Contact dermatitis from a textile flame retardant

We report a case of contact sensitivity to Flammentin ASN®, a flame retardant used on cotton and wool. The patient was a painter who was protecting his face with a white cotton cap. He presented with eczema of the forehead and face at the sites of cap contact. Patch tests with the treated cap and flame retardant were positive; a formaldehyde patch test was negative. Flame retardants are used in construction, materials and textiles. Contact sensitivity is rarely described and we compare our case to those published in the literature.     

Sensitivity to a flame retardant, Tris(2,3-dibromopropyl)phosphate (Firemaster LVT 23 P)

Tris(2,3-dibromoprophyl) phosphate (TDB P) is marketed under many different trade names as a flame retardant, used in clothing and home furnishings. DTB P is chemically related to tricresylphosphate (TCP) and triphenylphosphate (TPP) used as plasticizers in plastics and lacquers. The International Contact Dermatitis Research Group (ICDRG) in 1976 examined the incidence of sensitization to TDB P and found two positives among 1103 patients. One of these two cases is reported here in detail. It concerns a woman, aged 56, with spectacle frame dermatitis. The spectacle frame did not contain TDB P and sensitization with another phosphate ester is assumed.     

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.     

Contact allergy to the fungicide benomyl?

Benomyl is a widely used fungicide. Contact allergy to benomyl has been reported in a few cases. We describe a group of 62 workers, exposed to benomyl. None had contact dermatitis from benomyl. It appears that benomyl at most is a weak sensitizer. We suggest that earlier-reported allergy may represent cross-reactions and/or that the development of contact allergy to benomyl requires previous exposure to other chemically related pesticides.     

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.     

Contact sensitivity to acrylate compounds in guinea pigs

As reports of contact dermatitis in humans due to acrylate compounds have increased considerably in recent years, it was decided to investigate the ability of these chemicals to evoke contact sensitivity skin reactions in guinea pigs. 21 different acrylate and methacrylate compounds were scanned for their ability to induce contact sensitivity, using 5 different sensitization protocols. Contact reactions of varying intensities were produced to all the mono-, di- and triacrylates tested. However, it was not possible to sensitize guinea pigs to any methacrylates. It would appear that guinea pigs cannot be contact sensitized to acrylate chemicals that are substituted on carbon 2.     

Contact urticaria to formaldehyde

A patient developed urticaria following exposure to formaldehyde vapour. Evidence is given that this compound releases histamine from the skin of susceptible persons. The action mechanism seems to be different from IgE-mediated hypersensitivity, as the passive transfer test was negative.     

Contact sensitivity and systemic reaction to pseudoephedrine and lignocaine

There are 4 cases reported of generalized erythema, joint swelling, tachycardia and rigors with oral pseudoeph-edrine (1–3), many cases of non-purpuric fixed drug eruption from oral pseudoephedrine (3); and 2 cases of positive patch tests to pseudoephedrine, 1 after a fixed drug eruption (3), and 1 after a generalized eczema (4). There are reports of adverse reactions to lignocaine fol-lowing its use as a subcutaneous injection, deep dental infiltration, and as a topical application (5). Adverse re-actions to lignocaine are quite common, but immune pathology cannot usually be demonstrated. Adverse re-actions that are mediated by the immune system are generally of the immediate type (Type I), whilst delayed allergy is rare (6).     

Contact dermatitis to antituberculosis drugs

The literature has been reviewed for contact dermatitis occurring to antituberculosis agents. Of the 12 known drugs, 6 (isoniazid, rifampicin, ethambutol, para-aminosalicylic acid, streptomycin and kanamycin) have been documented by patch test to cause this type of dermatitis in certain individuals. Cross sensitization has been observed to contribute significantly to the allergic reactions noted from isoniazid, streptomycin, and kanamycin. Hyposensitization has also been discussed in this review.     

Contact dermatitis from telefax paper

A nonatopic female secretary developed hand dermatitis after 1 year of full-time work with telefax paper. Her dermatitis improved on sick leave and vacation and relapsed at work. Patch testing showed allergic reactions to several fragrances, balsam of Peru, colophony and neomycin. In 3 patch test sessions, her own telefax papers gave a doubtful reaction which persisted for 4 days, but it could not be determined whether the reactions were allergic or irritant. The colophony content of the telefax paper was about 1%, and it was possible that colophony in the telefax paper was responsible for the weak path test reactions. Accordingly, the contact dermatitis would have been allergic. The patient has now been relocated, does not handle telefax paper, and is symptomless. We concluded that our patient had an occupational hand contact dermatitis induced by telefax paper and possibly caused by colophony allergy.