Charlotte Devantier Jensen.pmd - Videncenter for Allergi

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2288 Charlotte Devantier Jensen 89. Scheper RJ, von BM, Boerrigter GH, Bruynzeel D, van DA, Vos A. Induction of immunological memory in the skin. Role of local T cell retention. Clin Exp Immunol 1983;51:141-148. 90. Nakagawa S, Fukushiro S, Gotoh M, Kohda M, Namba M, Tanioku K. Studies on the retest reaction in contact sensitivity to DNCB. Dermatologica 1978;157:13-20. 91. Hindsén M, Bruze M. The significance of previous contact dermatitis for elicitation of contact allergy to nickel. Acta Derm Venereol 1998;78:367-370. 92. Christensen OB, Lindstrom C, Löfberg H, Möller H. Micromorphology and specificity of orally induced flare-up reactions in nickel-sensitive patients. Acta Derm Venereol 1981;61:505-510. 93. Möller H, Björkner B, Bruze M. Clinical reactions to systemic provocation with gold sodium thiomalate in patients with contact allergy to gold. Br J Dermatol 1996;135:423-427. 94. Moed H, Boorsma DM, Tensen CP, Flier J, Jonker MJ, Stoof TJ, von Blomberg BM, Bruynzeel DP, Scheper RJ, Rustemeyer T, Gibbs S. Increased CCL27-CCR10 expression in allergic contact dermatitis: implications for local skin memory. J Pathol 2004;204:39-46. 95. Allenby CF, Basketter DA. An arm immersion model of compromised skin (II). Influence on minimal eliciting patch test concentrations of nickel. Contact Dermatitis 1993;28:129-133. 96. Choi JM, Lee JY, Cho BK. Chronic irritant contact dermatitis: recovery time in man. Contact Dermatitis 2000;42:264-269. 97. Widmer J, Elsner P, Burg G. Skin irritant reactivity following experimental cumulative irritant contact dermatitis. Contact Dermatitis 1994;30:35-39. 98. Lammintausta K, Maibach HI, Wilson D. Human cutaneous irritation: induced hyporeactivity. Contact Dermatitis 1987;17:193- 198. 99. Freeman S, Maibach H. Study of irritant contact dermatitis produced by repeat patch test with sodium lauryl sulfate and assessed by visual methods, transepidermal water loss, and laser Forum for Nord Derm Ven Vol. 10, 2005 – Suppl. 8 Doppler velocimetry. J Am Acad Dermatol 1988;19:496-502. 100. Proksch E, Brasch J. Influence of epidermal permeability barrier disruption and Langerhans’ cell density on allergic contact dermatitis. Acta Derm Venereol 1997;77:102-104. 101. Andersen KE, Maibach HI. Cumulative irritancy in the guinea pig from low grade irritant vehicles and the angry skin syndrome. Contact Dermatitis 1980;6:430-434. 102. Jensen CS, Lisby S, Baadsgaard O, Volund A, Menné T. Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel-exposure regulation. Br J Dermatol 2002;146:636-642. 103. Kynemund PL, Agner T, Held E, johansen JD. Methyldibromoglutaronitrile in leave-on products elicits contact allergy at low concentration. Br J Dermatol 2004;151:817-822. 104. Avnstorp C. Prevalence of cement eczema in Denmark before and since addition of ferrous sulfate to Danish cement. Acta Derm Venereol 1989;69:151-155. 105. Johansen JD. Fragrance contact allergy: a clinical review. Am J Clin Dermatol 2003;4:789-798. 106. Bruze M, Johansen JD, Andersen KE, Frosch P, Lepoittevin JP, Rastogi S, Wakelin S, White I, Menné T. Deodorants: An experimental provocation study with cinnamic aldehyde. Journal of the American Academy of Dermatology 2003;48:194-200. 107. Johansen JD, Andersen KE, Rastogi SC, Menné T. Threshold responses in cinnamic-aldehyde-sensitive subjects: results and methodological aspects. Contact Dermatitis 1996;34:165-171. 108. Johansen JD, Andersen KE, Svedman C, Bruze M, Bernard G, Gimenez-Arnau E, Rastogi SC, Lepoittevin JP, Menné T. Chloroatranol, an extremely potent allergen hidden in perfumes: a dose-response elicitation study. Contact Dermatitis 2003;49:180-184. 109. Svedman C, Bruze M, Johansen JD, Andersen KE, Goossens A, Frosch PJ, Lepoittevin JP, Rastogi S, White IR, Menné T. Deodorants: an experimental provocation study with hydroxycitronellal. Contact Dermatitis 2003;48:217-223.
In recent years the cosmetic preservative methyldibromoglutaronitrile (MDBGN) has gained notice due to a significant increase in the frequency of contact allergy to the chemical in Europe. A 10-year analysis, involving 16 dermatological clinics in 11 European countries, revealed a rise in the average frequency of sensitivity to MDBGN from 0.7% in 1991 to 3.5% in 2000 in consecutive eczema patients. These observations promote MDBGN to an important contact allergen in Europe. The aim of this project was to characterize different aspects of the allergic response to MDBGN in previously sensitized individuals. During 3 clinical elicitation studies, sensitized subjects were exposed to the preservative in experimental use tests designed to resemble the actual use-situation of cosmetic products among consumers. Aspects examined were: the allergic response to MDBGN in a rinse-off product, the implication of application frequency, and the significance of previous exposure. Some types of rinse-off products, e.g. liquid soaps, are potentially used many times a day and may thus carry a similar risk of causing contact allergic contact dermatitis as leave-on products (moisturizers, lotions etc.) used only once or a few times a day. The EU Commission service has requested a revision of the use-level of MDBGN in leave-on products, while the use of MDBGN in rinse-off products is unchanged. The first experiment investigated the allergic response elicited in pre-sensitized individuals from exposure to a rinse-off product preserved with the maximum permitted level of MDBGN. 19 contact-allergic individuals participated in a double-blind, randomized repeated open application test (ROAT) using two coded liquid soaps with and without MDBGN. 7/19 subjects (37%) developed allergic contact dermatitis from the MDBGNcontaining soap. The experiment showed that the exposure to a rinse-off product containing the maximum permitted level of MDBGN easily can elicit allergic contact dermatitis in presensitized individuals and indicates that the permitted level of MDBGN in rinse-off products may be too high. It is recommended that the currently allowed level of MDBGN in rinseoff products is re-evaluated. The second experiment examined whether one high-dose exposure a day of MDBGN is more or less potent than several Contact allergy to the preservative methyldibromoglutaronitrile 29 SUMMARY IN ENGLISH low-dose exposures with regard to elicitation of allergic contact dermatitis in pre-sensitized individuals. This knowledge may be useful in the risk assessment and regulation of cosmetic ingredients in products potentially used several times a day. MDBGN-sensitized individuals were exposed to MDBGN in a double-blind, randomized manner both with a single highdose application a day and with 4 low-dose applications a day. The daily high-dose and multiple low-dose exposures had approximately equal capabilities of eliciting allergic contact dermatitis. According to this study, particular care must be taken in the risk assessment of products containing MDBGN that may be applied to the skin several times in one day. Examples of this could be occupationally used products, like soaps and hand-care products. The aim of the third trial was to investigate whether skin with previous dermatitis elicited by MDBGN showed an augmented response when re-exposed to the allergen. Challenge was performed both by patch testing and in a use test with an MDBGN-containing soap. Areas of allergic contact dermatitis were elicited on the back and on the arms of 17 MDBGNsensitized individuals. After one month, the previously eczematous areas were challenged with MDBGN. On the back of the subjects, the test sites were patch tested with a serial dilution of MDBGN and a use test was performed on the arms with an MDBGN-containing soap. A statistically significant augmented patch test response was seen on the back areas with previous dermatitis. 9 patients developed dermatitis on the arms from exposure to the MDBGN-containing soap in the use test. Of these, 8 had an augmented response on the areas with prior allergic contact dermatitis. Even though allergic contact dermatitis appears healed, an increased reactivity to exposure from the allergen that elicited the pre-existing dermatitis is present. In summary it was concluded that 1) MDBGN in rinse-off products can elicit allergic contact dermatitis in sensitized individuals, 2) multiple daily exposures to MDBGN appear to accumulate, and 3) skin areas with previous allergic contact dermatitis from MDBGN are hyperreactive to re-exposure both by patch testing and in a use test even though the skin appears clinically healed. Forum for Nord Derm Ven Vol. 10, 2005 – Suppl. 8
Page 1 and 2: Contact allergy to the preservative
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Page 27: 42. Senff H, Exner M, Gortz J, Goos

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