Mari-Ann Flyvholm

Formaldehyde-releasers: relationship to formaldehyde contact allergy. Contact allergy to formaldehyde and inventory of formaldehyde-releasers

This is one of series of review articles on formaldehyde and formaldehyde‐releasers (others: formaldehyde in cosmetics, in clothes and in metalworking fluids and miscellaneous). Thirty‐five chemicals were identified as being formaldehyde‐releasers. Although a further seven are listed in the literature as formaldehyde‐releasers, data are inadequate to consider them as such beyond doubt. Several (nomenclature) mistakes and outdated information are discussed. Formaldehyde and formaldehyde allergy are reviewed: applications, exposure scenarios, legislation, patch testing problems, frequency of sensitization, relevance of positive patch test reactions, clinical pattern of allergic contact dermatitis from formaldehyde, prognosis, threshold for elicitation of allergic contact dermatitis, analytical tests to determine formaldehyde in products and frequency of exposure to formaldehyde and releasers. The frequency of contact allergy to formaldehyde is consistently higher in the USA (8–9%) than in Europe (2–3%). Patch testing with formaldehyde is problematic; the currently used 1% solution may result in both false‐positive and false‐negative (up to 40%) reactions. Determining the relevance of patch test reactions is often challenging. What concentration of formaldehyde is safe for sensitive patients remains unknown. Levels of 200–300 p.p.m. free formaldehyde in cosmetic products have been shown to induce dermatitis from short‐term use on normal skin.

Nickel content of food and estimation of dietary intake

ZusammenfassungEs wird zusammenfassend über den Nickelgehalt von Lebensmitteln berichtet. Ein gründliches Wissen darüber ist von Bedeutung, da die Dermatologen der Ansicht sind, daß das Wiederauftreten von Handekzemen auf perorale Nickelaufnahme zurückgeführt werden kann. Das Überhandnehmen der Nickelallergie in der dänischen Bevölkerung ist bei Frauen 10% und bei Männern 2%. Die Nickelaufnahme durch die dänische Kost wird durchschnittlich auf 150 μg/Person/Tag geschätzt. Wurzelgemüse und anderes Gemüse, Mehl, Grütze und Brot tragen zum Nickelgehalt in der Kost relativ viel bei. Spezielle Lebensmittel, wie Kakao und Schokolade, Sojabohnen, Haferflocken, Nüsse und Mandeln, frische und getrocknete Hülsenfrüchte, haben hohe Nickelgehalte. Der Verzehr dieser Produkte in größeren Mengen kann die Nickelaufnahme bis zu 900 μg/Person/Tag oder mehr erhöhen. Dieses ist innerhalb des Bereiches von 600-5 600 μg Nickel, der das Handekzem provozieren kann, wenn es als einzelne Dosis als Nickelsulphat gegeben wird. Die Frage ist, ob Nickel in der Kost Handekzeme provozieren kann. Dieses kann nur und sollte auch durch Studien über Diäten mit wenig bzw. viel Nickel aufgeklärt werden.SummaryNickel contents of foods are reviewed. A thorough knowledge of nickel in food is of new relevance. Among dermatologists it is a general opinion that flare of hand eczema can occur after per oral nickel exposure. The prevalence of nickel allergy in the Danish population is 10% for women and 2% for men. Nickel intake from the Danish diet is estimated as 150 μg/person/day on average. Roots and vegetables, meal, grain and bread relatively supply the average diet with much nickel. Certain food items, e.g. cocoa and chocolate, soya beans, oatmeal, nuts and almonds, fresh and dried legumes, have very high nickel contents. Consumption of these items in larger amounts may increase the nickel intake to 900 μg/person/day or more. Within the range of 600-5,600 μg of nickel may provoke hand eczema, when given in single doses as nickel sulphate. An obvious question is thus whether nickel in the diet can cause flare of hand eczema. This should and can only be established by provocation studies with low-level nickel diets combined with a single food having a high nickel content.

Formaldehyde-releasers in cosmetics: relationship to formaldehyde contact allergy

This is the second part of an article on formaldehyde‐releasers in cosmetics. The patch test relationship between the releasers in cosmetics to formaldehyde contact allergy is reviewed and it is assessed whether products preserved with formaldehyde‐releasers may contain enough free formaldehyde to pose a threat to individuals with contact allergy to formaldehyde. There is a clear relationship between positive patch test reactions to formaldehyde‐releasers and formaldehyde contact allergy: 15% of all reactions to 2‐bromo‐2‐nitropropane‐1,3‐diol and 40–60% of the reactions to the other releasers are caused by a reaction to the formaldehyde in the test material. There is only fragmented data on the amount of free formaldehyde in cosmetics preserved with formaldehyde donors. However, all releasers (with the exception of 2‐bromo‐2‐nitropropane‐1,3‐diol, for which adequate data are lacking) can, in the right circumstances of concentration and product composition, release >200 p.p.m. formaldehyde, which may result in allergic contact dermatitis. Whether this is actually the case in any particular product cannot be determined from the ingredient labelling. Therefore, we recommend advising patients allergic to formaldehyde to avoid leave‐on cosmetics preserved with quaternium‐15, diazolidinyl urea, DMDM hydantoin, or imidazolidinyl urea, acknowledging that many would tolerate some products.

Hand eczema: prevalence and risk factors of hand eczema in a population of 2274 healthcare workers.

Background. Healthcare workers are at increased risk of developing hand eczema.

Formaldehyde-releasers in cosmetics: relationship to formaldehyde contact allergy Part 1. Characterization, frequency and relevance of sensitization, and frequency of use in cosmetics

In this part of a series of review articles on formaldehyde‐releasers and their relationship to formaldehyde contact allergy, formaldehyde‐releasers in cosmetics are discussed. In this first part of the article, key data are presented including frequency of sensitization and of their use in cosmetics. In Europe, low frequencies of sensitization have been observed to all releasers: 2‐bromo‐2‐nitropropane‐1,3‐diol 0.4–1.2%, diazolidinyl urea 0.5–1.4%, imidazolidinyl urea 0.3–1.4%, quaternium‐15 0.6–1.9% (for DMDM hydantoin no recent data are available). All releasers score (far) higher prevalences in the USA; the possible explanations for this are discussed. The relevance of positive patch test reactions has been insufficiently investigated. In the USA, approximately 20% of cosmetics and personal care products (stay‐on products: 17%, rinse‐off products 27%) contain a formaldehyde‐releaser. The use of quaternium‐15 is decreasing. For Europe, there are no comparable recent data available. In the second part of the article, the patch test relationship of the releasers in cosmetics to formaldehyde contact allergy will be reviewed and it will be assessed whether products preserved with formaldehyde‐releasers may contain enough free formaldehyde to pose a threat to individuals who have contact allergy to formaldehyde.

Self‐reported hand eczema in a hospital population

Occupational skin diseases are frequent in the healthcare sector. The objective of this study was to obtain baseline data on hand eczema and risk factors for hand eczema in an unselected hospital population. A questionnaire study on hand eczema and risk factors for hand eczema was performed among hospital employees at a middle‐size Danish hospital. A total of 1909 employees from all job groups and all departments were included. Response rate was 65.3%. The overall frequency of self‐reported hand eczema within the past 12 months was 23%. Divided into job groups, the frequencies varied from 8% to 32% and were significantly higher among assistant nurses (32%), nurses (30%), and nursing aids (27%). For the individual departments, the hand eczema frequencies varied from 7% to 50%, with the highest frequencies reported at medical and surgical wards. Occupational risk factors for hand eczema such as use of protective gloves and hand washing were significantly more frequent among respondents with hand eczema within the past year, which suggests a potential for prevention through workplace interventions. In conclusion, high frequencies of hand eczema were observed among assistant nurses, nurses, and nursing aids. Hand eczema was more frequent among women and in the younger age groups.

Isothiazolinones in commercial products at Danish workplaces

In recent years, a steep increase in the frequency of occupational contact allergy to isothiazolinones has been reported from several European countries.

Formaldehyde-releasers: relationship to formaldehyde contact allergy. Part 2. Formaldehyde-releasers in clothes: durable press chemical finishes.

This is one of a series of review articles on formaldehyde‐releasers and their relationship to formaldehyde contact allergy and in this paper formaldehyde‐releasers used as durable press chemical finishes (DPCF) in textiles are discussed. The literature on allergy to DPCF since 1980 is presented in two parts. Part 1 (this article) presents a short historical overview of the problems with formaldehyde in clothes and discusses the chemistry of durable press chemical finishes, legislation in various countries, and studies on the amount of formaldehyde present in clothes. In addition, the DPCF that have caused contact allergy are presented with CAS, synonyms, molecular formula, chemical structure, applications, and patch test studies. In the forthcoming part 2, the frequency of sensitization to DPCF, occupational contact sensitization, relevance of patch test reactions, and relationship to formaldehyde contact allergy will be reviewed, followed by a discussion of both parts of the article together.

A quantification of occupational skin exposures and the use of protective gloves among hairdressers in Denmark

Background. Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals.

Occupational allergic contact dermatitis diagnosed by a systematic stepwise exposure assessment of allergens in the work environment

Information on the presence of contact allergens and irritants is crucial for the diagnosis of occupational contact dermatitis. Ingredient lists and Material Safety DataSheets (MSDSs) may be incomplete.