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.     

Occupational contact allergy to (meth)acrylates

Among 13,833 patients suspected of contact dermatitis examined during the years 1978-1999, occupational contact allergy to (meth)acrylates was diagnosed in 31 patients. The 3 most common sensitizers were ethyleneglycol dimethacrylate (17 positive patch tests), 2-hydroxyethyl methacrylate (14) and triethyleneglycol dimethacrylate (6). The aim of this report was to assess the different occupations and industries responsible for occupational sensitization to (meth)acrylates. 14 of the 31 patients work in the dental sector, either as a dentist or as a student of dental technology, where (meth)acrylate-containing dental prostheses and dental composites are mainly responsible for allergy to (meth)acrylates. An increasing trend in dermatological problems related to the expansion of the use of (meth)acrylates is clearly reflected in the patient population of our dermatology department.     

Occupational dermatitis in dental personnel: contact dermatitis with special reference to (meth)acrylates in 174 patients

Between 1995 and 1998, 174 dental personnel were referred as patients to the Department of Occupational and Environmental Dermatology, Stockholm. After clinical examination, 131 were patch tested with the Swedish standard series and 109 with a dental screening series. Furthermore, 137 were tested for IgE-mediated allergy to natural rubber latex (NRL). Hand eczema was diagnosed in 109/174 (63%), 73 (67%) being classified as irritant contact dermatitis and 36 (33%) as allergic. Further diagnoses included other eczemas, urticaria, rosacea, psoriasis, tinea pedis, bullous pemphigoid or no skin disease. 77/131 (59%) had positive reactions to substances in the standard series and 44/109 (40%) to substances exclusive to the dental series. 24/109 (22%) patients had positive reactions to (meth)acrylates, the majority with reactions to several test preparations. Reactions to HEMA (2-hydroxyethyl methacrylate), EGDMA (ethyleneglycol dimethacrylate) and MMA (methyl methacrylate) were most frequent. 9 of the 24 were positive only to (meth)acrylates, the remaining 15 also had reactions to allergens in the standard series. 23 of these had hand eczema and 1 facial eczema. In 17 of the 24 allergic to (meth)acrylates, the dermatitis had started in 1995 or later, in 15 within the previous 12 months. Of 8 who had been sick-listed, 7 also had a history of atopy and 6 were allergic to nickel. The most frequent allergens besides (meth)acrylates were nickel, cobalt, palladium, fragrance mix, colophonium and thiuram mix. Allergy to natural rubber latex was diagnosed in 14/137 (10%). In conclusion, irritant hand dermatitis was the dominant diagnosis. Contact allergy to (meth)acrylate was seen in 22% of the patch tested patients, with reactions to 3 predominant test substances. 1/3 of the patients with allergy to (meth)acrylates had been sick-listed for dermatitis, but in all these cases the (meth)acrylate allergy was seen together with atopy and/or further contact allergies.     

Positive patch test reactions to allergens of the dental series and the relation to the clinical presentations

The clinical manifestations of contact allergic dermatitis to dental materials are not uniform. This study was performed to detect the frequent allergens in the dental series associated with contact dermatitis and to define the causal relationship between the different allergens and the relevant clinical presentations. Between the years 2000 and 2004, 134 patients, aged 20-80 years, were patch tested. 121 patients were included in the study. The most frequent oral manifestations were cheilitis and perioral dermatitis (25.6%), burning mouth (15.7%), lichenoid reaction (14.0%), and orofacial granulomatosis (10.7%). 18 (14.9%) patients were dental personnel, all of whom suffered from hand dermatitis. The common allergens detected included goldsodiumthiosulphate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%), cobalt chloride (5.0%), and 2-hydroxyethyl methacrylate (5.8%). Positive reactions to metals were frequent in all the different clinical variants, and no specific association between a specific clinical presentation and a particular allergen was found. Allergy to mercury was not a significant factor contributing to the pathogenesis of oral lichenoid reactions. However, a strong association with contact allergy to mercury in dental fillings was found in 2 patients with orofacial granulomatosis.     

Two decades of occupational (meth)acrylate patch test results and focus on isobornyl acrylate

Background Wheat protein derivatives are used in a variety of products worldwide. Gluten is commercially used ‘as is' or with modifications such as hydrolysis, which is carried out to overcome its insolubility. Several cases of contact urticaria following exposure to hydrolysed wheat protein (HWP) in cosmetics or of anaphylaxis caused by deamidated gluten in food or non‐food products have been described. Objectives To evaluate the types of HWP that have higher allergenicity for percutaneous sensitization. Methods We enrolled 7 patients with wheat‐dependent exercise‐induced anaphylaxis who had been sensitized to HWP primarily through the percutaneous and/or the rhinoconjunctival route by using facial soap containing HWP. Reaction to wheat proteins was confirmed by IgE immunoblotting and basophil CD203c expression with six HWP variants. Results The IgE of all the patients reacted to HWPs composed of large polypeptide aggregates. High molecular weight (MW) HWPs were also found to induce significant enhancement of basophil CD203c expression. Conclusions HWPs composed of large polypeptide aggregates possibly induce sensitization to a greater degree than lower‐MW HWPs. Basophil surface CD203c expression is useful for evaluating the allergenicity of HWPs.     

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.     

Contact allergy to epoxy (meth)acrylates

Background: Contact allergy to epoxy (meth)acrylates, 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA), 2,2-bis[4-(2-hydroxy-3-acryloxypropoxy)phenyl]-propane (bis-GA), 2,2-bis[4-(methacryl-oxyethoxy)phenyl] propane (bis-EMA), 2,2-bis[4-(methacryloxy)phenyl]-propane (bis-MA), and glycidyl methacrylate (GMA) is often manifested together with contact allergy to diglycidyl ether of bisphenol A (DGEBA) epoxy resin.
Objective: To analyse patterns of concomitant allergic reactions to the five epoxy (meth)acrylates in relation to exposure.
Methods: We reviewed the 1994–2008 patch test files at the Finnish Institute of Occupational Health (FIOH) for reactions to the five epoxy (meth)acrylates, and examined the patients' medical records for exposure.
Results: Twenty-four patients had an allergic reaction to at least one of the studied epoxy (meth)acrylates, but specific exposure was found only in five patients: two bis-GMA allergies from dental products, two bis-GA allergies from UV-curable printing inks, and one bis-GA allergy from an anaerobic glue. Only 25% of the patients were negative to DGEBA epoxy resin.
Conclusions: The great majority of allergic patch test reactions to bis-GMA, bis-GA, GMA and bis-EMA were not associated with specific exposure, and cross-allergy to DGEBA epoxy resin remained a probable explanation. However, independent reactions to bis-GA indicated specific exposure. Anaerobic sealants may induce sensitization not only to aliphatic (meth)acrylates but also to aromatic bis-GA.     

Delayed patch test reaction to budesonide in an 8-year-old

Topical corticosteroids are an emerging cause of allergic contact dermatitis in children that may often be missed. It is important to consider patch testing with corticosteroids to detect allergic contact dermatitis in patients with persistent or worsening of dermatitis despite topical corticoseroid treatment. However, delayed reactions (>7 days) to topical corticosteroids may occur, leading to false-negative reactions and misdiagnosis. Herein, we report a case of an 8-year-old girl who developed a positive reaction to budesonide on day 12 of patch testing.     

The impact of meteorological conditions on patch test results with 12 standard series allergens (fragrances, biocides, topical ingredients)

Background Fluctuating irritability of the skin induced by low ambient temperature and humidity may compromise the reproducibility of patch testing. Objectives To assess the impact of temperature and absolute humidity at the time of patch testing on the occurrence of irritant or doubtful (IR/?), weak positive (+) and (strong) positive (++/+++) reactions, respectively, among 12 allergens included in the German Standard Series. Methods Analysis of clinical data collected in the surveillance network IVDK ( http://www.ivdk.org ) between January 1993 and December 2001 (n = 73 691 patients) combined with meteorological data obtained by the national services in Germany and Austria. Multinomial logistic regression analysis was used to estimate the risk associated with temperature, absolute humidity and vapour pressure, respectively, adjusted for sex, age, atopic dermatitis and duration of patch test application. Results For low temperature and humidity, a relevant increase of IR/? reaction frequency was observed in the cases of paraben mix and (chloro‐) methylisothiazolinone. Both IR/? and + reactions were significantly increased with respect to the allergens fragrance mix, oil of turpentine, methyldibromo glutaronitrile + phenoxyethanol and particularly formaldehyde, while ++/+++ reactions were hardly affected by weather conditions. Conclusions The observed increase of IR/? reactions may be due to epidermal barrier function impairment. The impact of dry/cold weather on + reactions in terms of possibly false‐positive reactions is restricted to few allergens. In the case of + reactions of unknown relevance, a re‐test under warm conditions or verification tests such as the repeated open application test or the provocative use test may be recommendable.     

Sensitizing potential of urethane (meth)acrylates in the guinea pig

Urethane (meth)acrylates are used as prepolymers in ultraviolet-curable inks, varnishes and coating formulations for industrial purposes as well as resins for dental applications. The sensitizing capacity of 3 commonly used urethane (meth)acrylates was investigated using the guinea pig maximization test. The study shows that an aliphatic urethane acrylate is not only a more potent sensitizer than an aromatic one, but also more sensitizing than a (meth)acrylated aliphatic urethane.     

Standard patch test results in patients with contact dermatitis in Israel: age and sex differences

Previous studies have shown that the prevalence of specific allergens varies by geographic area, population, age and sex. The objective of the present study was to determine the relative frequency of positive reactions to different sensitizers in Israeli patients with clinically suspected contact dermatitis (CD) and to identify possible sex and age differences. A total of 943 consecutive patients were tested for CD using the European standard patch test series. The most frequent allergen was nickel sulfate followed by potassium dichromate and fragrance mix. Positive reactions to nickel sulfate were more common among women, especially those in the younger age group (younger than 40 years). Positive reactions to balsam of Peru were more common among men, especially those in the older age group (40 years or older). This study presents the result of the standard patch test in Israel with stratification according to age and sex. The findings of the present study, combined with reports on geographic/population differences in the prevalence of specific allergens in CD, indicate the need for further investigations to identify prominent local allergens for better adaptation of the standard patch test to local needs.