Allergic contact dermatitis caused by self‐adhesive electrocardiography electrodes in an infant

Deswysen, Anne-Catherine; Zimerson, Erik; Goossens, An; Bruze, Magnus; Baeck, Marie

doi:10.1111/cod.12137

Cited by 23 publications

(16 citation statements)

References 8 publications

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“…The presence of plant materials in medical devices has already been reported, for example, concerning ACD caused by self‐adhesive electrocardiography electrodes in a young girl . In this case, positive patch test reactions to Compositae mix, but not to SLM components, were noted; chromatographic analysis confirmed the presence of herbal extracts in the adhesive part of the electrodes (not specified).…”

Section: Discussionmentioning

confidence: 51%

Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

et al. 2019

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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

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Section: Discussionmentioning

confidence: 51%

Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

et al. 2019

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“…Recently, Herman and Goossens emphasized the need to disclose composition of medical devices in Europe by mentioning the new regulation (EU 2017/745) that will be fully applicable by May 2020 . Full ingredient declaration and labeling of medical devices are mandatory, but the presence of impurities should not be overlooked, as hidden allergens could contaminate the final product . In this report, ACD to ECG electrodes was caused by monomeric acrylic acid present as an impurity in the hydrogel part, as showed by negative patch test reactions to its declared components, including poly‐acrylic acid.…”

Section: Discussionmentioning

confidence: 92%

“…Numerous and heterogeneous components of medical devices may cause allergic contact dermatitis (ACD) . Among medical devices used in cardiology, electrocardiogram (ECG) electrodes can cause ACD and many allergens have been reported, for example (meth)acrylates and non‐acrylate components such as propylene glycol, p‐tert ‐butylphenol formaldehyde resin, nickel and rarely hidden allergens (eg, [modified] colophonium or acrylic acid monomers) . In this work, a new case of ACD caused by monomeric acrylic acid (2‐propenoic acid) (CAS no.…”

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confidence: 99%

Contact sensitivity to electrocardiogram electrodes due to acrylic acid: A rare cause of medical device allergy

et al. 2019

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“…Adhesive manufacturers can modify colophonium with different processes, depending on the desired quality of the final product . Unmodified colophonium is a well‐known sensitizer, and it can also be used in the manufacture of medical adhesives . Hydrogenated modified colophonium seems to be a less strong sensitizer; however, once oxidized, it becomes a strong sensitizer .…”

Section: Discussionmentioning

confidence: 99%

Allergic contact dermatitis caused by Finn Chambers AQUA in two patients

2018

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K E Y W O R D S : allergic contact dermatitis, case report, colophonium Adhesives are widely used in medical material, and may cause allergic contact dermatitis (ACD). It is important to know the full composition of medical material to avoid iatrogenic ACD in sensitized patients.Over time, colophonium and rubber components have been replaced by other adhesives to avoid ACD. 1 CASE REPORTSWe report on a 15-year-old child with a history of ACD caused by colophonium contained in adhesive bandage, and an 83-year-old woman with a history of ACD caused by colophonium contained in a hydrocolloid dressing. Both patients were patch tested with Finn Chambers AQUA (FCA). Both patients showed erythema and oedema under every chamber on day (D) 2 and D4 (Figures 1 and 2A). Later, components of FCA, plastics and the glue series (Martitor, Barcelona, Spain) were patch tested by the use of Curatest (Lohmann & Rauscher, Neuwied, Germany). We observed positive reactions to colophonium, abietic acid and the 3M transfer adhesive of FCA (used to fix the filter papers to the aluminium chambers) in both patients on D2 and D4 (Figure 2B).Patch testing with Finn Chambers was performed, and no reaction was observed. Information on the adhesives used in FCA was requested from the manufacturer, and the adhesive used to fix the filter papers to the aluminium chambers did indeed contain modified colophonium. DISCUSSIONColophonium is a complex mixture of >100 different compounds, and its main component is abietic acid. 2,3 Adhesive manufacturers can modify colophonium with different processes, depending on the desired quality of the final product. 4 Unmodified colophonium is a well-known sensitizer, and it can also be used in the manufacture of medical adhesives. 2,5 Hydrogenated modified colophonium seems to be a less strong sensitizer; however, once oxidized, it becomes a strong sensitizer. 4 Unmodified colophonium 20% pet. is present in most baseline series. However, it may be difficult to diagnose ACD caused by modified colophonium, because not all possible sensitizers are included in the baseline series. 6 We present two cases of ACD caused by Finn Chambers AQUA.Recently, two cases of contact allergic reactions to FCA have already been described. The authors analysed extracts of the FCA by using gas chromatography-mass spectrometry, and colophonium-related substances were identified. 7 After the cases had been reported to the manufacturer, the adhesive used in the FCA was replaced. Our patients and one of the cases published by Hamnerius et al 7 have been retested with this new FCA, and no reactions were observed.In conclusion, physicians and consumers need to know the exact composition of materials used in medical devices to avoid applying sensitizers. 2 Furthermore, communication between physicians and manufacturers is essential to improve the quality and security of the medical devices. ACKNOWLEDGEMENTSWe would to thank the manufacturer for collaborating with us. CONFLICTS OF INTERESTThe authors have no conflicts of interest to report. ...

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Allergic contact dermatitis caused by self‐adhesive electrocardiography electrodes in an infant

Cited by 23 publications

References 8 publications

Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

Contact sensitivity to electrocardiogram electrodes due to acrylic acid: A rare cause of medical device allergy

Allergic contact dermatitis caused by Finn Chambers AQUA in two patients

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