for some of the investigated disperse dyes. Four dyes in these items could be detected and confirmed by the use of high-performance liquid chromatography. A pair of light brown ladies' tights manufactured and purchased in Italy contained Disperse Yellow 3, Disperse Blue 124, and Disperse Blue 106, and a set of black bra and panties purchased in India contained Disperse Orange 1. Conclusions. The eight disperse dyes that are most frequently incriminated in textile dye dermatitis are very rarely used in textiles nowadays.     

Contact sensitization to disperse dyes in children

From January 1996 to December 2000, 1098 children, including 667 subjects with suspected allergic contact dermatitis and 431 patients with atopic dermatitis (AD), were patch tested with seven disperse dyes: disperse blue 124 (DB124), disperse blue 106 (DB106), disperse red 1 (DR1), disperse yellow 3 (DY3), disperse orange 3 (DO3), p-aminoazobenzene (PAAB), and p-dimethylaminoazobenzene (PDAAB). Of these, 51 patients (4.6%; 34 girls and 17 boys) proved sensitized to disperse dyes. AD or history of AD was present in 30 patients (59%). The most common sensitizer was DY3 (17 patients), followed by DO3 (15 patients), and DB124 (14 patients). Among dye-positive patients, about 12% were sensitized to disperse dyes alone and only 14% reacted to para-phenylenediamine. In disperse dye-sensitive children not affected by AD, the feet, axillae, and groin appeared to be the most common localizations, whereas in those with AD, involvement of the face and the flexural areas of the limbs was more common. In conclusion, our study showed that in children with suspected contact sensitization, disperse dyes should be regarded as potential triggering allergens.     

Occupational contact dermatitis to textile dyes in airline personnel.

BACKGROUND: Reports of textile dye allergic contact dermatitis are becoming frequent in the literature. Occupational exposure to textile dyes has been reported, but less frequently. OBJECTIVE: To report 2 cases of allergic contact dermatitis to Disperse Blue dyes 106 and 124 occurring in airline personnel. METHODS: The patients were patch tested to the European or North American standard series, a textile dye series, and 1 patient was tested with pieces of textile from an airplane seat. RESULTS: Patch testing elicited in both patients a 2+ reaction to Disperse Blue dyes 106 and 124, and a 1+ reaction to paraphenylenediamine in one patient. CONCLUSION: We describe 2 cases of occupational textile dye allergy occurring in airline personnel. Both cases showed the utility of Disperse Blue dyes 106 and 124 to serve as the screening allergens for textile dermatitis. Mandatory uniforms might be an occupational hazard in certain professions.     

High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para-phenylenediamine

Cross-sensitization between para-phenylenediamine (PPD) and Disperse Orange 3 (DO3), among other textile dyes, has frequently been reported. We evaluated the frequency of simultaneous patch test reactions to PPD and a range of textile dyes. Retrospectively, we studied 128 patients who were patch test positive to PPD and who had also been tested to textile dyes. The dyes that most commonly also reacted were DO3 (46.1%) followed by Disperse Yellow 3 (21.9%). 80% of 55 patients who had a + + or stronger reaction to PPD also reacted to DO3. Dyes that were least likely also to react were Bismarck Brown (0%), Naphthol AS (1.06%), Disperse Yellow 9 (1.06%), Disperse Blue 3 (1.56%) and Disperse Red 11 (2.13%). We interpreted the simultaneous patch test reactions to PPD and DO3 as due either to cross-sensitivity proper, or to metabolic conversion of textile dyes in the skin to PPD.     

Patch testing of patients allergic to Disperse Blue 106 and Disperse Blue 124 with thin-layer chromatograms and purified dyes

Background:  Former investigations have demonstrated that patch test preparations containing Disperse Blue (DB) 106 and DB 124 are impure.
Objective:  To investigate the significance of impurities in preparations of disperse dyes with regard to contact allergy.
Materials/methods:  21 patients allergic to DB 106 and/or DB 124 were tested with dilution series of commercial and purified DB 106 and DB 124. All patients were additionally tested with thin-layer chromatography (TLC) strips made from the commercial preparations containing DB 106 and 18 of them also with TLC strips containing DB 124.
Results:  13 of 21 and 12/18 patients tested positively to the strips of DB 106 and DB 124, respectively. Among these patients, 4/13 and 5/12, respectively, did not react to the main spot but reacted to other spots. Dilution series of purified DB 106 and DB 124 were positive in 10 patients each, while 16 and 15 patients, respectively, tested positively to the dilution series of the corresponding commercial disperse dye.
Conclusion:  Approximately 25% of the patients, diagnosed as contact allergic to DB 106 and DB 124, only reacted to impurities in the patch test preparations. This has implications for diagnosis and prevention.     

Contact allergy to textile dyes in southern Sweden

Contact allergy to disperse dyes in textiles is documented in prevalence studies from southern Europe. To evaluate the prevalence of allergic patch test reactions to different textile dyes in southern Sweden, and to look at the sites of dermatitis in individuals hypersensitive to textile dyes, we retrospectively investigated 3325 consecutively patch-tested patients. They had all been patch tested with the standard test series supplemented with a textile dye mix (TDM) consisting of 8 disperse dyes, i.e. Disperse (D) Blue 35, 106 and 124, D Yellow 3, D Orange 1 and 3 and D Red 1 and 17. All but 3 of the TDM-positive patients were additionally tested with the separate dyes included in the mix. The frequency of contact allergy to TDM was 1.5%, which is comparable with studies from southern Europe. The most common dye allergen was D Orange 1. The high prevalence of allergic reactions to D Orange 1 was unexpected, whereas test reactions to D Blue 106 and 124 were lower than expected from other studies. Compared to all tested patients, the TDM-positive patients more often had dermatitis on their arms, face, neck and axillary folds, and women also had a higher frequency of hand dermatitis.     

Multiple azo disperse dye sensitization mainly due to group sensitizations to azo dyes

A female patient, with a previous episode of contact dermatitis caused by a blue dress developed similar dermatitis due to a navy -blue dress. Patch tests revealed multiple allergic positive reactions to paraphenylenediamine (PPD). The navy-blue dress, its extracts, 6 azo disperse dyes in a textile series, as well as 3 dye components, including Disperse (DP) Red 153, which were present in the dress: these were composed of 9 azo disperse dyes, all dyes being of a different chemical structure. On the basis of chemical similarities between these 16 azo dyes including PPD, these are classified into the following 4 groups: thiazol-azoyl-PPD group (including DP Blue 106. DP Blue 12-1 and 5 used dyes), aminoazobenzene group (DP Red 1. DP Red 17. DP Brown 1 and 2 used dyes). PPD group (PPD and DP Orange 3) and benzothiazol-azoyl-PPD group (2 dyes in DP Red 153). With few exceptions, cross-sensitizations between dyes in the same group have been reported by other authors, or are suggested by us, in the former 3 groups. Multiple azo disperse dye sensitization is therefore considered lo be attributable mainly to group sensitizations to azo dyes.)     

Contact allergy to Disperse Blue 106 and Blue 124 in black "velvet" clothes

9 cases of allergic contact dermatitis due to black "velvet" fabrics, mostly leggings, are reported. In all cases, the 2 disperse dyes Blue 106 and 124 were shown to be the responsible contact sensitizers. Preparation of a chloroform extract and separation of the different disperse dyes by analytical and preparative thin-layer chromatography showed that 8 of the 9 black "velvet" clothes contained the same composition, namely Disperse Blue 1, 106, and 124, Disperse Red 1 and Disperse Yellow 3. In experimental studies performed previously. Disperse Blue 124 has been demonstrated to be a moderate sensitizer while Disperse Blue 106 proved to be the strongest found so far among the azo disperse dyes.     

Patch testing with a textile dye mix in a baseline series in two countries

Disperse dyes are the most common contact sensitizers among textile dyes. The main aim of this study was to investigate the outcome of patch testing with a textile dye mix 6.6%. A total of 2,049 patients from Sweden and 497 from Belgium were tested with the mix, consisting of Disperse (D) Blue 35, D Yellow 3, D Orange 1 and 3, D Red 1 and 17, 1.0% each, and D Blue 106 and D Blue 124, 0.3% each. Of the total number, 65 patients, 2.6%, tested positively to the mix, 4.2% of the Belgian patients and 2.1% of the Swedish patients. Patch testing with the mix 6.6% revealed significantly more patients with contact allergy compared with testing with a previous mix 3.2% (p < 0.01). Contact allergy to the mix was significantly more common in the Belgian than in the Swedish patients.     

Textile dermatitis in Israel: a retrospective study.

BACKGROUND:The diagnosis of contact dermatitis caused by clothing may be difficult because of its clinical polymorphism. Data in the literature suggest that textile dermatitis is more common than previously thought. OBJECTIVE: Our purpose was to study our patients suspected of having textile contact dermatitis from 1991 to 1997. METHODS: The records of the patients with positive reactions to allergens from the Textile Colors and Finish series in 3 contact dermatitis clinics were reviewed. All the patients were clinically evaluated and patch tested with the European Standard series and the Textile Colors and Finish series (Chemotechnique Diagnostics, Malm?, Sweden). RESULTS: Twenty-two of the 55 patients (40%) had positive patch tests to the textile dye allergens. Four of them had occupationally related textile dermatitis. The most frequent allergens were Disperse Blue 124, Disperse Blue 85, Disperse Red 17, and Disperse Blue 106. Erythematosquamous lesions were the most common forms of textile dermatitis (56%), followed by pustular lesion (16%) and hyperpigmented patches (8%). CONCLUSIONS: The relatively high percentage of positive results (40%) was attributable to the selected cohort of patients. In our series, positive reactions to the allergens Disperse Blue 124, 85, and 106 were common findings. Clinically, pustular allergic contact dermatitis, triggered by textile dyes was observed along with the more frequent erythematosquamous clinical form.     

Contact allergy to Disperse Blue 106 and Disperse Blue 124 in German and Austrian patients, 1995 to 1999

Between 1995 and 1999, 1986 patients were tested in the 31 participating centres of the Information Network of Departments of Dermatology (IVDK), all of them members of the German Contact Dermatitis Research Group, with a textile dyes series containing Disperse Blue (DB) 106 and 124, and since 1997 also with a mix of both. 86 patients (4.3%) reacted positively to DB 106 and/or DB 124; with good concordance between the 2 allergens (Cohen's weighted kappa 0.72), and the single allergens and the mix (kappa=0.75 in both cases), which had been tested in parallel in 969 and 975 patients, respectively. In contrast, concordance between DB 106/124 and p-phenylenediamine and p-aminoazobenzene, respectively, was poor. Some 70% of positive reactions to DB 106/124 had current clinical relevance. Furthermore, a significant increase in the proportion of DB 106/124-positive patients among those tested was found from 1995 to 1999. Hence, DB 106/124 are important allergens deserving close monitoring. The use of a mix of DB 106 and DB 124 seems justified in view of the close chemical similarity of both compounds. If possible, the presence of the allergen(s) in individual textiles considered causative should be checked by thin layer or column chromatography.     

Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition.

BACKGROUND:Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis. OBJECTIVES: To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to diperse blue dyes in these patients. METHODS: We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%). RESULTS: Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments. CONCLUSIONS: Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.     

P01Contact dermatitis from textile colours in three Spanish towns

Objective:  Prevalence of textile dye contact dermatitis (TD‐CD) are lacking in many countries. Our aim is to know the frequency of TD‐CD in three different areas of Spain.
Methods:  100 patients were tested with Spanish standard series and the five most frequent TD in each city. D. Orange 1, D. Orange 3, D. Blue 35, D. Blue 106, D. Blue 124 were included in Murcia and Seville, and the three last and D. Red 1, D. Red 17 in Santiago.
Results:  23/300 (15 women and 8 men) were positives to one or more TD. D. Blue 124 was the most frequent allergen (18/300), followed by D. Blue 106 (17/300). D. Red 1, D. Red 17 and D. Orange 1 were positives in 2/200. D. Orange 3 and D. Blue 35 were positives in 1/200. Eczema was located on hands in 13 cases. Clinical picture was variable. Origin of sensitization was clothing and occupational. Relevance was obtained in 20/23 cases.
Conclusions:  The study confirm an high frequency of disperse dye allergy in Spain with a very different prevalence in the three areas: Seville 14%, Murcia 5% and Santiago 4%, that are probably due to social and cultural factors. We recommend the inclusion of D. Blue 106, D. Blue 124, D. Blue 35, D. Red 1, D. Red 17, D. Orange 1 and D. Orange 3 in standard series in order to detect sensitivity to textile colours that is most frequent than previously suspected.     

Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study

BACKGROUND: The exact incidence of textile dermatitis is unknown because of the lack of controlled epidemiological studies. Nevertheless, the increasing frequency of contact dermatitis to clothing has been demonstrated, thus indicating the importance of further investigations in this field. OBJECTIVE: To analyse the results from a 4-year prospective study of the clinical and aetiological features of contact dermatitis to textiles in Israel. We also aimed to assess the frequency and relevance of sensitization to textile dyes and resins in these patients. METHODS: Six hundred and forty-four patients (441 female and 203 male), referred for the investigation of contact dermatitis, and suspected of having textile allergic contact dermatitis (ACD), were studied. All patients were patch tested with the standard series (TRUE Tests), textile colour and finish series (TCFS) clothing extracts and pieces of garment in some cases. Readings were performed on days 2, 3 and in many patients also on day 7. RESULTS: Eighty-three patients (12.9%) had an allergic reactions to a dye and/or resin allergen. Of them, 43 (51.8%) had positive patch tests to the textile dye allergens, 28 (33.7%) to the formaldehyde and textile finish resins and 12 (14.4%) to allergens from both groups. The highest incidence of sensitization from the dye group allergens was due to Disperse Blue (DB) 124 (30.6%), DB 106 (27.0%) and DB 85 (8.1%) and from the resin group to melamine formaldehyde and ethyleneurea melamine formaldehyde (20.7% each) and urea formaldehyde (18.3%). Present relevance of the patch tests was found in 81.4% of the cases. Concomitant sensitization with allergens from the standard series included nickel sulphate, potassium dichromate, formaldehyde, rubber additives and others. Although chronic dermatitis was the typical clinical presentation, less frequent forms such as purpuric, hyperpigmented and papulopustular lesions and atypical forms such as erythema multiforme-like, nummular-like lesions, lichenification and erythrodermia were observed in 24.4% of the cases. The atypical manifestations were provoked by sensitization to dye allergens and never to resins. Along with the typical distribution in areas of friction on the trunk and extremities, less frequent areas including the hands, face, genital area and the soles were affected too. CONCLUSIONS: In view of the increasing frequency of contact dermatitis to clothing, the clinical assessment should include awareness of the classical as well as the unusual and atypical clinical forms and locations of ACD to textiles, for they are not infrequent. Although dyes and among them DB 106 and DB 124 are the most frequent allergens inducing textile dermatitis, concomitant testing with allergens from the textile dyes and resin groups is recommended when investigating patients with textile dermatitis.     

Is PPD a useful screening agent?

In this study, the usefulness was assessed of para-phenylenediamine (PPD) base as a marker for contact allergy to para-compounds and disperse dyes. 59 patients with a positive reaction to PPD were patch tested with a series of para compounds and disperse dyes. This dyes series was also tested in patients with a suspect medical history of contact allergy to hair, fabric or leather dyes. In total 610 patients were tested. As 24 patients became positive over the weekend, late readings, day 6 or 7, are important. These reactions were most probably relevant in 17/24 patients. Positive reactions to PPD correlated well with reactions to para compounds like p-aminoazobenzene and p-toluenediamine sulphate but not with disperse dyes. Reactions to Disperse Blue (106, 124) and Orange (1 and 3) were seen most frequently. PPD is a good screening agent for hair dye, but not for disperse dye, sensitivity.