Occupational allergic contact dermatitis caused by isothiazolinones in ultrasound gel: 2 cases

Corazza, Monica; Amendolagine, Graziana; Cristofaro, Dario; Bernardi, Tatiana; Foti, Caterina; Romita, Paolo; Borghi, Alessandro

doi:10.1111/cod.12831

Cited by 8 publications

(12 citation statements)

References 6 publications

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“…50,51 The painters in the present study were predominantly sensitized with Ultrasound gel as a leave-on non-cosmetic product is another important source of occupational ACD for gynaecologists/perinatologists as it may contain MCI/MI or MI. 55 The overall prevalence of sensitization to MCI/MI or MI between 1996 and 2019 was 3.3% in our series of 2310 patients from Turkey. Late positive patch test reactions, as previously reported, 37 were observed in two patients (2.6%).…”

Section: Discussionmentioning

confidence: 51%

Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone contact allergy: A 24‐year, single‐center, retrospective cohort study from Turkey

et al. 2020

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Background: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI allergy caused a global epidemic during the period 2010 to 2015, reaching its peak in 2013/14. Objective: To investigate the characteristics of MCI/MI and MI allergy in Turkey over 24 years. Methods: A total of 2310 patients patch tested between 1996 and 2019 with MCI/MI 0.01% aq. or MCI/MI 0.02% aq., with or without MI 0.2% aq., were analyzed. Results: The overall prevalence of contact sensitization was 3.3% (n = 77) with a peak level of 16.4% in 2015. The prevalence gradually decreased thereafter, but was still high (6.5%) in 2019. Seventy-three patients had clinically relevant sensitizations. MI could detect clinically relevant sensitizations in all seven patients with a negative patch test reaction to MCI/MI 0.02%. Non-occupational allergic contact dermatitis (ACD) was most frequently seen, mainly in women, with hand/face eczema from rinse-off or leave-on cosmetics, such as wet wipes. Occupational ACD was mainly seen among men with airborne eczema from wall paints in house painters, or with hand eczema from hair gel/wax in men's barbers. Conclusions: The prevalence of MCI/MI and MI sensitization in Turkey following the peak in 2015 is still high. This is probably due to the currently allowed level of 100 ppm for MI in rinse-off cosmetics. This needs to be urgently reduced.

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Section: Discussionmentioning

confidence: 51%

Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone contact allergy: A 24‐year, single‐center, retrospective cohort study from Turkey

et al. 2020

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“…In the sponge of a vacuum pump used to treat an ulcer in a patient sensitised to MI by previous accidental exposure, 754 ppm MCI and 315 ppm MI were found [ 95 ]. Undisclosed presence was noted in adhesive labels, leading to ACD of the exposed fingers [ 96 ], partially airborne ACD after using ironing water preserved with MI in 4 British patients [ 97 ], soothing and cooling gel pads applied to the lower lids during application of lash extensions [ 98 ], airborne ACD accompanied by a dry cough in a construction worker [ 99 ], (partly airborne) ACD due to a stainless steel cleaning spray [ 100 ], foot dermatitis due to a shoe glue preserved with MI [ 101 ], occupational ACD in two gynaecologists due to MI in ultrasound gel [ 102 ], chronic dermatitis of the trunk and proximal extremities in a 7-year-old girl due to liquid laundry detergent [ 103 ], although it has been claimed, based on a small study, that MI cannot be detected in the laundered fabric [ 104 ]. Newly painted rooms, with airborne exposure to MI for several weeks, is a well-known cause of elicitation of ACD by MI [ 85 , 105 , 106 , 107 ], partly leading to very severe and atypical clinical presentations [ 108 ].…”

Section: Resultsmentioning

confidence: 99%

Contact Allergy: A Review of Current Problems from a Clinical Perspective

Uter

Werfel

White

et al. 2018

IJERPH

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Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.

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“…Isothiazolinones are strong sensitizers, commonly used as preservatives in cosmetics, cleaning and polishing agents, detergents, paints, glues, and even ultrasound gel. 3,4 Sensitization rates to MI and MCI have been increasing. 5 For these reasons, MI and MCI/MI have been completely banned from leave-on products in Europe since 2015, but are still allowed at concentrations up to 15 ppm in rinse-off products.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usability of a spot test for isothiazolinones

et al. 2019

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K E Y W O R D S : benzisothiazolinone, contact allergy, methylchloroisothiazolinone, methylisothiazolinone, spot test Contact allergy to isothiazolinones is frequent, especially to methylisothiazolinone (MI) alone and combined with methylchloroisothiazolinone (MCI/MI). While the incidence of MI allergy is decreasing, 1 it remains clinically relevant, in part due to occupational exposures.A spot test kit for detection of isothiazolinones in industrial water systems is commercially available (Tintometer Group) (http://www. lovibondwater.com/product/isothiazoline.aspx). This spot test was recently used to identify a clinically relevant but undeclared exposure to MI in the raw material of a facial gel mask, 2 suggesting the clinical value of the test.The manufacturer states that the test can detect isothiazolinones down to the level of 0.75 ppm; however, it is unclear whether this applies to the most relevant isothiazolinones responsible for contact allergy. We examined the sensitivity of this spot test against 3 common isothiazolinones, and report two clinical cases where application of the test helped us identify MI and MCI/MI sources in allergic patients. SPOT TESTThe spot test kit for isothiazolinones (Tintometer Group) was tested against 3 common isothiazolinones/mixtures: MCI/MI (CAS no. 55965-84-9); MI (CAS no. 2682-20-4); and benzisothiazolinone (BIT) (CAS no. 2634-33-5). The spot test is based on a colorimetric method, where the presence of isothiazolinone derivatives results in a blue color change. The exact basis of the test method is company proprietary information and the analytes used come in a coded form. A reading scale is provided (Figure 1). The detection limit of the test as declared by the manufacturer is 0.75 ppm, where the solution gets a blue undertone, and ends at 7.5 ppm, where it becomes dark blue. The test is negative if no color change occurs, that is, if the solution (in water) remains clear (Figure 1). A range of test solutions corresponding to the reading scale of the spot test (0-7.5 ppm) and added higher concentrations of 10-200 ppm (Table 1) were prepared by using sterile-filtered water (Fresenius Kabi, Bad Homburg vor der Höhe, Germany) and the patch test materials: MCI/MI (allergEAZE, SmartPractice, Phoenix, Arizona) 200 ppm, MI (allergEAZE) 2000 ppm, and BIT (97% Sigma-Aldrich, Copenhagen, Denmark) in w/w% as shown in Table 1. The spot tests were performed with the 5 coded reagents provided in the test kit in accordance with instructions from the manufacturer. The mixing of test solution and reagents takes approximately 5 minutes. The developed color was compared to the test kit standards. Unblinded readings were conducted by one investigator (LA or UFF), approximately 10 seconds after the mixing according to instructions.

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Occupational allergic contact dermatitis caused by isothiazolinones in ultrasound gel: 2 cases

Abstract: Adverse reactions to ecographic gels, mainly allergic contact dermatitis or contact urticaria, have been described in patients who undergo ultrasound procedures. This report describes 2 cases of occupational allergic contact dermatitis (OACD) in 2 obstetrical sonographers

Cited by 8 publications

References 6 publications

Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone contact allergy: A 24‐year, single‐center, retrospective cohort study from Turkey

Methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone contact allergy: A 24‐year, single‐center, retrospective cohort study from Turkey

Contact Allergy: A Review of Current Problems from a Clinical Perspective

Usability of a spot test for isothiazolinones

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