The epidemic of methylisothiazolinone contact allergy in Europe: follow‐up on changing exposures

Uter, Wolfgang; Aalto‐Korte, Kristiina; Agner, Tove; Andersen, Klaus Ejner; Bircher, Andreas J.; Brans, Richard; Bruze, Magnus; Diepgen, Thomas L.; Foti, Caterina; Giménez‐Arnau, Ana M.; Gonçalo, Margarida; Goossens, An; McFadden, John; Paulsen, Evy; Svedman, Cecilia; Rustemeyer, Thomas; White, Ian R.; Wilkinson, S. M.; Johansen, Jeanne Duus

doi:10.1111/jdv.15875

Cited by 60 publications

(57 citation statements)

References 21 publications

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“…Nevertheless, MI and other isothiazolinones are still important contact allergens, and exposure and sensitization trends warrant close surveillance. 22 While 2-bromo-2-nitro-1,3-propanediol was phased out of the baseline series in 2013-2014, IPBC had been added, yielding positive reactions in about 1% of the patients tested. Concerning patch testing with formaldehyde in the IVDK, it should be noted that formaldehyde is still tested at 1% aqua and not 2% aqua as recommended in the European baseline series.…”

Section: Discussionmentioning

confidence: 99%

Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*

et al. 2020

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Summary Background Changing patterns of exposure lead to changes in the spectrum of contact allergy in the general population and in patients patch tested for suspected contact allergy. The main contact allergens (haptens) are assembled in the so‐called ‘baseline series’. Objectives To present the current spectrum of contact allergy to baseline series allergens, and its temporal development over the last 12 years, based on data collected by the 56 active departments of the trinational Information Network of Departments of Dermatology (IVDK). Methods Patch‐test data, along with core demographic and clinical information, subdivided into 4‐year periods for all patients patch tested with the baseline series in the IVDK, were analysed descriptively. Moreover, log‐binomial regression analysis addressed temporal trends of specific contact allergies, adjusted for potentially confounding factors. Results Among the 125 436 patients tested with the German baseline series, the most common allergens were nickel (14·7%), fragrance mix I (8·1%), Myroxylon pereirae resin (7·5%) and cobalt (5·2%), with no conclusive trend. The rise and fall of contact allergy to methylchloroisothiazolinone/methylisothiazolinone (MI), following (self‐) regulation in the European Union, reflected the MI contact allergy epidemic. Propolis showed a marked upward trend with a prevalence of 3·94% during the period 2015–2018. Conclusions Decreases in sensitization prevalence likely reflect reduced exposure, with some lag, as seen with hydroxyisohexyl 3‐cyclohexene carboxaldehyde. If no (sufficient) decrease can be observed despite interventions, such as for nickel and chromium, affected subgroups should be identified and their causative exposures explored. Finally, increases such as that observed with propolis, certainly warrant targeted investigation of the exposures driving sensitization, and possibly intervention. What is already known about this topic? Contact allergy is prevalent in the general population. Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends. This study describes the demographic and clinical profile of patients tested from 2007 to 2018. This research identifies contact allergens that require (further) preventive efforts. Linked Comment: Schuttelaar. Br J Dermatol 2020; 183:800–801.

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Section: Discussionmentioning

confidence: 99%

Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*

et al. 2020

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“…21 Consequently, the use of MCI/MI and MI in leave-on cosmetics was prohibited in Europe in 2016 and 2017, respectively, 22,23 and in 2018 the concentration of MI in rinse-off cosmetics was reduced by the European Commission to the same level as MCI/MI, ie, 15 ppm. 24 The introduction of similar legislative measures around the world led to an observable decrease in the incidence of non-occupational ACD due to isothiazolinones, mainly from cosmetic products, 12,16,25,26 while an increase in occupational ACD was observed in some countries after the epidemic due to the lack of legal restrictions of the use of isothiazolinones in industrial products. 26 There are only limited data on ACD from MCI/MI and MI in Turkey, 27,28 where MCI/MI and MI up to 15 ppm and 100 ppm, respectively, are currently allowed only in rinse-off cosmetics.…”

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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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“…The incidence of ACD to methylisothiazolinone (MI) has been unprecedentedly high in Europe and other parts of the world. Regulation (and prior pre-emptive partial withdrawals from the market) have led, in the EU and those countries adopting its regulation, to a significant decline, for instance, from 5.97% in 2015 to 4.72% in 2016, and further to 2.96% in 2017, according to an EECDRG study [99]. The same study also identified a significant shift of currently clinically relevant products, that is, those products which elicited ACD leading to consultation for patch testing, from leave-on cosmetics to rinse-off cosmetics and household products.…”

Section: Preservativesmentioning

confidence: 99%

Contact Allergy—Emerging Allergens and Public Health Impact

Uter

Werfel

Lepoittevin

et al. 2020

IJERPH

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Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals “Contact Dermatitis” and “Dermatitis” were manually searched, covering the years 2018–2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N’-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just as we have with cosmetics at present (apart from full listing of fragrance substances) in Europe, must be put on the legislative agenda.

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The epidemic of methylisothiazolinone contact allergy in Europe: follow‐up on changing exposures

Cited by 60 publications

References 21 publications

Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*

Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*

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

Contact Allergy—Emerging Allergens and Public Health Impact

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