Shaw Tatyana Simpson Brenda Wilson Brittney Oostman Holly Rainey David Storrs Frances

BACKGROUND:Rising use of sunscreen products has led to increased reporting of adverse reactions to sunscreens.OBJECTIVE:To investigate possible photoallergic reactions in patients who identified themselves as “being allergic” to sunscreens.METHODS:Patients filled out questionnaires about types of sunscreens they used and timing of their “allergic” reactions. Next, they consented to be photopatch-tested with active sunscreen ingredients, including the new sunscreen Anthelios SX (containing Mexoryl SX) and the new ultraviolet filters Tinosorb M and Tinosorb S. Standard allergen patch testing was also done.RESULTS:Twenty-seven patients self-reported “sunscreen allergy.” Photopatch testing is difficult for patients; hence, only 11 agreed to proceed with the testing. Eight patients had negative patch testing results. One patient reacted to benzophenone-2. Another had a prior reaction to titanium dioxide and titanium oxalate but did not react to the silicone-coated titanium in our study. Yet another patient had relevant photopatch reactions to benzophenone-3 and ethylhexyl dimethyl para-aminobenzoic acid (PABA). None reacted to the Tinosorbs or Anthelios SX. Few positive reactions to the standard allergens were not relevant.CONCLUSION:Although small, this study parallels prior studies in concluding that true delayed type IV hypersensitivity (allergic contact dermatitis and photoallergy) to sunscreens is more infrequent than patients tend to believe.

Adams Alison K. Connolly Suzanne M.

BACKGROUND:Vitamin E, of which the most biologically active form is α-tocopherol, has become widely known for its antioxidant effects. It has been ingested or applied topically for purported anti-aging effects and for cosmetic enhancement.OBJECTIVE:To determine whether the incidence of allergic contact dermatitis from vitamin E has increased in recent years.METHODS:With the approval of the Mayo Clinic institutional review board, we retrospectively analyzed patch-test data from patients tested from June 1987 through December 2007.RESULTS:A total of 2,950 patients were patch-tested during this period, and 18 patients (0.61%) had positive reactions to α-tocopherol; 6 (0.53%) of 1,136 patients tested from June 1987 through December 1997 had positive results, and 12 (0.66%) of 1,814 patients tested from January 1998 through December 2007 had positive results (p = .69).CONCLUSION:Vitamin E appears to be a relatively rare contact allergen in our experience.

Wattanakrai Penpun Temnithikul Bhakinai Pootongkam Suwimon

BACKGROUND:Corticosteroid allergy is a complication of topical therapy detected by patch-testing with corticosteroid allergens.OBJECTIVE AND METHODS:Ten-year retrospective review to study the prevalence and patterns of corticosteroid allergy in Thai patients.RESULTS:Of 882 patients who were patch-tested, 29 (3.29%) had allergic reactions to corticosteroids. Of these 29 patients, 17 (58.62%) had positive reactions to one corticosteroid, and 12 (41.38%) reacted to multiple corticosteroids. Rates of reaction to corticosteroid groups ranged from 31.03 to 80.95%. Concomitant reactions between groups were noted. The prevalence of topical corticosteroid allergy (using two screening allergens, tixocortol pivalate and budesonide) was 2.27% (20 of 882). Testing with additional steroid allergens in suspected cases increased the prevalence to 3.29%. Tixocortol pivalate detected 51.72% of corticosteroid-allergic cases, and budesonide detected 24.14%. Combining both tixocortol and budesonide detected 68.97% of cases.CONCLUSION:Corticosteroid allergy is found to multiple corticosteroids, and concomitant reactions occur across groups. Group D1 corticosteroid esters produced a higher positive reaction rate (61.9%) than groups D2 (52.38%) and A (51.72%). This may be due to different prescribing habits or the easy access to D1 corticosteroids sold over the counter by pharmacies in Thailand.

Marie Api Anne Belsito Donald Bickers David Bruze Magnus Calow Peter Greim Helmut Hanifin Jon M. McNamee Pauline M. Rogers Adrianne E. Saurat Jean-Hilaire Sipes I.Glenn Tagami Hachiro

BACKGROUND:Contact hypersensitivity quantitative risk assessment (QRA) for fragrance ingredients is being used to establish new international standards for all fragrance ingredients that are potential skin sensitizers.OBJECTIVE:The objective was to evaluate the retrospective clinical data on three fragrance ingredients in order to provide a practical assessment of the predictive value of the QRA approach. It is important to have data to assess that the methodology provides a robust approach for primary prevention of contact sensitization induction for fragrance ingredients identified as potential sensitizers.METHODS:This article reviews clinical data for three fragrance ingredients-cinnamic aldehyde, citral, and isoeugenol-to assess the utility of the QRA approach for fragrance ingredients.RESULTS:This assessment suggests that had the QRA approach been available at the time standards were established for these fragrance ingredients, the clinical response might have been noticeably improved. Prospectively, with the establishment of QRA-derived standards, there should be a continued downward trend in patch test–positive rates for cinnamic aldehyde, citral, and isoeugenol over time.CONCLUSION:While it is recognized that the availability of retrospective data is limited, a longitudinal review of these data gives confidence that the QRA approach should be an effective tool for primary prevention. This study also highlights the importance of continued active monitoring of clinical patch-test data for fragrance ingredients.

Swerdlin Amy Rainey David Storrs Frances J.

Allergic contact dermatitis due to citrus fruits is rare, but has been reported in cooks and bartenders. We report an interesting case of a bartender with hand dermatitis who had an allergic contact sensitivity to lime peel, fragrance mix I, and fragrance mix II. Most reported cases of citrus peel allergy are due to d-limonene, which makes up the majority of the peel oil. However, our patient had an allergic reaction to geraniol, which is a minor component of the peel oil and is present in fragrance mix I. It is important to consider a contact sensitivity to citrus in patients who have positive reactions to fragrance mix I and II and who are occupationally exposed to citrus fruits. An initial positive reaction to fragrance mixes should prompt further testing to citrus in these individuals.

Corazza Monica Borghi Alessandro Ricci Michela Sarno Oriele Virgili Annarosa

Szyfelbein Masterpol Katherine Gottlieb Alice B. Scheinman Pamela L.

Hession Meghan T. Scheinman Pamela L.

Veraldi Stefano Maria Serini Stefano Violetti Silvia Alberti

Bellini Veronica Assalve Danilo Lisi Paolo