Trends in the Prevalence of Methylchloroisothiazolinone/Methylisothiazolinone Contact Allergy in North America and Europe

Author:

Reeder Margo J.1,Warshaw Erin234,Aravamuthan Srikanth1,Belsito Donald V.5,Geier Johannes6,Wilkinson Mark7,Atwater Amber Reck8,White Ian R.9,Silverberg Jonathan I.1011,Taylor James S.12,Fowler Joseph F.13,Maibach Howard I.14,DeKoven Joel G.15,Buhl Timo16,Botto Nina14,Giménez-Arnau Ana Maria17,Gallo Rosella18,Mowad Christen19,Lang Claudia C. V.20,DeLeo Vincent A.21,Johnston Graham22,Pratt Melanie D.23,Brockow Knut24,Adler Brandon L.21,Houle Marie-Claude25,Dickel Heinrich26,Schuttelaar Marie Louise A.27,Yu JiaDe28,Spiewak Radoslaw29,Dunnick Cory30,Filon Francesca Larese31,Valiukevičienė Skaidra32,Uter Wolfgang33

Affiliation:

1. Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison

2. Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota

3. Department of Dermatology, University of Minnesota, Minneapolis

4. Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota

5. Department of Dermatology, Columbia University Irving Medical Center, New York, New York

6. Information Network of Departments of Dermatology, Institute at the University Medical Center Göttingen, Göttingen, Germany

7. Department of Dermatology, Leeds Teaching Hospitals National Health Service Trust, Chapel Allerton Hospital, Leeds, England

8. Department of Dermatology, Duke University Medical Center, Durham, North Carolina

9. St John’s Institute of Dermatology, Guy’s Hospital, London, England

10. Department of Dermatology, George Washington University School of Medicine, Washington, DC

11. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

12. Department of Dermatology, Cleveland Clinic, Cleveland, Ohio

13. Division of Dermatology, University of Louisville, Louisville, Kentucky

14. Department of Dermatology, University of California, San Francisco

15. Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

16. Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany

17. Department of Dermatology, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain

18. Clinica Dermatologica, IRCCS–AOU San Martino–IST and Department of Health Sciences, University of Genoa, Genoa, Italy

19. Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania

20. Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland

21. Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles

22. Department of Dermatology, Leicester Royal Infirmary, Leicester, England

23. Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada

24. Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University Munich, Munich, Germany

25. Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec, Quebec, Canada

26. Department of Dermatology, Venereology and Allergology, St Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany

27. Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands

28. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

29. Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland

30. Department of Dermatology, University of Colorado, Denver

31. Department of Public Health, Occupational Medicine, University of Trieste, Trieste, Italy

32. Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania

33. Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany

Abstract

ImportanceThe common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US.ObjectiveTo compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) combination and MI alone in North America and Europe from 2009 to 2018.Design, Setting, and ParticipantsThis retrospective analysis of North American Contact Dermatitis Group, European Surveillance System on Contact Allergies (ESSCA), and the Information Network of Departments of Dermatology (IVDK) databases included data from patients presenting for patch testing at referral patch test clinics in North America and Europe.ExposuresPatch tests to MCI/MI and MI.Main Outcomes and MeasuresPrevalence of allergic contact dermatitis to MCI/MI and MI.ResultsFrom 2009 to 2018, participating sites in North America and Europe patch tested a total of 226 161 individuals to MCI/MI and 118 779 to MI. In Europe, positivity to MCI/MI peaked during 2013 and 2014 at 7.6% (ESSCA) and 5.4% (IVDK) before decreasing to 4.4% (ESSCA) and 3.2% (IVDK) during 2017 and 2018. Positive reactions to MI were 5.5% (ESSCA) and 3.4% (IVDK) during 2017 and 2018. In North America, the frequency of positivity to MCI/MI increased steadily through the study period, reaching 10.8% for MCI/MI during 2017 and 2018. Positive reactions to MI were 15.0% during 2017 and 2018.Conclusions and RelevanceThe study results suggest that in contrast to the continued increase in North America, isothiazolinone allergy is decreasing in Europe. This trend may coincide with earlier and more stringent government regulation of MI in Europe.

Publisher

American Medical Association (AMA)

Subject

Dermatology

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