Allergic contact dermatitis from acetophenone azine in a Canadian child

Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children

“…124 Acetophenone azine is considered a strong sensitizer, and reactions can be severe, with rapid spreading and dissemination. [125][126][127][128] However, acetophenone azine is often missed because it is not included in traditional patch test series, but it should be considered, particularly in foot and shin dermatitis. It has been named the 2021 ACDS Allergen of the Year (Amber Reck Atwater, MD, personal communication).…”

Acetophenone Azine: The 2021 American Contact Dermatitis Society Allergen of the Year

“…3 A 6-year-old Canadian male soccer player presented with leg dermatitis and later generalized dermatitis and dermatitis on the soles of the feet with positive reactions to pieces of his shin pads and shoe insoles as well as to AA 1% and 0.1% in petrolatum. 4 A 17-year-old British male (another trend, all males so far!) hockey player developed dermatitis localized to the legs and positive patch tests to the worn foam inner lining of his shin pads as well as to AA 0.1%, 0.01%, and 0.001% in acetone.…”

“…1 Several authors noted that AA could be a by-product of EVA synthesis and that sports equipment manufacturers might not be aware of its presence in EVA. 2,[4][5][6] Some noted that AA concentration was higher in shin guards than in shoe insoles; they thought this explained why patients reacted first to their shin guards and were perhaps even initially sensitized to the shin guards, as well as why shoe insole contact allergy commonly was reported later or only after allergy to shin guards had already developed. 4,6…”

“…Patients with contact allergy to AA may have negative patch testing to screening series and/or supplemental series and may have strong positive reactions to pieces of suspected foam shin pads or shin guards, shoes, and/or flip-flops. Although Koumaki et al 5 recommended patch testing for AA contact allergy with AA 0.1% in acetone, Besner Morin et al 4 mentioned that petrolatum may be a more desirable vehicle because it could maintain stability for a longer period of time. In fact, a 2021 article highlighting the American Contact Dermatitis Society Allergen of the Year recommends testing with either AA 0.1% in acetone or AA 0.1% in petrolatum.…”

“…1 There are only a few European and Canadian case reports and one case series of AA contact allergy in the literature, all of which are associated with foam shin pads or shin guards, shoe insoles, and/or flip-flops. [2][3][4][5][6] Acetophenone azine is an important emerging allergen, and in this column, we will introduce you to AA and the sneaky places it can lurk and cause allergic contact dermatitis (ACD). We also highlight diagnosis, management, and patch testing for AA contact allergy.…”