<i>N</i>,<i>N</i>‐dimethylacrylamide—A new sensitizer in the FreeStyle Libre glucose sensor

Mowitz, Martin; Herman, Anne; Baeck, Marie; Isaksson, Marléne; Antelmi, Annarita; Hamnerius, Nils; Pontén, Ann; Bruze, Magnus

doi:10.1111/cod.13243

Cited by 71 publications

(82 citation statements)

References 18 publications

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“…Four of the five patients had previously worn a FreeStyle sensor before wearing the Enlite glucose sensor or insulin infusion set; therefore, primary sensitization to IBOA from the former was suspected. The exposure time for the FreeStyle Libre sensor is much longer and the concentration of IBOA in it appears to be higher compared with the Enlite sensor or insulin infusion set . Patient 4 who reacted to colophonium (and the derivative glyceryl rosinate) but not to IBOA had never used a Freestyle sensor.…”

Section: Discussionmentioning

confidence: 99%

Allergic contact dermatitis caused by isobornyl acrylate in the Enlite glucose sensor and the Paradigm MiniMed Quick‐set insulin infusion set

et al. 2019

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Background: The FreeStyle Libre glucose sensor has caused many cases of allergic contact dermatitis, and isobornyl acrylate (IBOA) in this sensor has been identified as one of the culprit allergens.Objectives: To report on the presence of IBOA in devices produced by Medtronic, namely, the Enlite sensor and the insulin infusion set Paradigm MiniMed Quick-set. Patients and Methods: Five patients reacting to the glucose sensor Enlite and/or the insulin infusion set Paradigm MiniMed Quick-set observed in three clinics (two Belgian and one Swedish) were patch tested with the baseline and other series, as well as with IBOA; four of them also with pieces of adhesive patches from the devices, and two with a thin layer chromatogram of Enlite glucose sensor extracts. Gas chromatography-mass spectrometry (GC-MS) analyses were performed.Results: Four patients reacted to IBOA and one to colophonium, a known allergen in Enlite, and three to the adhesive part of the sensor or the insulin infusion set. IBOA was identified in the sensor by GC-MS, and its presence was indicated in the infusion set.Conclusions: IBOA is a contact allergen in Enlite glucose sensor, and likely also in the infusion set. Therefore, these devices are not suitable alternatives for patients sensitized to the FreeStyle Libre sensor.acrylates, allergic contact dermatitis, delayed hypersensitivity, glucose sensor, insulin pump, isobornyl acrylate, medical device

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Section: Discussionmentioning

confidence: 99%

Allergic contact dermatitis caused by isobornyl acrylate in the Enlite glucose sensor and the Paradigm MiniMed Quick‐set insulin infusion set

et al. 2019

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“…Several cases of ACD due to the glucose sensor FreeStyle Libre have previously been reported . To our knowledge, this is the first case of acquired leukoderma following sensitization to FreeStyle Libre.…”

Section: Discussionmentioning

confidence: 99%

“…Several chemicals have been reported to cause depigmentation. Hitherto, neither IBOA nor DMAA, the two potent sensitizers used in the glucose sensor, have been described as causing depigmentation. However, medical devices with adhesives have been reported to cause hypopigmentation, as have some acrylates .…”

Section: Discussionmentioning

confidence: 99%

Induction of leukoderma following allergic contact dermatitis to FreeStyle Libre

2019

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K E Y W O R D S : allergic contact dermatitis, case report, FreeStyle Libre, glucose sensor, hydroquinone monomethyl ether, hypopigmentation, isobornyl acrylate, leukoderma, medical device Isobornyl acrylate (IBOA) is a potent contact sensitizer contained in the glucose sensor FreeStyle Libre. 1 Many cases of allergic contact dermatitis (ACD) have already been described in this regard. We herein describe a case of ACD caused by IBOA and followed by hypopigmentation in the application areas of this sensor. | CASE REPORTA 35-year-old woman with diabetes mellitus type 1 was referred to our department with pruritic annular erythematous dermatitis under an adhesive patch of the glucose sensor FreeStyle Libre fixed to the inner side of her arm. These lesions occurred following 5 months of sensor use. Approximately 6 months later, hypopigmentation appeared on the periphery of the area of dermatitis, where sensors had been applied, and on the inner side of both arms (Figure 1A, B). There was no hypopigmentation on any other part of her body, and there was no personal or family history suggesting an autoimmune disease, such as vitiligo. She had never applied corticosteroid cream or hydrocolloid dressings between the sensor and skin. She was patch tested with the European baseline series, an acrylate, plastic, and glue series (Chemotechnique Diagnostics, Vellinge, Sweden; and Trolab; Almirall Hermal, Reinbek, Germany, respectively), a piece of the adhesive patch of the glucose sensor "as is"; IBOA (Sigma-Aldrich, Steinheim, Germany, 0.1% pet. and prepared by the hospital pharmacy [Saint-Luc]); and N,N-dimethylacrylamide (DMAA; Sigma-Aldrich and prepared by the Department of Occupational and Environmental Dermatology in Malmö) 0.1% pet. Patch tests were performed using IQ Ultra test chambers (Chemotechnique Diagnostics) and fixed with Fixomull stretch (BSN Medical, Hamburg, Germany) on the upper back. Readings were performed on day (D) 2 and D4. The patch test reactions were classified according to ESCD criteria. 2 A positive reaction was observed for both IBOA (+/++) and DMAA (+/+), as well as for the adhesive part of FreeStyle Libre (+/?+; Figure 1C). A biopsy of the depigmented area showed a complete absence of epidermal melanocytes, which was confirmed via immunohistochemistry using SOX10 labeling. 456HERMAN ET AL.

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“…By the use of ordinary Finn Chambers, she was then tested with aluminium chloride hexahydrate 10% pet., colophonium 20% pet., hydroabietyl alcohol 10% pet., abietic acid 10% pet., and an ultrasonic bath extract of 10 FCA filter papers. She was also tested with an aimed series for glucose sensor‐related substances; this testing is reported elsewhere . Patch tests were performed as in case 1.…”

Section: Case Reportsmentioning

confidence: 99%