Wearable Woes: Allergens in Diabetic Devices

Hartsough, Emily M.; Hylwa, Sara

doi:10.1097/der.0000000000000673

Cited by 8 publications

(15 citation statements)

References 25 publications

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“…Treatment of type 1 diabetes mellitus (T1DM) in children has advanced significantly with the development of continuous subcutaneous insulin infusions (CSIIs), continuous glucose monitors (CGMs), flash glucose monitors (FGMs), and sensor augmented pumps (SAPs). Use of these devices has been shown to improve overall glycemic control [ 38 ].…”

Section: New Sources Of Pediatric Acdmentioning

confidence: 99%

“…Allergens found in diabetes devices include IBOA, ethyl cyanoacrylate, N,N-dimethylacrylamide (DMAA), and colophony (Table 2 ) [ 38 – 42 ]. IBOA is an acrylate highly utilized in medical devices as an adhesive.…”

Section: New Sources Of Pediatric Acdmentioning

confidence: 99%

“… Hartsough and Hylwa [ 38 ], Lombardo et al [ 41 ], Raison-Peyron et al [ 42 ] CSII continuous subcutaneous insulin infusion, FGM flash glucose monitor, CGM continuous glucose monitor, IBOA isobornyl acrylate, DMAA N,N-dimethylacrylamide * Absent from FreeStyle Libre 2 ** Absent from Dexcom G5 …”

Section: New Sources Of Pediatric Acdmentioning

confidence: 99%

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What We Have Learned–Milestones in Pediatric Contact Dermatitis

2022

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Purpose of Review This review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children. Recent Findings ACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use. Summary ACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.

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Section: New Sources Of Pediatric Acdmentioning

confidence: 99%

Section: New Sources Of Pediatric Acdmentioning

confidence: 99%

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What We Have Learned–Milestones in Pediatric Contact Dermatitis

2022

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“…Since 2005, when the first insulin pump was introduced into the American market, 1 several continuous subcutaneous insulin infusion (CSII) sets and glucose sensors (GS) have become available to patients with diabetes, improving disease control and enhancing their quality of life (QoL) 2 . There are two main categories of GS, continuous glucose monitors (CGM) and flash glucose monitors (FGM) 3–5 .…”

Section: Introductionmentioning

confidence: 99%

Contact dermatitis in children caused by diabetes devices

et al. 2022

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Background: Insulin pumps and glucose monitoring devices improve diabetes mellitus control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices have been reported.Objective: To investigate the culprits of localized contact dermatitis in paediatric patients with diabetes caused by insulin pumps and glucose monitoring devices.Methods: Retrospective analysis of 15 paediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pumps and glucose monitoring devices.Results: Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster. Conclusion:A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to BP. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices.

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“…[1][2][3] In the last years, several contact allergens have been identified in these medical devices. [4][5][6][7][8][9] The culprit contact allergens have mainly been used in glues in attachment areas, that is, where different materials must adhere to each other, but not necessarily primarily in the adhesive patch in direct contact with the skin. However, the contact allergens migrate from the original attachment areas to the adhesive patch.…”

mentioning

confidence: 99%

Further Evidence of Allergic Contact Dermatitis Caused by 2,2′-Methylenebis(6-tert-Butyl-4-Methylphenol) Monoacrylate, a New Sensitizer in the Dexcom G6 Glucose Sensor

et al. 2022

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BackgroundSince the spring of 2020, we have seen several patients experiencing severe allergic contact dermatitis (ACD) from the Dexcom G6 glucose sensor after the composition of the sensor's adhesive patch had been changed. We have previously reported the finding of a new sensitizer, 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate, in the Dexcom G6 adhesive patch. Three patients with ACD from Dexcom G6 tested positive to this sensitizer. They were also allergic to isobornyl acrylate, a sensitizer present both in Dexcom G6 and in other medical devices previously used by these patients.ObjectiveThe aim of the study was to report the first 4 cases sensitized to 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate without a simultaneous allergy to isobornyl acrylate.MethodsThe cases were patch tested their own materials, a medical device series, and 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in several concentrations.ResultsAll 4 cases tested positive to 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate at either 1.0% or 1.5% in petrolatum, whereas 20 controls tested negative to both concentrations.ConclusionsThe cases reported here provide further evidence of 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate as a relevant culprit sensitizer in patients with ACD from Dexcom G6. However, the initially used patch test concentration (0.3%) did not suffice to elicit positive reactions in these cases, which is why patch testing at 1.5% is recommended.

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Wearable Woes: Allergens in Diabetic Devices

Cited by 8 publications

References 25 publications

What We Have Learned–Milestones in Pediatric Contact Dermatitis

What We Have Learned–Milestones in Pediatric Contact Dermatitis

Contact dermatitis in children caused by diabetes devices

Further Evidence of Allergic Contact Dermatitis Caused by 2,2′-Methylenebis(6-tert-Butyl-4-Methylphenol) Monoacrylate, a New Sensitizer in the Dexcom G6 Glucose Sensor

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