Allergic Contact Dermatitis from Carmine

Daniel W. Shaw

Disclosures

Dermatitis. 2009;20(5):292-295. 

In This Article

Discussion

Carmine was implicated as the allergen in this patient by her contact dermatitis exclusively from carmine-containing lipsticks and eye shadows, a positive patch-test result with carmine 2.5% pet, negative carmine patch-test results in 30 other patients, and a positive antecubital provocative use test with carmine 2.5% pet. For comparison, carmine concentrations used by one major manufacturer range from 0.01 to 4% in lipsticks, 0.05 to 10% in blushes, and 0.02 to 20% in eye shadows (Ken Marenus, PhD, vice president, regulatory affairs, The Estée Lauder Companies, personal communication, June 3, 2008). The nonirritancy of patch testing with carmine 2.5% pet is further supported by the negative results of repeat-insult patch testing with carmine 20% pet in 50 subjects (Brian Jones, PhD, director, research and development, Mary Kay, Inc., personal communication, April 17, 2009).

The false-negative patch-test results on the back of this patient from the same cosmetics that caused contact dermatitis of the lips and eyelids are not unusual. The author has observed this repeatedly with other lip and eyelid cosmetics. It is probably partly a result of regional anatomic variability in percutaneous absorption.[29]

Two previously published reports describe four patients with delayed hypersensitivity (allergic contact dermatitis) from carmine; all of the cases were caused by lip products.[25,26] Three of these cases were documented by patch tests with the lip salve base with and without carmine. In two cases in which carmine patch testing was performed, results with 0.1% concentrations in liquid paraffin[25] and in petrolatum were positive.[26]

In contrast to the rarity of reports of delayed hypersensitivity reactions to carmine, there are at least 33 published descriptions of patients with immediate hypersensitivity to carmine.[6,8–24] As summarized in recent reports,[6,24] in 17 of these patients, allergy was caused by occupational exposures, including exposures in carmine manufacturing, cosmetic blending, spice blending in a sausage factory, and among butchers handling additives to sausages, burgers, and salami. Symptoms included asthma, rhinitis, and conjunctivitis. In 16 patients, reactions were non-occupational; many of these reactions were anaphylactic and were mostly due to ingestion of foods or beverages colored with carmine. These included the alcoholic beverage Campari (Gruppo Campari, Milan, Italy),[11,14,17,23] juices,[19,23] yogurt,[12,17,24] artificial crab,[17,19] fish paste,[22] and a popsicle.[15] Many of these patients also described immediate itching, an erythematous eruption, urticaria, or intense rhinorrhea within minutes of their using carmine-containing cosmetics.[3,11,15,17,19,24] One case was caused by the ingestion of azithromycin tablets.[24]

These immediate hypersensitivity reactions to carmine are immunoglobulin E–mediated and directed against cochineal proteins.[6,7,16,18,19,21,23] A major carmine allergen was recently shown to have amino acid sequence homologies with phospholipases, which are known insect allergens.[7]

In contrast, the identity of the allergen causing the delayed hypersensitivity reaction seen in allergic contact dermatitis from carmine has not been determined. Our patient declined further patch testing with purified carminic acid to determine if it was the allergenic ingredient.

Listing of carmine on labels is currently required in the United States for retail-sale cosmetics and over-the-counter drugs but not for foods, cosmetics for professional use only, and free cosmetic samples.[3] Owing to concerns about anaphylactic immediate hypersensitivity reactions, the FDA will require disclosure of the presence of carmine or cochineal extract on the labels of all foods and cosmetics, beginning in January 2011.[30] The FDA plans to initiate separate rules for prescription pharmaceuticals.[3]

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