Contact Dermatitis • Contact Points AIRBORNE CONTACT ALLERGY TO METHYLISOTHIAZOLINONE • ALWAN ET AL.
Presumed airborne contact allergy to methylisothiazolinone causing acute severe facial dermatitis and respiratory difficulty Wisam Alwan1 , Ian R. White2 and Piu Banerjee1,2 1 Department of Dermatology, University Hospital Lewisham, Lewisham High Street, London, SE13 6LH, UK and 2 Department of Cutaneous Allergy, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK doi:10.1111/cod.12219
Key words: airborne; allergic contact dermatitis; contact dermatitis; contact sensitization; MCI; methylchloroisothiazolinone; methylisothiazolinone; MI; paint.
Background Methylisothiazolinone (MI) is a biocidal preservative (1) that is commonly used in cosmetics, wet-wipes, paint, and household products. MI is used in cosmetics (now supported only for rinse-off products) in combination with methylchloroisothiazolinone (MCI) at a concentration of 3.75 ppm. Since 2005, MI has additionally been permitted as a stand-alone preservative in cosmetic products at up to 100 ppm. There is now an epidemic of contact allergy to MI (2). Recently, several cases of airborne contact dermatitis caused by MI have been published and highlighted (3).
Case Report A 52-year-old female presented with acute severe facial dermatitis and dyspnoea. Her past medical history Correspondence: Dr Wisam Alwan. Department of Dermatology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH. Tel: 0208 333 3000; Fax: 0208 333 3096. E-mail: [email protected] Conflicts of interest: The authors declare no conflict of interests.
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included mild psoriasis, but no previous history of asthma or other respiratory conditions. The symptoms started 10 days prior to presentation, with an itchy rash over the cheeks, which progressed to involve the entire face, eyelids, upper chest, and dominant hand. Temporary resolution of the rash was achieved with a 5-day course of prednisolone; however, the rash recurred within 3 days of discontinuing the drug. The patient then became acutely dyspnoeic, and required emergency treatment. The symptoms had started 2 days after she had painted her living room with B&Q Value™ Matt Emulsion, and the flare of symptoms shortly followed her resumption of painting. When examined, she had a confluent scaly, erythematous rash affecting the face and exposed areas of the chest. The upper and lower eyelids were involved, and there was significant periorbital oedema. The patient was treated again with prednisolone and topical steroids, and advised to avoid entering the painted room for 2 months. She avoided all cosmetic products containing MI. Subsequent patch testing (Finn
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 316–328
Contact Dermatitis • Contact Points CHROMIUM ALLERGY FROM CONCRETE WORK • HEDBERG ET AL.
Chambers® on Scanpor® tape) confirmed the pre-patch test diagnosis of allergic contact dermatitis; there was a 3+ reaction to MI 0.2% aq. on D2. The B&Q Value™ Matt Emulsion paint was analysed in the Department of Environmental Science, Aarhus University and confirmed as containing circa 100 ppm MI (Rossana Rossi, personal communication).
Discussion Airborne contact dermatitis caused by MI has been recognized in people using paint (4) and in paint factories (5), and dyspnoea has been reported in patients with airborne contact allergy to MI (6, 7) and MCI/MI (8). The
lack of regulations regarding its use in paint means that there is no current maximum permitted concentration and no requirement to label paints and other noncosmetic products (other than household detergents) in which MI is used as an ingredient. As with its use in cosmetics, urgent action is required to assess and manage the risk of using MI in paints and other non-cosmetic products. Given the profound effects that MI can have on the skin and other organ systems, greater transparency is needed from industry in terms of labelling to allow consumers to choose products safely, and the inclusion of MI under Classification Labelling and Packaging regulations is essential.
References 1 US Enviromental Protection Agency (EPA). Reregistration Eligibility Decision (RED) datasheet for methylisothiazolinone, 1998. Available at: http://www.epa.gov/ oppsrrd1/REDs/factsheets/3092fact.pdf (last accessed 23 December 2013). 2 McFadden J P, Mann J, White J M L et al. Outbreak of methylisothiazolinone allergy targeting those aged ≥ 40 years. Contact Dermatitis 2013: 69: 53–63. 3 Lundov M D, Zachariae C, Menn´e T, Johansen J D. Airborne exposure to preservative methylisothiazolinone causes
severe allergic reactions. Br Med J 2012: 345: e8221. 4 Kaae J, Menn´e T, Thyssen J P. Presumed primary contact sensitization to methylisothiazolinone from paint: a chemical that became airborne. Contact Dermatitis 2012: 66: 341–342. 5 Thyssen J P, Sederberg-Olsen N, Thomsen J F, Menn´e T. Contact dermatitis from methylisothiazolinone in a paint factory. Contact Dermatitis 2006: 54: 322–324. 6 Lundov M D, Mosbech H, Thyssen J P et al. Two cases of airborne allergic contact
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 316–328
dermatitis caused by methylisothiazolinone in paint. Contact Dermatitis 2011: 65: 176–179. 7 Lundov M, Friis U F, Menn´e T, Johansen J D. Methylisothiazolinone in paint forces a patient out of her apartment. Contact Dermatitis 2013: 69: 251–259. 8 Bohn S, Niederer M, Brehm K, Bircher A J. Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation. Contact Dermatitis 2000: 42: 196–201.
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Presumed airborne contact allergy to methylisothiazolinone causing acute severe facial dermatitis and respiratory difficulty Wisam Alwan1 , Ian R. White2 and Piu Banerjee1,2 1 Department of Dermatology, University Hospital Lewisham, Lewisham High Street, London, SE13 6LH, UK and 2 Department of Cutaneous Allergy, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK doi:10.1111/cod.12219
Key words: airborne; allergic contact dermatitis; contact dermatitis; contact sensitization; MCI; methylchloroisothiazolinone; methylisothiazolinone; MI; paint.
Background Methylisothiazolinone (MI) is a biocidal preservative (1) that is commonly used in cosmetics, wet-wipes, paint, and household products. MI is used in cosmetics (now supported only for rinse-off products) in combination with methylchloroisothiazolinone (MCI) at a concentration of 3.75 ppm. Since 2005, MI has additionally been permitted as a stand-alone preservative in cosmetic products at up to 100 ppm. There is now an epidemic of contact allergy to MI (2). Recently, several cases of airborne contact dermatitis caused by MI have been published and highlighted (3).
Case Report A 52-year-old female presented with acute severe facial dermatitis and dyspnoea. Her past medical history Correspondence: Dr Wisam Alwan. Department of Dermatology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH. Tel: 0208 333 3000; Fax: 0208 333 3096. E-mail: [email protected] Conflicts of interest: The authors declare no conflict of interests.
320
included mild psoriasis, but no previous history of asthma or other respiratory conditions. The symptoms started 10 days prior to presentation, with an itchy rash over the cheeks, which progressed to involve the entire face, eyelids, upper chest, and dominant hand. Temporary resolution of the rash was achieved with a 5-day course of prednisolone; however, the rash recurred within 3 days of discontinuing the drug. The patient then became acutely dyspnoeic, and required emergency treatment. The symptoms had started 2 days after she had painted her living room with B&Q Value™ Matt Emulsion, and the flare of symptoms shortly followed her resumption of painting. When examined, she had a confluent scaly, erythematous rash affecting the face and exposed areas of the chest. The upper and lower eyelids were involved, and there was significant periorbital oedema. The patient was treated again with prednisolone and topical steroids, and advised to avoid entering the painted room for 2 months. She avoided all cosmetic products containing MI. Subsequent patch testing (Finn
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 316–328
Contact Dermatitis • Contact Points CHROMIUM ALLERGY FROM CONCRETE WORK • HEDBERG ET AL.
Chambers® on Scanpor® tape) confirmed the pre-patch test diagnosis of allergic contact dermatitis; there was a 3+ reaction to MI 0.2% aq. on D2. The B&Q Value™ Matt Emulsion paint was analysed in the Department of Environmental Science, Aarhus University and confirmed as containing circa 100 ppm MI (Rossana Rossi, personal communication).
Discussion Airborne contact dermatitis caused by MI has been recognized in people using paint (4) and in paint factories (5), and dyspnoea has been reported in patients with airborne contact allergy to MI (6, 7) and MCI/MI (8). The
lack of regulations regarding its use in paint means that there is no current maximum permitted concentration and no requirement to label paints and other noncosmetic products (other than household detergents) in which MI is used as an ingredient. As with its use in cosmetics, urgent action is required to assess and manage the risk of using MI in paints and other non-cosmetic products. Given the profound effects that MI can have on the skin and other organ systems, greater transparency is needed from industry in terms of labelling to allow consumers to choose products safely, and the inclusion of MI under Classification Labelling and Packaging regulations is essential.
References 1 US Enviromental Protection Agency (EPA). Reregistration Eligibility Decision (RED) datasheet for methylisothiazolinone, 1998. Available at: http://www.epa.gov/ oppsrrd1/REDs/factsheets/3092fact.pdf (last accessed 23 December 2013). 2 McFadden J P, Mann J, White J M L et al. Outbreak of methylisothiazolinone allergy targeting those aged ≥ 40 years. Contact Dermatitis 2013: 69: 53–63. 3 Lundov M D, Zachariae C, Menn´e T, Johansen J D. Airborne exposure to preservative methylisothiazolinone causes
severe allergic reactions. Br Med J 2012: 345: e8221. 4 Kaae J, Menn´e T, Thyssen J P. Presumed primary contact sensitization to methylisothiazolinone from paint: a chemical that became airborne. Contact Dermatitis 2012: 66: 341–342. 5 Thyssen J P, Sederberg-Olsen N, Thomsen J F, Menn´e T. Contact dermatitis from methylisothiazolinone in a paint factory. Contact Dermatitis 2006: 54: 322–324. 6 Lundov M D, Mosbech H, Thyssen J P et al. Two cases of airborne allergic contact
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 316–328
dermatitis caused by methylisothiazolinone in paint. Contact Dermatitis 2011: 65: 176–179. 7 Lundov M, Friis U F, Menn´e T, Johansen J D. Methylisothiazolinone in paint forces a patient out of her apartment. Contact Dermatitis 2013: 69: 251–259. 8 Bohn S, Niederer M, Brehm K, Bircher A J. Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation. Contact Dermatitis 2000: 42: 196–201.
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