连续贴片测试的丹麦湿疹患者对 N-异丙基-N'-苯基对苯二胺的接触过敏:2013 年至 2023 年历史数据的观察性研究。

IF 4.8 1区 医学 Q2 ALLERGY Contact Dermatitis Pub Date : 2024-06-25 DOI:10.1111/cod.14629
Christoffer Kursawe Larsen, Mikkel Bak Jensen, Jakob F. B. Schwensen
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Schwensen","doi":"10.1111/cod.14629","DOIUrl":null,"url":null,"abstract":"<p><i>N</i>-isopropyl-<i>N</i>′-phenyl-paraphenylenediamine (IPPD) is used as antioxidant in industrial black rubber items such as tyres and domestic rubber products such as sport watches<span><sup>1, 2</sup></span> IPPD may cause allergic contact dermatitis known as “Volkswagen dermatitis.”<span><sup>3</sup></span> The European baseline series (EBS) contains IPPD (0.1% in pet.).<span><sup>4</sup></span> The prevalence of contact allergy (CA) to IPPD is low in many studies (&lt;1%).<span><sup>5</sup></span> IPPD is considered a screening allergen in favour of black rubber mix (IPPD), <i>N</i>-cyclohexyl-<i>N</i>-phenyl-4-phenylenediamine (CPPD) and <i>N</i>,<i>N</i>′-diphenyl-p-phenylenediamine (DPPD) that was removed from the EBS in 1992 as CPPD and DPPD were in short supply.<span><sup>6</sup></span> Though, testing with IPPD alone may result in underdiagnosing.<span><sup>7</sup></span> New surveillance data on IPPD are needed. [Correction added on 4 September 2024, after first online publication: The heading ‘BACKGROUND’ has been removed in this version.]</p><p>The objective of this study is to investigate the epidemiology of CA to IPPD from 2013 to 2023.</p><p>An observational study using historical data from the Allergen Database at Gentofte Hospital, Denmark, was conducted. We included patients ≥18 years old being consecutively patch tested with IPPD (0.1% in pet.). at Gentofte Hospital from 2013 to 2023. Patch testing was performed and interpreted as previously.<span><sup>8</sup></span> Patients patch tested several times during our study period were likewise handled as previously.<span><sup>8</sup></span> Information on patch test results, current clinical relevance,<span><sup>8</sup></span> the MOAHLFA-index (Male/Occupational dermatitis/Atopic dermatitis/Hand dermatitis/Leg dermatitis/Facial dermatitis/Age &gt;40), and occupation was extracted.<span><sup>8</sup></span> Time trends were assessed using the Cochrane-Armitage test for trend. Associations between IPPD CA and the MOAHLFA-index were assessed by binary logistic regressions adjusting for sex, age &gt;40/≤40, and atopic dermatitis. Further, crude odds ratios were calculated.</p><p>As sub-analysis, patch test results on patients tested with CPPD, DPPD or <i>N</i>,<i>N</i>-di-2-naphthyl-4-phenylenediamine (all 1% in pet.) as part of the specialised rubber series from 2013 to 2023 were extracted.</p><p>A <i>p</i>-value &lt;0.05 was considered significant. SPSS Statistics-25 and R-version-2023.12.0 were used for statistical analysis. The study is approved under the umbrella project (p-2023-14 475), <i>Region Hovedstaden - Forskningsjuras</i> internal directory of active research projects.</p><p>A total of 7575 unique patients were consecutively patch tested with IPPD from 2013 to 2023. The overall prevalence of CA to IPPD was 0.41% (31/7575) and a significantly decreasing trend was identified from 2013 to 2023 (Cochrane-Armitage <i>p</i> &lt; 0.05) (Figure 1). The current clinical relevance was 20% (6/30).</p><p>No significant associations were found between IPPD CA and any variable from the MOAHLFA-index (Table 1).</p><p>The occupations among those with IPPD CA and occupational dermatitis were: Worker in food industry (<i>n</i> = 2); cleaner (<i>n</i> = 1), healthcare worker (<i>n</i> = 1); lab work (<i>n</i> = 1); warehouse work (<i>n</i> = 1); unemployed (<i>n</i> = 1).</p><p>Of patients tested with CPPD, DPPD, or <i>N</i>,<i>N</i>-di-2-naphthyl-4-phenylenediamine, 0.76% (15/1975) had positive reaction to CPPD, 0.40% (8/1978) to DPPD, and 0% (0/1978) to <i>N</i>,<i>N</i>-di-2-naphthyl-4-phenylenediamine. Co-testing with IPPD and DPPD or CPPD showed that of patients reacting to IPPD, 92.3% (12/13) and 46.2% (6/13) also reacted to CPPD or DPPD, respectively. Further, all patients reacting to CPPD or DPPD also reacted to IPPD (Tables S1 and S2).</p><p>In this study, we investigated the epidemiology of CA to IPPD from 2013 to 2023. The found prevalence (0.41%) is lower than reported from European Surveillance System on Contact Allergy 2019/2020 data (0.79%).<span><sup>9</sup></span> No associations with the MOAHLFA-index were identified even though IPPD CA previously has been associated with occupational dermatitis.<span><sup>10</sup></span> IPPD proved to be a well-screening allergen for the components of black rubber mix. The importance of IPPD in the EBS may nevertheless be questioned considering the low prevalence of IPPD CA, the decreasing trend, low clinical relevance, and lack of relevant occupations. Data used in this study are from a specialised tertiary hospital and only severe cases are included. In Demark, IPPD CA may therefore be caught elsewhere, for example, private dermatologists and departments of occupational medicine. Further surveillance data should evaluate the relevance of IPPD in the EBS.</p><p>\n <b>Christoffer Kursawe Larsen:</b> Conceptualization; methodology; formal analysis; investigation; writing – original draft. <b>Mikkel Bak Jensen:</b> Conceptualization; investigation; methodology; formal analysis; writing – review and editing. <b>Jakob F. B. Schwensen:</b> Writing – review and editing; supervision.</p><p>This work is supported by the Danish Environmental Protection Agency under the Ministry of Environment of Denmark.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10527,"journal":{"name":"Contact Dermatitis","volume":null,"pages":null},"PeriodicalIF":4.8000,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cod.14629","citationCount":"0","resultStr":"{\"title\":\"Contact allergy to N-isopropyl-N′-phenyl paraphenylenediamine in consecutively patch tested Danish eczema patients: An observational study with historical data from 2013 to 2023\",\"authors\":\"Christoffer Kursawe Larsen,&nbsp;Mikkel Bak Jensen,&nbsp;Jakob F. B. 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[Correction added on 4 September 2024, after first online publication: The heading ‘BACKGROUND’ has been removed in this version.]</p><p>The objective of this study is to investigate the epidemiology of CA to IPPD from 2013 to 2023.</p><p>An observational study using historical data from the Allergen Database at Gentofte Hospital, Denmark, was conducted. We included patients ≥18 years old being consecutively patch tested with IPPD (0.1% in pet.). at Gentofte Hospital from 2013 to 2023. 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引用次数: 0

摘要

N-isopropyl-N′-phenyl-paraphenylenediamine (IPPD) 被用作轮胎等工业用黑色橡胶制品和运动手表等家用橡胶制品的抗氧化剂1, 2 IPPD 可能导致过敏性接触性皮炎,即 "大众皮炎 "3。4 在许多研究中,IPPD 的接触过敏(CA)发病率很低(1%)。5 IPPD 被认为是一种筛选过敏原,而黑橡胶混合物(IPPD)、N-环己基-N-苯基-4-苯二胺(CPPD)和 N,N′-二苯基对苯二胺(DPPD)则被认为是一种筛选过敏原,由于 CPPD 和 DPPD 供不应求,1992 年已从 EBS 中删除。不过,仅用 IPPD 进行检测可能会导致诊断不足7 。[首次在线发表后,于 2024 年 9 月 4 日添加更正:本研究的目的是调查 2013 年至 2023 年期间 CA 至 IPPD 的流行病学情况。我们纳入了 2013 年至 2023 年期间在 Gentofte 医院连续接受 IPPD(宠物为 0.1%)贴片测试的年龄≥18 岁的患者。8 提取了有关斑贴试验结果、当前临床相关性、8 MOAHLFA 指数(男性/职业性皮炎/特异性皮炎/手部皮炎/腿部皮炎/面部皮炎/年龄>40)和职业的信息。8 使用 Cochrane-Armitage 趋势检验评估时间趋势。通过二元逻辑回归评估了 IPPD CA 与 MOAHLFA 指数之间的关系,并对性别、年龄>40/≤40 和特应性皮炎进行了调整。此外,还计算了粗略的几率比。作为子分析,提取了作为 2013 年至 2023 年专用橡胶系列的一部分,使用 CPPD、DPPD 或 N,N-二-2-萘基-4-苯二胺(均为宠物用 1%)对患者进行的斑贴试验结果。使用 SPSS Statistics-25 和 R-version-2023.12.0 进行统计分析。该研究在Hovedstaden - Forskningsjuras地区活跃研究项目内部目录的总括项目(p-2023-14 475)下获得批准。从2013年到2023年,共有7575名患者连续接受了IPPD贴片测试。IPPD的CA总患病率为0.41%(31/7575),从2013年到2023年呈显著下降趋势(Cochrane-Armitage p <0.05)(图1)。目前的临床相关性为20%(6/30)。IPPD CA与MOAHLFA指数中的任何变量之间均未发现显著关联(表1):患有 IPPD CA 和职业性皮炎的患者的职业是:食品业工人(n = 2);清洁工(n = 1);医护人员(n = 1);实验室工作(n = 1);仓库工作(n = 1);无业(n = 1)。在接受 CPPD、DPPD 或 N,N-二-2-萘基-4-苯二胺检测的患者中,0.76%(15/1975)对 CPPD 呈阳性反应,0.40%(8/1978)对 DPPD 呈阳性反应,0%(0/1978)对 N,N-二-2-萘基-4-苯二胺呈阳性反应。IPPD和DPPD或CPPD的联合检测显示,对IPPD产生反应的患者中,分别有92.3%(12/13)和46.2%(6/13)对CPPD或DPPD也产生反应。此外,所有对 CPPD 或 DPPD 有反应的患者也对 IPPD 有反应(表 S1 和 S2)。发现的发病率(0.41%)低于欧洲接触过敏监测系统 2019/2020 年的数据报告(0.79%)。9 尽管 IPPD CA 以前曾与职业性皮炎有关,但未发现与 MOAHLFA 指数的关联。尽管如此,考虑到 IPPD CA 患病率低、呈下降趋势、临床相关性低以及缺乏相关职业,IPPD 在 EBS 中的重要性可能会受到质疑。本研究中使用的数据来自一家专业的三级医院,仅包括重症病例。因此,在丹麦,IPPD CA可能在其他地方(如私人皮肤科医生和职业医学部门)发现。进一步的监测数据应评估 IPPD 在 EBS 中的相关性。 克里斯托弗-库尔萨维-拉森(Christoffer Kursawe Larsen):构思;方法;正式分析;调查;撰写 - 原稿。Mikkel Bak Jensen:概念化;调查;方法论;正式分析;写作 - 审阅和编辑。作者声明无利益冲突。
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Contact allergy to N-isopropyl-N′-phenyl paraphenylenediamine in consecutively patch tested Danish eczema patients: An observational study with historical data from 2013 to 2023

N-isopropyl-N′-phenyl-paraphenylenediamine (IPPD) is used as antioxidant in industrial black rubber items such as tyres and domestic rubber products such as sport watches1, 2 IPPD may cause allergic contact dermatitis known as “Volkswagen dermatitis.”3 The European baseline series (EBS) contains IPPD (0.1% in pet.).4 The prevalence of contact allergy (CA) to IPPD is low in many studies (<1%).5 IPPD is considered a screening allergen in favour of black rubber mix (IPPD), N-cyclohexyl-N-phenyl-4-phenylenediamine (CPPD) and N,N′-diphenyl-p-phenylenediamine (DPPD) that was removed from the EBS in 1992 as CPPD and DPPD were in short supply.6 Though, testing with IPPD alone may result in underdiagnosing.7 New surveillance data on IPPD are needed. [Correction added on 4 September 2024, after first online publication: The heading ‘BACKGROUND’ has been removed in this version.]

The objective of this study is to investigate the epidemiology of CA to IPPD from 2013 to 2023.

An observational study using historical data from the Allergen Database at Gentofte Hospital, Denmark, was conducted. We included patients ≥18 years old being consecutively patch tested with IPPD (0.1% in pet.). at Gentofte Hospital from 2013 to 2023. Patch testing was performed and interpreted as previously.8 Patients patch tested several times during our study period were likewise handled as previously.8 Information on patch test results, current clinical relevance,8 the MOAHLFA-index (Male/Occupational dermatitis/Atopic dermatitis/Hand dermatitis/Leg dermatitis/Facial dermatitis/Age >40), and occupation was extracted.8 Time trends were assessed using the Cochrane-Armitage test for trend. Associations between IPPD CA and the MOAHLFA-index were assessed by binary logistic regressions adjusting for sex, age >40/≤40, and atopic dermatitis. Further, crude odds ratios were calculated.

As sub-analysis, patch test results on patients tested with CPPD, DPPD or N,N-di-2-naphthyl-4-phenylenediamine (all 1% in pet.) as part of the specialised rubber series from 2013 to 2023 were extracted.

A p-value <0.05 was considered significant. SPSS Statistics-25 and R-version-2023.12.0 were used for statistical analysis. The study is approved under the umbrella project (p-2023-14 475), Region Hovedstaden - Forskningsjuras internal directory of active research projects.

A total of 7575 unique patients were consecutively patch tested with IPPD from 2013 to 2023. The overall prevalence of CA to IPPD was 0.41% (31/7575) and a significantly decreasing trend was identified from 2013 to 2023 (Cochrane-Armitage p < 0.05) (Figure 1). The current clinical relevance was 20% (6/30).

No significant associations were found between IPPD CA and any variable from the MOAHLFA-index (Table 1).

The occupations among those with IPPD CA and occupational dermatitis were: Worker in food industry (n = 2); cleaner (n = 1), healthcare worker (n = 1); lab work (n = 1); warehouse work (n = 1); unemployed (n = 1).

Of patients tested with CPPD, DPPD, or N,N-di-2-naphthyl-4-phenylenediamine, 0.76% (15/1975) had positive reaction to CPPD, 0.40% (8/1978) to DPPD, and 0% (0/1978) to N,N-di-2-naphthyl-4-phenylenediamine. Co-testing with IPPD and DPPD or CPPD showed that of patients reacting to IPPD, 92.3% (12/13) and 46.2% (6/13) also reacted to CPPD or DPPD, respectively. Further, all patients reacting to CPPD or DPPD also reacted to IPPD (Tables S1 and S2).

In this study, we investigated the epidemiology of CA to IPPD from 2013 to 2023. The found prevalence (0.41%) is lower than reported from European Surveillance System on Contact Allergy 2019/2020 data (0.79%).9 No associations with the MOAHLFA-index were identified even though IPPD CA previously has been associated with occupational dermatitis.10 IPPD proved to be a well-screening allergen for the components of black rubber mix. The importance of IPPD in the EBS may nevertheless be questioned considering the low prevalence of IPPD CA, the decreasing trend, low clinical relevance, and lack of relevant occupations. Data used in this study are from a specialised tertiary hospital and only severe cases are included. In Demark, IPPD CA may therefore be caught elsewhere, for example, private dermatologists and departments of occupational medicine. Further surveillance data should evaluate the relevance of IPPD in the EBS.

Christoffer Kursawe Larsen: Conceptualization; methodology; formal analysis; investigation; writing – original draft. Mikkel Bak Jensen: Conceptualization; investigation; methodology; formal analysis; writing – review and editing. Jakob F. B. Schwensen: Writing – review and editing; supervision.

This work is supported by the Danish Environmental Protection Agency under the Ministry of Environment of Denmark.

The authors declare no conflicts of interest.

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来源期刊
Contact Dermatitis
Contact Dermatitis 医学-过敏
CiteScore
4.60
自引率
30.90%
发文量
227
审稿时长
4-8 weeks
期刊介绍: Contact Dermatitis is designed primarily as a journal for clinicians who are interested in various aspects of environmental dermatitis. This includes both allergic and irritant (toxic) types of contact dermatitis, occupational (industrial) dermatitis and consumers" dermatitis from such products as cosmetics and toiletries. The journal aims at promoting and maintaining communication among dermatologists, industrial physicians, allergists and clinical immunologists, as well as chemists and research workers involved in industry and the production of consumer goods. Papers are invited on clinical observations, diagnosis and methods of investigation of patients, therapeutic measures, organisation and legislation relating to the control of occupational and consumers".
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