W. G. van Ketel

Reactions in selected patients to 22 fragrance materials

182 patients on the basis of 6 criteria were suspected of suffering from contact sensitization to cosmetics. 77 (42%) gave a positive reaction to one or more of a series of 22 fragrance and flavor raw materials. The hands were most often involved. Cinnamic alcohol, hydroxycitronellal, eugentol, coumarin, and abitol gave the most common positive reactions; less frequent were cinnamic aldehyde, dihydrocoumarin and dimethylcitraconate. Their relevance could not be traced. However, the first 4 substances were the most frequently identified in 79 suspected cosmetics sent in for analysis by the patients or their physicians. The stability of room‐stored petrolatum‐fragrance mixtures should be checked.

Contact urticaria from rubber gloves after dermatitis from thiurams

In 41 volunteers who were not Type IV allergic to cinnamic aldehyde or eugenol, the 2 chemicals were tested each at 2%, alone and combined, with petrolatum control. Skin contact was 30 min by occlusion on the forearm with Epitest Finn chambers on Scanpor tape, reading the result immediately after removal and up to 60 min afterwards. There were no reactions to eugenol. The 23 who reacted to cinnamic aldehyde showed urticaria in 10, moderate erythema in 10, and minimal erythema in II, but the combined cinnamic aldehyde/eugenol showed a diminished reaction compared to cinnamic aldehyde alone, in 6 out of the 10 with urticaria and 3 out of the 9 erythematous responders. Guin et al. (I) have reported similar results. The diminishing effect of eugenol was apparent when applied to the skin from 75 min to just before the cinnamic aldehyde immediate test; washing off the eugenol before the cinnamic aldehyde immediate test did not obviate it unless this was done less than 4 min after the eugenol was applied. Cinnamic aldehyde 5% in acetone, polyethylene glycol 400 (70:30) applied to the guinea pig ear caused a dose-related immediate oedema to us and erythematous response which was maximal approximately 60 min after challenge. Addition of eugenol 5% to cinnamic aldehyde 5% resulted in a complete inhibition of the response observed with cinnamic aldehyde alone. We suggest that quenching of the induction of Type-IV sensitization by eugenol (2) maybe related to the diminution of the inflammatory response produced by the combined cinnamic aldehyde/eugenol mixture compared to that from cinnamic aldehyde alone.

Sensitization to povidone-iodine.

Eight patients are described with adverse skin reactions to povidone-iodine-containing preparations (Betadine). Patch test reactions were positive to povidone-iodine 5 or 10 per cent in petrolatum or to Betadine Solution, Ointment, or Scrub. In five of eight patients, also tested with potassium iodide in concentrations ranging from 5 to 20 per cent in petrolatum, the reactions were negative. Open tests with iodine tincture performed in three patients were completely negative. Allergy to povidone-iodine seems not to be based on sensitization to iodine.

The Problem of the Sensitization to Dithiocarbamates in Thiuram-Allergic Patients

Because of the occurrence of hand dermatitis in members of a surgical staff due to allergy to thiuram-containing rubber gloves, an investigation was performed about cross-sensitization between thiuram

Sensitization to olive oil (olea europeae)

Sensitization to olive oil is seldom reported in the literature. By use of epiculaneous tests a delayed type of hypersensitivity to pure freshly‐prepared olive oil could be demonstrated in two patients. Patch tests with certain major constituents of olive oil; the methyl ester of linoleic acid, the glyceryl ester of palmitic acid, the glyceryl ester of stearic acid, glyceryl trioleate and glycerids of arachidic acid, appeared to be negative. In one patient a weak, reaction to balsam of Peru was found, ft is concluded that Sensitization to olive oil must be taken into consideration, especially when it is used as a vehicle in patch testing.

Sensitization to benomyl and related pesticides

Occupational contact dermatitis to chemicals as ingredients of pesticides seems to be rare considering the extent of their use (I). One reason has been given by Fregert (2) who described a patient with allergic dermatitis from 2 pesticides including benomyl. In his patient, dermatitis was short-lived because of discontinous spreading. This fact may apply in general to all growers. Furthermore, growers frequently change their use of different types of pesticide. When looking in a growers store of pesticides, I 0 or more different pesticides may be present, to be used at different times. Even workers in a nursery (and of course florists) often have not the slightest idea which pesticides have been spread. It is amazing that only a few cases have been reported of simultaneous sensitization to 2 or more pesticides. We report 3 new cases of sensitivity to benomyl (Ben late®, methyl-1butylcarbamoyl-2-benzimidazole carbamate) (Fig. I) in combination with simultaneous sensitization to other pesticides in 2 patients. The patients were tested with benomyl I % in pet. After testing with this concentration, no skin reactions were seen in 10 control persons by van Ketel (3), who reported benomyl sensitization in a man growing mainly begonias.

Sensitivity to the pesticide benomyl

(Bojs & Moller 1974), patients 1 to 3 are also considered truly allergic to this antibiotic. The great liability of this patient category to become sensitized to a variety of contactants is also illustrated in the table. Patients 5 and 6 showed weak reactions to the ointment in spite of strong reactions to the ingredient(s). This may be due to the histamineliberating property of polymyxin B, which can influence the development of a delayed hypersensitivity reaction (Magnusson 1963). The addition of an antihistamine to intracutaneously injected polymyxin B results in an increased expression of delayed allergy (Bjorkner & Moller 1973). 1

Skin Testing in Chronic Urticaria

In 164 patients with chronic recurrent urticaria, the value of skin tests was investigated, Patch tests carried out with the standard series of the International Contact Dermatitis Research Group and with a series of penicillins revealed positive reactions in 22 (35/162) and 6.9% (11/158), respectively. IN 21.5% (33/152) positive intracutaneous tests to cilligen and/or penicillin G were observed. 35% (51!147) of the patients had one or more positive intracutaneous tests with inhalants. Scratch tests with food allergens showed positive reactions in 12.5% (12/95). There was no difference in results between patients with idiopathic urticaria or angio-oedema and those with physical urticaria. The value of these findings is discussed. Most of the patients with penicillin allergy, were recommended to be on a diet free from milk and milk products. In 50% this was successful.

Chelating effect of EDTA on nickel

The chelating effect of disodium ethylenediamine tetra‐acetate (EDTA) in nickel‐allergic patients was investigated. After pretreatment of the right half of the patients back with 10% EDTA in a cream, and the left half of the back with the cream base only, various concentrations of nickel sulphate were patch tested on these areas. The blocking effect of the 10% EDTA cream appeared to be significant in comparison with that of the cream base only (p < 0.01).

Dermatitis from an aftershave.

A barber, aged 32, developed a contact dermatitis localized to the dorsa of the fingers. All reactions to patch tests with ICDRG standard series, plastics and glues, dyes and disinfectants were negative. The patient was also tested with 10 cosmetics which he used frequently. Only one positive reaction (to an aftershave) was obtained. Further patch testing with 22 perfume ingredients showed positive reactions to methyl heptine carbonate (0.5 % pet.), hydroxycitronellal (10 % pet.) and cinnamic alcohol (5 % pet.). By thin layer chromatography, column chromatography and gas chromatography all three fragrance compounds appeared to be demonstrable in the aftershave. As Larsen (1975) stated, it is possible that other, not tested, perfume ingredients might be sensitizers in cases of perfume dermatitis. This author describes the possibility of interaction of fragrance ingredients and oxidation or reduction of non-allergenic compounds resulting in sensitizing substances. While hydroxycitronellal and cinnamic alcohol are well-known sensitizers (Larsen 1977), methyl heptine carbonate is not mentioned as a sensitizer in many series of perfume ingredients, although it was reported earlier.