Continuous usage of a hair dye product containing 2‐methoxymethyl‐para‐phenylenediamine by hair‐dye‐allergic individuals

Abstract

Funding sourcesNone. Conflicts of interest SummaryBackground Despite a positive patch test reaction to para-phenylenediamine (PPD) and/or toluene-2,5-diamine (PTD), many people attempt to continue dyeing their hair with products containing PPD or its derivatives. Objectives Investigation of elicitation reactions among PPD/PTD-allergic individuals to hair dye products containing the less sensitizing PPD derivative 2-methoxymethyl (ME)-PPD. Methods Elicitation reactions were studied in 43 PPD/PTD-allergic individuals by a 45-min pretest with an ME-PPD-containing hair dye on their forearm. Upon a negative result this was followed by exposure to subsequent hair colour treatment(s). Results Overall, 38 of 43 PPD/PTD-allergic individuals did not develop an elicitation reaction during the pretest with ME-PPD-containing hair dye products, and were eligible for subsequent hair colour treatments. Of these 38 PPD/PTD-allergic individuals, 29 tolerated subsequent hair dyeing with ME-PPD-containing hair dye products, while seven showed mild and two showed moderate/marked allergic reactions upon the first hair colour treatment. Conclusions Hair dye products with the less sensitizing ME-PPD were tolerated by 29 of 43 (67%) PPD/PTD-allergic individuals throughout continued hair dyeing with an average of nine treatments per year. Five individuals reacted upon pretesting, while only mild-to-moderate/marked skin reactions occurred upon hair dyeing in nine individuals who were not identified by the pretest. To our knowledge this is the first study among PPD/PTD-allergic individuals indicating that a negative 45-min pretest with a hair dye product helps to avoid severe allergic reactions.

Cross‐elicitation responses to 2‐methoxymethyl‐p‐phenylenediamine in p‐phenylenediamine‐allergic individuals: Results from open use testing and diagnostic patch testing

“…Together with our findings, these data suggest that an individual threshold for cross-elicitation to ME-PPD exists in PPD-allergic subjects. We assume that the skin site-specific occurrence of the cross-elicitation responses to ME-PPD between forearm and back (in the present study) or scalp (in the study from Kock et al 13 ) is related to the presence of (sufficient) residual memory T cells. Similar findings have been reported for patients with allergy to nickel: a rapid response to nickel only occurred after re-exposure to nickel on the exact body site that had been previously exposed, and the magnitude of the elicitation responses correlated with local recruitment of epidermal CD8 + T cells.…”

“…In line with previous studies on ME‐PPD, our hair dye open use and patch test data further support the recommendation for hair dye‐allergic individuals to avoid hair colouring, because cross‐elicitation responses to ME‐PPD cannot be excluded …”

“…In agreement with the present results, a study from Kock et al investigating cross-elicitation reactions to repeated hair dyeing with ME-PPD in PPD-allergic and/or TDA-allergic individuals showed that 29 of 43 were able to tolerate repeated hair colouring with an average of 9 treatments per year. 13 In that study, 9 subjects did not react to the initial 45-minute open use test on the forearm, and 7 of them developed allergic contact dermatitis symptoms during the first hair colouration with ME-PPD. Together with our findings, these data suggest that an individual threshold for cross-elicitation to ME-PPD exists in PPD-allergic subjects.…”

“…and patch test data further support the recommendation for hair dyeallergic individuals to avoid hair colouring, because cross-elicitation responses to ME-PPD cannot be excluded. 7,10,13 Despite intensive investigations, the precise hapten responsible for PPD allergy has not been identified. 15 Considering that induction of sensitization with PPD has been shown to be dependent on duration of exposure, 16 PPD oxidation to protein reactive auto-oxidation products such as Bandrowski's base may be involved in elicitation.…”

Advice for patients with hair dye allergy remains ‘stop using permanent hair dyes’

“…In this current study, patients known to be allergic to permanent hair dye, through a positive diagnostic patch test with p‐phenylenediamine, continued dyeing their hair with a preparation containing (ME)‐PPD . The patients first underwent an open skin test of the dye preparation.…”