Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

Abstract

Background: Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series. Objectives: To compile patch test results of subjects affected, and provide potential explanations for this association. Patients and Methods: Fifty-three Freestyle Libre-allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM. Results: Thirty-three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography-mass spectrometry (GC-MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA. Conclusion: Significant co-sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC-MS analysis. Cross-reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist. K E Y W O R D S allergic contact dermatitis, chemical analysis, diabetes mellitus, FreeStyle Libre, GC-MS, glucose sensor, isobornyl acrylate, medical device, sesquiterpene lactones, simultaneous reactions

Contact dermatitis caused by glucose sensors in diabetic children

“…Possible cross‐reactions between IBOA and SLM have been reported previously . In this previous paper, we observed that 62.26% of patients sensitized to IBOA tested positively to SLM, contained in the European baseline series.…”

“…The share of co‐sensitization is thus stable without, to date, any further explanation of this phenomenon. The two most likely hypotheses remain a co‐sensitization, rather than cross‐reactivity but also the possible presence of a common precursor to IBOA and lactones, such as camphene …”

Allergic contact dermatitis by isobornyl acrylate in glucose monitoring devices: Report of two cases

“…However, sensitization to different acrylates present in both insulin pumps and blood glucose meters have been described . In some of the series, a high frequency of sensitization to sesquiterpene lactones was recorded, as in one of our patients. The most frequent acrylate involved is IBOA .…”

“…In some of the series, a high frequency of sensitization to sesquiterpene lactones was recorded, as in one of our patients. The most frequent acrylate involved is IBOA . Therefore, it seems advisable to promptly eliminate IBOA in these types of devices.…”

“…However, allergic contact dermatitis by acrylates used as adhesives in these devices has become a new problem for patients using these devices. [1][2][3][4][5][6] We report two new cases of allergic contact dermatitis due to isobornyl acrylate (IBOA) in patients with diabetes using the FreeStyle Libre system (Abbott Laboratories, Chicago, Illinois).…”