A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, t...A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, test results with the individual constituents and after repeated open application test (ROAT) of FM II are described. Furthermore, cosmetic products which had caused a contact dermatitis in patients were analysed for the presence of the individual constituents. In 1701 patients, the individual constituents of the medium (14%) and the highest (28%) concentration of FM II were simultaneously applied with the new mix at 3 concentrations (break-down testing for the lowest concentration of FM II (2.8%) was performed only if the mix was positive). ROAT was performed with the concentration of the FM II which had produced a positive or doubtful (+or ?+) patch test reaction. Patients’products were ana-lysed for the 6 target compounds by gas chromatography-mass spectrometry (GC-MS). Results:50 patients (2.9%) showed a positive reaction to 14%FM II and 70 patients (4.1%) to 28%FM II. 24/50 (48%) produced a positive reaction to 1 or more of the individual constituents of 14%FM II and 38/70 (54.3%) to 28%FM II, respectively. If doubtful reactions to individual constituents are included, the break-down testing was positive in 74%and 70%, respectively. Patients with a positive reaction to 14%FM II showed a higher rate of reactions to the individual constituent of the 28%FM II:36/50 (72%). Positive reactions to individual constituents in pa-tients negative to FM II were exceedingly rare. If doubtful reactions are regarded as negative, the sensitivity, specificity, positive predictive value and negative predictive value for the medium concentration of FM II towards at least 1 individual constituent was 92.3%(exact 95%confidence interval 74.9-99.1%), 98.4%(97.7-99.0%), 48%(33.7-62.6%) and 99.9%(99.6-100.0%), respectively. For the high concentration, the figures were very similar. The frequency of positive reactions to the individual constituents in descending order was the same for both FM II concentrations:hydroxyisohexyl 3-cyclohexene carboxaldehyde(Lyral.)>citral>farnesol>citronellol >αhexyl-cinnamic aldehyde (AHCA). No unequivocally positive reaction to coumarin was observed. Lyralwas the dominant individualconstituent,with positive reactions in 36%of patients reacting to 14%FM II and 37.1%to 28%FM II. 5/11 patients developed a positive ROAT after a median of 7 days (range 2-10). The 5 patients with a doubtful or negative reaction to 28%FM II were all ROAT negative except 1. There were 7 patients with a certain fragrance history and a positive reaction to either 28%or 14%FM II but a negative reaction to FM I. Analysis with GC-MS in a total of 24 products obtained from 12 patients showed at least 1-5 individual constituents per product:Lyral. (79.2%), citronellol (87.5%), AHCA (58.3%), citral (50%) and coumarin (50%). The patients were patch test positive to Lyral., citral and AHCA. In conclusion, patients with a certain fragrance history and a negative reaction to FMI can be identified by FM II. Testing with individual constituents is positive in about 50%of cases reacting to either 14%or 28%FM II.展开更多
The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patie...The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.展开更多
Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy...Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology,Gentofte Hospital,Denmark,from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+reaction. One of the patients with a positive reaction provided samples of margarine,salad cream,oil and mayonnaise. These were analysed with high-performance liquid chromatography,and amoderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking’tulip fingers’or allergic contact dermatitis from garlic and onions. In conclusion,allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases,despite frequent exposure. The large number of ?+reactions raises the question as to whether the recommended patch test concentration is too low.展开更多
文摘A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, test results with the individual constituents and after repeated open application test (ROAT) of FM II are described. Furthermore, cosmetic products which had caused a contact dermatitis in patients were analysed for the presence of the individual constituents. In 1701 patients, the individual constituents of the medium (14%) and the highest (28%) concentration of FM II were simultaneously applied with the new mix at 3 concentrations (break-down testing for the lowest concentration of FM II (2.8%) was performed only if the mix was positive). ROAT was performed with the concentration of the FM II which had produced a positive or doubtful (+or ?+) patch test reaction. Patients’products were ana-lysed for the 6 target compounds by gas chromatography-mass spectrometry (GC-MS). Results:50 patients (2.9%) showed a positive reaction to 14%FM II and 70 patients (4.1%) to 28%FM II. 24/50 (48%) produced a positive reaction to 1 or more of the individual constituents of 14%FM II and 38/70 (54.3%) to 28%FM II, respectively. If doubtful reactions to individual constituents are included, the break-down testing was positive in 74%and 70%, respectively. Patients with a positive reaction to 14%FM II showed a higher rate of reactions to the individual constituent of the 28%FM II:36/50 (72%). Positive reactions to individual constituents in pa-tients negative to FM II were exceedingly rare. If doubtful reactions are regarded as negative, the sensitivity, specificity, positive predictive value and negative predictive value for the medium concentration of FM II towards at least 1 individual constituent was 92.3%(exact 95%confidence interval 74.9-99.1%), 98.4%(97.7-99.0%), 48%(33.7-62.6%) and 99.9%(99.6-100.0%), respectively. For the high concentration, the figures were very similar. The frequency of positive reactions to the individual constituents in descending order was the same for both FM II concentrations:hydroxyisohexyl 3-cyclohexene carboxaldehyde(Lyral.)>citral>farnesol>citronellol >αhexyl-cinnamic aldehyde (AHCA). No unequivocally positive reaction to coumarin was observed. Lyralwas the dominant individualconstituent,with positive reactions in 36%of patients reacting to 14%FM II and 37.1%to 28%FM II. 5/11 patients developed a positive ROAT after a median of 7 days (range 2-10). The 5 patients with a doubtful or negative reaction to 28%FM II were all ROAT negative except 1. There were 7 patients with a certain fragrance history and a positive reaction to either 28%or 14%FM II but a negative reaction to FM I. Analysis with GC-MS in a total of 24 products obtained from 12 patients showed at least 1-5 individual constituents per product:Lyral. (79.2%), citronellol (87.5%), AHCA (58.3%), citral (50%) and coumarin (50%). The patients were patch test positive to Lyral., citral and AHCA. In conclusion, patients with a certain fragrance history and a negative reaction to FMI can be identified by FM II. Testing with individual constituents is positive in about 50%of cases reacting to either 14%or 28%FM II.
文摘The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.
文摘Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology,Gentofte Hospital,Denmark,from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+reaction. One of the patients with a positive reaction provided samples of margarine,salad cream,oil and mayonnaise. These were analysed with high-performance liquid chromatography,and amoderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking’tulip fingers’or allergic contact dermatitis from garlic and onions. In conclusion,allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases,despite frequent exposure. The large number of ?+reactions raises the question as to whether the recommended patch test concentration is too low.
