Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre.

Publisher: Wiley Country of Publication: England NLM ID: 7604950 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0536 (Electronic) Linking ISSN: 01051873 NLM ISO Abbreviation: Contact Dermatitis Subsets: MEDLINE

Publication: <2005-> : Oxford : Wiley
Original Publication: Copenhagen, Munksgaard.

Patch Tests*; Acrylates/*adverse effects ; Blood Glucose Self-Monitoring/*adverse effects ; Camphanes/*adverse effects ; Dermatitis, Allergic Contact/*etiology ; Diabetes Mellitus, Type 1/*immunology ; Sesquiterpenes/*adverse effects; Adolescent ; Adult ; Aged ; Blood Glucose Self-Monitoring/instrumentation ; Child ; Child, Preschool ; Dermatitis, Allergic Contact/diagnosis ; Diabetes Mellitus, Type 1/blood ; Female ; Gas Chromatography-Mass Spectrometry ; Humans ; Male ; Middle Aged ; Young Adult

Background: Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series.
Objectives: To compile patch test results of subjects affected, and provide potential explanations for this association.
Patients and Methods: Fifty-three Freestyle Libre-allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM.
Results: Thirty-three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography-mass spectrometry (GC-MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA.
Conclusion: Significant co-sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC-MS analysis. Cross-reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist.
(© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Herman A, Aerts O, Baeck M, et al. Allergic contact dermatitis caused by isobornyl acrylate in Freestyle(R) Libre, a newly introduced glucose sensor. Contact Dermatitis. 2017;77:367-373.
Oppel E, Högg C, Summer B, Ruëff F, Reichl FX, Kamann S. Isobornyl acrylate contained in the insulin patch pump OmniPod as the cause of severe allergic contact dermatitis. Contact Dermatitis. 2018;79:178-180.
Raison-Peyron N, Mowitz M, Bonardel N, Aerts O, Bruze M. Allergic contact dermatitis caused by isobornyl acrylate in OmniPod, an innovative tubeless insulin pump. Contact Dermatitis. 2018 Apr 10;79:76-80. https://doi.org/10.1111/cod.12995.
Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing-recommendations on best practice. Contact Dermatitis. 2015;73:195-221.
Bruze M, Frick M, Persson L. Patch testing with thin-layer chromatograms. Contact Dermatitis. 2003;48:278-279.
Andersen RM, Skov L, Menné T, Johansen JD. Clinical consequences of sesquiterpene lactone mix contact allergy in Denmark. Br J Dermatol. 2015;172:1430-1431.
Lepoittevin JP, Berl V, Giménez-Arnau E. Alpha-methylene-gamma-butyrolactones: versatile skin bioactive natural products. Chem Rec. 2009;9:258-270.
Dupuis G, Benezra C, Schlewer G, Stampf JL. Allergic contact dermatitis to alpha-methylene-gamma-butyrolactones. Preparation of alantolactone-protein conjugates and induction of contact sensitivity in the guinea pig by an alantolactone-skin protein conjugate. Mol Immunol. 1980;17:1045-1051.
Le Coz CDG, Paulsen E. Plants and plant products. Contact Dermatitis. Vol 5. Berlin and Heidelberg: Springer, Verlag; 2011:873-916.
Wilkinson M, Gonçalo M, Aerts O, et al. The European baseline series and recommended additions: 2019. Contact Dermatitis. 2019;80:1-4.
Isaksson M, Hansson C, Inerot A, et al. Multicentre patch testing with compositae mix by the Swedish Contact Dermatitis Research Group. Acta Derm Venereol. 2011;91:295-298.
Kanerva L, Estlander T, Alanko K, Jolanki R. Patch test sensitization to compositae mix, sesquiterpene-lactone mix, compositae extracts, laurel leaf, chlorophorin, mansonone A, and dimethoxydalbergione. Am J Contact Dermat. 2001;12:18-24.
Diepgen TL, Ofenloch RF, Bruze M, et al. Prevalence of contact allergy in the general population in different European regions. Br J Dermatol. 2016;174:319-329.
Rustemeyer T, de Groot J, von Blomberg BM, et al. Assessment of contact allergen cross-reactivity by retesting. Exp Dermatol. 2002;11:257-265.
Stampf JL, Schlewer G, Ducombs G, Foussereau J, Benezra C. Allergic contact dermatitis due to sesquiterpene lactones. A comparative study of human and animal sensitivity to alpha-methylene-gamma-butyrolactone and derivatives. Br J Dermatol. 1978;99:163-169.
Schlewer G, Stampf JL, Benezra C. Synthesis of and allergic contact dermatitis to bicyclo-[2,2,1]-heptyl-alpha-methylene-gamma-butyrolactones derived from norbornene and camphene. Can J Biochem. 1978;56:153-157.
Schlewer G, Stampf JL, Benezra C. Synthesis of alpha-methylene-gamma-butyrolactones: a structure-activity relationship study of their allergenic power. J Med Chem. 1980;23:1031-1038.
Johansen JD, Frosch PJ, Lepoittevin JP. Molecular aspects in allergic and irritant contact dermatitis. Contact Dermatitis. 5 ed. Berlin and Heidelberg: Springer; 2011:91-110.
Deswysen AC, Zimerson E, Goossens A, Bruze M, Baeck M. Allergic contact dermatitis caused by self-adhesive electrocardiography electrodes in an infant. Contact Dermatitis. 2013;69:379-381.
Foti C, Romita P, Rigano L, et al. Isobornyl acrylate: an impurity in alkyl glucosides. Cutan Ocul Toxicol. 2016;35:115-119.
Kerre S, Strobbe T, Naessens T, Theunis M, Foubert K, Aerts O. Alkyl glucosides: newly identified allergens in foam wound dressings. Contact Dermatitis. 2018;79:191-193.
Christensen LP, Jakobsen HB, Paulsen E, Hodal L, Andersen KE. Airborne Compositae dermatitis: monoterpenes and no parthenolide are released from flowering Tanacetum parthenium (feverfew) plants. Arch Dermatol Res. 1999;291:425-431.
Henkel. Säkerhetsdatablad enligt rådets förordning (EG) nr 1907/2006. LOCTITE AA 3926 LC MED known as LOCTITE 3926 LIGHT CURE. 2018. http://mymsds.henkel.com/mymsds/Search.do?BUSAREA=0006&DOCTYPE=MSDS&COUNTRY=SE&LANG=SV&MATNR=1171008. Accessed January 3, 2019.

Keywords: FreeStyle Libre; GC-MS; allergic contact dermatitis; chemical analysis; diabetes mellitus; glucose sensor; isobornyl acrylate; medical device; sesquiterpene lactones; simultaneous reactions

0 (Acrylates)
0 (Camphanes)
0 (Sesquiterpenes)
IX0PRH184P (isobornyl acrylate)

Date Created: 20190606 Date Completed: 20200302 Latest Revision: 20200302

20221213

10.1111/cod.13330

31166016