Background: Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series. Objectives: To compile patch test results of subjects affected, and provide potential explanations for this association. Patients and Methods: Fifty-three Freestyle Libre-allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM. Results: Thirty-three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography-mass spectrometry (GC-MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA. Conclusion: Significant co-sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC-MS analysis. Cross-reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist. K E Y W O R D S allergic contact dermatitis, chemical analysis, diabetes mellitus, FreeStyle Libre, GC-MS, glucose sensor, isobornyl acrylate, medical device, sesquiterpene lactones, simultaneous reactions
Cutaneous adverse events (CAE) from FreeStyle Libre include allergic contact dermatitis (ACD) caused by the allergen isobornyl acrylate (IBOA). We aim to report CAE from this glucose sensor, ACD to IBOA in particular, and the outcome of using barrier films as a prevention. RESEARCH DESIGN AND METHODSA monocentric, retrospective review of medical files from adult and pediatric patients with diabetes using Freestyle Libre, in the period between December 2016 and April 2019, was performed with a focus on CAE. RESULTSFifty-seven of 1,036 patients with diabetes (5.5%) were referred to our dermatology department because of CAE from FreeStyle Libre. Thirty-nine of 1,036 (3.8%) had ACD due to IBOA. Only two patients, of whom one sensitized to IBOA, had a benefit from using barrier films. CONCLUSIONSCAE occurred in 5.5% of FreeStyle Libre users, and 3.8% suffered from ACD due to IBOA. Barrier films had limited value in the prevention.FreeStyle Libre (Abbott Diabetes Care, Witney, U.K.) is a sensor-based, flash-continuous glucose monitoring system applied on the skin for up to 14 days (1). However, it contains isobornyl acrylate (IBOA), a newly discovered allergen, which may cause allergic contact dermatitis (ACD) (2-5). We report a single-center experience of cutaneous adverse events (CAE) from this glucose sensor, including ACD due to IBOA, and the outcome of using barrier films as a prevention in these patients. RESEARCH DESIGN AND METHODSThe medical files of 614 adult and 422 pediatric patients with diabetes, using FreeStyle Libre in the period between December 2016 and April 2019, were retrospectively reviewed with a focus on CAE. In our center, patients are usually referred to the dermatology department for an allergy workup, including patch tests with IBOA 0.1% dispersed in petrolatum according to published guidelines (6). Whenever a barrier film (Cavilon No Sting Barrier Film) had been used to prevent the CAE ( 7), applied according to the manufacturers' recommendations, its impact on the CAE was verified.
depressed, white scars, which may represent a diagnostic clue as they are not seen in common EBS subtypes. At ultrastructural level, basal keratinocyte tonofilament clumping can be misleading, as it is typical of dominant severe EBS. The rapid identification of the EXPH5 causative mutation by NGS analysis allowed establishing the correct diagnosis. Our patient is the first Italian case reported with EBS-EXPH5. She carries the frameshift mutation p.Pro1929LeufsTer8, already described in an Iraqi family. 3 Seven additional frameshift/nonsense mutations in EXPH5 gene have been reported to date (Table 1). As compared to EBS due to de novo dominant mutations in keratin genes, the recessive EBS-EXPH5 form has a 25% recurrence risk. Consequently, molecular analysis represents the more accurate approach for genetic counselling of the prospective parents. The patient's parents have given written informed consent to the publication of their child case details. We thank Mr. Gabriele Bacile for iconography preparation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.