Patients with patch test reactions associated with eye care products: Retrospective analysis of North American contact dermatitis group data, 2001‐2018

Abstract

Eye care products (ECP) may cause allergic contact dermatitis (ACD). METHODSThis ethics-approved study employed standard North American Contact Dermatitis Group (NACDG) methodology. 1 ECPs were defined as over-the-counter (OTC) eye drops/ointments, lid care products, and contact lens solutions. Patients tested by the NACDG (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) with a ≥1 positive patch test reaction associated with an ECP comprised the ECP-positive group. Irritant contact dermatitis (ICD) to ECPs was considered separately. RESULTSOf 43,722 patients, 154 (0.4%) had ≥1 positive patch test reaction attributed to an ECP. ECP-positive patients had significantly greater odds of being female, >40 years old, or with a history of hay fever (Table 1). When up to three anatomic sites were considered, all ECPpositive patients had facial involvement (Table 2).Eighty-three of the 154 ECP-positive patients (53.9%) had 99 total reactions to NACDG screening allergens; the remainder (n = 71) had reactions to allergens/substances not on the screening series. The top NACDG screening allergens present in ECPs were thimerosal, 47.8% (current relevance [CR] 45.5%); benzalkonium chloride (BAC), 26.1%

Topical eye medications causing allergic contact dermatitis

“…As found by others, patch test positive patients were mainly over 40 years of age. 1,2 Furthermore, they often had a history of a chronic eye disease (cataract or glaucoma), which are more common with increasing age, and often require daily use of topical eye medications (glaucoma). The number of positive tests was similar in men and women, which has also been shown by others.…”

“…Allergic contact dermatitis (ACD) in the eye region may be caused by eye medications, and symptoms can be difficult to distinguish from other skin diseases, such as atopic dermatitis (AD), irritant contact dermatitis, psoriasis, rosacea, or seborrheic dermatitis. In patch test populations, the frequency of a positive patch test to an eye medication/ingredient is less than 1%, 1,2 but much higher frequencies (35%–68%) have been demonstrated in populations where a specific suspicion of ACD to an eye medication has been raised 3,4 . Patch test positive patients are usually over 40 years old, and numerous culprits are reported with national differences 1–5 .…”

“…In patch test populations, the frequency of a positive patch test to an eye medication/ingredient is less than 1%, 1,2 but much higher frequencies (35%–68%) have been demonstrated in populations where a specific suspicion of ACD to an eye medication has been raised 3,4 . Patch test positive patients are usually over 40 years old, and numerous culprits are reported with national differences 1–5 . ACD to eye medications is probably underreported due to challenges to identify the culprit allergen 6 …”

“…3,4 Patch test positive patients are usually over 40 years old, and numerous culprits are reported with national differences. [1][2][3][4][5] ACD to eye medications is probably underreported due to challenges to identify the culprit allergen. 6 Delayed diagnostics, misdiagnosis or overlooked allergies may lead to chronic, severe dermatitis or conjunctivitis, 5 secondary infection, lacrimal drainage occlusion 7 and prolonged use of topical corticosteroids with the risk of side effects such as the development of cataract and glaucoma and may eventually compromise vision.…”

Ocular involvement in allergic drug reactions

“…In a recent study that examined patch testing for ECPs, screening for allergens in commercially available patch test products detected 53.9% of reactions, with the remainder requiring supplemental testing. The top allergens present in the screening panel included thiomersal, benzalkonium chloride, oleamidopropyl dimethylamine, propylene glycol, ethylenediamine dihydrochloride, and lanolin [56]. Benzalkonium chloride (BAK) deserves specific attention as a preservative in a variety of ophthalmic preparations as a means to prevent ocular infections from contaminated eye drops [57,58].…”