Patch test results to extracts of synthetic garments in textile dye positive patients

Abstract

Background Disperse dyes (DDs) are the most prevalent causes of textile‐related allergic contact dermatitis and are used for colouring synthetic textile materials based on fibres such as polyester, acrylic, acetate and polyamide. Eight DDs are included in a textile dye mix (TDM) 6.6% petrolatum (pet.) in the European baseline patch test series. Objectives The aim of this study was to patch test TDM 6.6% pet. positive individuals with the extracts of synthetic fibre clothes that do not contain any of the pure DDs present in the TDM 6.6% to study the reactivity pattern. Methods Seventy‐three TDM‐positive former patients tested between 2012 and 2017 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were invited to join the study, 10 participated. Twenty‐four textile items (collected in nine countries in Europe, Asia and North America in 2012) were extracted in dichloromethane. The TDM 6.6% was patch tested simultaneously with the 24 textile item preparations in petrolatum made from the extracts. Prior to patch testing the participants filled the 7‐question questionnaire regarding possible symptoms from textile exposure. Results Ten individuals, agreed to join the study. Eight of them reacted to TDM 6.6%. Nine participants reacted to 20 of 24 extracts. One reacted to 19 extracts, another to 14, 3 to 5 extracts, 1 to 4, 1 to 3 extracts and 2 to 2 extracts. One was negative to all tested preparations including TDM 6.6%. The participants mainly reacted to six textile extracts. All controls tested negatively to tested extracts. Four individuals of the 10 TDM‐allergic individuals previously had had problems after wearing clothes. Four out of the 10 participants had had atopic eczema in childhood. All women had dyed their hair with permanent hair dyes but none of the males. Conclusion TDM‐positive patients react to textile extracts made from synthetic garments, even if they do not contain any of the pure DDs present in TDM 6.6%. More studies are needed to pin‐point the culprit haptens in these extracts.

Sensitization to textile dyes in Spain: Epidemiological situation (2019–2022)

“…European studies have evaluated the frequency of allergy to TDM in consecutive patients. Prevalence ranges from 0.4% to 6.9%, with an average of 2%–3%, 2,5–12 which is similar to ours. In a nation‐wide study conducted in Italy from 2018 to 2019, Stingeni et al 11 found a lower prevalence of 1.5%, supporting a decreasing trend of contact sensitization to DDs in Italy.…”

“…Apart from that, there were four patients sensitized to a total of five and thus patch tests preparations, may contain impurities, dye precursors, dye metabolites or other chemicals, such as arylamines and halogenated dinitrobenzenes, which might be responsible for the positive reactions to the TDM or specific DDs, due to concomitant sensitization or cross-reactivity. 1,5,22 Considering available information of those cases that were simultaneously tested with both the TDM and its eight separate allergens as part of the textile dye series, in our study only 14.6% (6/41) of the cases would have been missed if patch-tested with the TDM alone. When compared to the entire textile dye series, this proportion would have been 16.7% (7/42).…”

“…Carlsson et al 1 showed that DO 3 was the only allergen of the TDM commonly used in synthetic garments on the Swedish market, whereas Malinauskiene et al 22 observed that the eight DDs of the TDM are very rarely used in textiles worldwide. Chromatography techniques have shown that individual textile dyes, and thus patch tests preparations, may contain impurities, dye precursors, dye metabolites or other chemicals, such as arylamines and halogenated dinitrobenzenes, which might be responsible for the positive reactions to the TDM or specific DDs, due to concomitant sensitization or cross‐reactivity 1,5,22 …”

“…There is further evidence that the TDM is a useful marker of textile contact allergy. Linauskiene et al 5 showed that a group of 9 out of 10 TDM‐positive Swedish patients reacted to textile extracts made from synthetic garments which did not contain pure DDs present in TDM 6.6%, probably because of the abovementioned unknown dye substances, DDs metabolites or impurities. However, Nijman et al 17 found that patch‐testing the TDM alone in a Dutch group with suspected textile ACD would involve missing a substantial amount of dye positive and clinically relevant cases.…”

“…was added to the European baseline series in 2015, 3 and to the Spanish baseline series in January 2022. 4 The mix contains eight DDs, namely Disperse Blue Contact allergy to TDM is widespread in Europe 2,[5][6][7][8][9][10][11] and clinical relevance of positive reactions ranges widely. 9,11 Data concerning both frequency of positivity and relevance, as well as variables linked to positivity, is scarce within the Spanish population.…”