Allergic Contact Dermatitis: Early Recognition and Diagnosis of Important Allergens

Sharon E. Jacob; Tace Steele

Dermatology Nursing. 2006;18(5):443-439, plus 4.

Allergen Sources

Allergens are commonly found in routine daily hygiene products such as vitamins (chromium, B12) and medicaments (Neosporin ^® , topical corticosteroid creams). The most common allergens in the United States are listed in Table 1 . For this review, the major allergens have been grouped into classification categories of metals and antimicrobials.

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Abstract and Introduction
Allergic Contact Dermatitis Mechanism of Action
Allergen Sources
Metals
Antimicrobial Preservatives and Antimicrobials
Rubber Chemical
Glues
Fragrances
Allergen Evaluation
References

Allergen Reference Table
Allergen	Products Allergen Found in	Foods/Drugs Allergen Found in
Nickel Sulfate	Jean snaps, metal pens, paper clips, cigarettes	Chocolate, soy, beer, oatmeal
Bacitracin	Neosporin, polysporin, polymyxin, bacitracin zinc	Animal feed
Neomycin Sulfate	Neosporin, polysporin, neomycin	N/A
Fragrance Mix	Cosmetics, detergents, soaps, deodorant	May cross react with tomato, cinnamon, vanilla
Quaternium 15	Formaldehyde-releasing preservative (FRP), baby lotion, baby wipes, cross reacts with permanent press clothing (PPC), and other FRPs	See formaldehyde
Formaldehyde	Paper products, nail polish, mascara lotion, shampoo, permanent press clothing	Jellies, preserved fruits, instant coffee, frozen cod, pollock and haddock, Italian cheeses, smoked ham skin, maple syrup, herring, caviar, diet cola, aspartame
Thimerosal	Preservative in vaccines, antifungal agents, mascara	N/A
Balsam of Peru	Flavoring agents, wound healing agent, baby care products, hemorrhoid preparations, toothpaste	Cross reacts with tomato, cinnamon, vanilla, chocolate, and cola
Cobalt Chloride	Metals: buckles, snaps, dental amalgam	Vitamin B₁₂, cocoa, liver, apricots
Sodium Gold Thiosulfate	Jewelry	Goldschlager liqueur
Thiuram Mix	Rubber accelerator: rubber gloves, syringe stoppers, toothbrushes, basketballs, shampoos	Cross reacts with antabuse and flea powder
P-phenylenediamiamine	Hair dye, henna, neoprene	Can cross react with black rubber mix, sulfonamides. Sulphonylureas, hydrochlorothiazide
Ethylene Urea/Melamine	Formaldehyde resin for textiles: permanent press, corduroy, rayon. Breakdown product of mancozeb, a fungicide, and zineb, a pesticide.	Widely used on fruit and vegetable crops.
MDBG/PE (Euxyl K)	Preservative: Nivea ^® , moist towelettes	N/A
Methylchloroisothiazolinone/ Methylisothiazolinone	Preservative: Eucerin ^® , latex paints, cleaning products, adhesives, topical medications	N/A
Bronopol	FRP, cross reacts with PPC	N/A
Carba Mix	Rubber accelerator: rubber bands, gloves, waistbands, basketballs	Cross react with disulfiram
Diazolidinyl Urea	FRP, cross reacts with other FRP and PPC	N/A
Potassium Dichromate	Metals, concrete, plaster, green pigment	Brewer's yeast, liver, bananas
DMDM Hydantoin	FRP, cross reacts with other FRP and PPC	N/A

Sources: Bohn et al., 2000; DermNet.com, 2005a; DermNet.com, 2005b; DermNet.com, 2005c; FDA, 2005; Flyvholm et al., 1984; Fuchs & Wahl, 1992; Garner, 2004; Gawkrodger, 2005; Geier et al., 2003; Gette et al., 1992; Hayashi et al., 1986; Hill & Belsito, 2003; Hogan, 2005; IPCS, 2005; Jacob & James, 2004; Menne et al., 1992; Onder et al., 2001; Rietschel & Fowler, 1995; Salam & Fowler, 2003; Saripalli et al., 2003; Schaller et al., 1989; Weiler & Russel, 1986; TRUEtest.com, 2001a, b, c

Reasons for False-Positive and False-Negative Readings
False Positives	False Negatives
Acute dermatitis during patch test	Degraded or expired testing materials
Degraded or expired testing materials	Early reading
Irritable or sensitive skin	Lack of UV light for photosensitizing allergens
Recent patch testing at same site	Narrow the scope of clinical investigation
Reaction to tape or aluminum/plastic wells	Showering or sweating during the test
Strong reaction to neighboring allergen	Sun exposure prior to the test
Inexperienced evaluator	Corticosteroids prior to the test

Sources: Bourke et al., 2001; TRUEtest.com, 2001b

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