Patch testing with sodium disulfite: North American Contact Dermatitis Group experience, 2017 to 2018

Abstract

Background Sodium disulfite (SD), also known as sodium metabisulfite, is an increasingly recognized cause of allergic contact dermatitis. Objectives The objective of this work was to characterize individuals with positive patch test reactions to SD as well as analyse reaction strength, clinical relevance, and sources. Methods This is a retrospective analysis of patients patch tested with SD (1% petrolatum) by the North American Contact Dermatitis Group (NACDG), 2017 to 2018. Results Of 4885 patients patch tested with SD, 132 (2.7%) had a positive reaction. Common primary anatomic sites of dermatitis were face (28.8%), hands (20.5%), and a scattered/generalized distribution (13.6%). Compared with SD‐negative patients, SD‐positive patients were more likely male (odds ratio 2.81, 95% confidence interval 1.98‐4.00) and/or over 40 years (odds ratio 1.95, 95% confidence interval 1.30‐2.94). Reactions were most commonly + (50.4%) or ++ (34.1%); 65.2% were considered currently relevant. About 15.2% were definitively confirmed in sources, commonly personal care products (18.9%, especially hair dye), and drugs/medications/alcoholic beverages (9.1%). Only 2.3% of positive reactions were linked to occupation. Conclusions Positive reactions to SD occurred in 2.7% of tested patients. Reactions were often clinically relevant and linked to personal care products and drugs/medications/alcoholic beverages.

Acute allergic contact dermatitis caused by sulphites in a cosmetic and a pharmaceutical cream

“…Sulphites are widely used for their antioxidant and preservative properties, notably in pharmaceuticals and personal care products. [1][2][3] Even though sulphites are recognised as contact allergens, their relevance in cases of acute contact dermatitis can rarely be labelled as definite. [1][2][3][4][5] We present a case of acute facial contact dermatitis caused by a cosmetic cream designated for 'sensitive' skin and aggravated by a pharmaceutical cream.…”

Occupational allergic contact dermatitis to sodium metabisulfite in shredded coconut

“…Patch testing is integral in the workup of chronic occupational hand dermatitis. Sodium metabisulfite (SMS) is used both in the food and drug industries, primarily as a preservative, but also as an antioxidant and bleaching agent 1,2 . Reports of allergic contact dermatitis (ACD) to SMS reflect these exposures, primarily with occupational cases in food workers and non‐occupational cases among individuals using SMS‐containing topical medicaments, cosmetics or intralesional or intravenous anaesthetics 3–5 .…”

“…Reports of allergic contact dermatitis (ACD) to SMS reflect these exposures, primarily with occupational cases in food workers and non‐occupational cases among individuals using SMS‐containing topical medicaments, cosmetics or intralesional or intravenous anaesthetics 3–5 . It has recently been added to the North American Contact Dermatitis Group Series (NACDG) and been considered as an addition to the European baseline series 1,6 . Interpretation of positive SMS patch tests and patient education can be challenging, as relevance can be difficult to ascertain.…”

“…Sodium metabisulfite (SMS) is used both in the food and drug industries, primarily as a preservative, but also as an antioxidant and bleaching agent. 1,2 Reports of allergic contact dermatitis (ACD) to SMS reflect these exposures, primarily with occupational cases in food workers and nonoccupational cases among individuals using SMS-containing topical medicaments, cosmetics or intralesional or intravenous anaesthetics. [3][4][5] It has recently been added to the North American Contact Dermatitis Group Series (NACDG) and been considered as an addition to the European baseline series.…”

“…[3][4][5] It has recently been added to the North American Contact Dermatitis Group Series (NACDG) and been considered as an addition to the European baseline series. 1,6 Interpretation of positive SMS patch tests and patient education can be challenging, as relevance can be difficult to ascertain.…”