Hey Doc, my feet itch! Can I be allergic to my shoes? P-tert-butylphenol formaldehyde resin allergy

Everyone knows there's nothing worse than being itchy and itchy feet are no different. 

Recently I saw a young child who was scratching so much, their feet were left raw and irritated.  Her family had recently gone south to escape the winter blues, and her mom was convinced she was infected with something.  She'd gone diving during the trip for the first time and wore a wet suit all day long.  The rest of her body itched to, but her feet were the worst.  The poor child was having difficulty walking because her feet were so raw. At times she was using a sharp object to scratch her skin. She was irritated because she couldn't sleep and was getting trouble in school because she wanted to scratch her feet.    

And so they asked, can be allergic to your shoes????     YES.

What could be going on?

• There are many adhesives in shoes that are can cause an allergic reaction
• The most common adhesive used in shoes is p-tert-butylphenol formaldehyde resin (PTBPFR)
•  PTBPFR is commonly used in leather and rubber products because it works quickly, durability, flexibility and ability to resist heat
• We don't know the true incidence of PTBPFR allergy, but it's been increasing since it's introduction in 1950's
• Other common adhesives are in shoes are acrylates, colophony, and epoxy products

What are the other names of  p-tert-butylphenol formaldehyde resin?

• p-tert-Butylphenol formaldehyde (PTBP) or paraformaldehyde
•  formaldehyde
• p-tert-butylphenol 
• polymer; p-tert-butylphenol formaldehyde resin (PTBP FR)
• formaldehyde, p-tert-butylphenol polymer; 
• 4-(1,1-cimethylethyl)phenol
• formaldehyde polymer
• Neoprene adhesives

Where else is p-tert-butylphenol formaldehyde resin found?

• Glue and fingernail adhesives, tape, labels, dressings and electrodes
• Rubber sports equipment- writs guards, shin guards, goggles, and athletic tape
• The bonder used in hearing aids and prosthetic devices
• Rubber products like shoes, neoprene wet suits, and sauna shorts
• Leather products like shoes, watch straps, purses and belts.
• Varnishes

Who's at risk for developing p-tert-butylphenol formaldehyde resin allergy?

• Moisture and heat break down the PTBPFR in the product exposing the product; sensitization via the skin can then occur.
• There may be some association with sleeping on memory foam mattresses or using foam pillows
• Athletes who use sports equipement may be at greater risk

What should you do if you suspect you are allergic to p-tert-butylphenol formaldehyde resin?

• See your local allergist/immunologist or dermatologist for an evaluation.  http://aaaai.execinc.com/find-an-allergist/
• They will take a detailed history to determine the cause of your rash.
• They may recommend patch testing to determine what is causing the rash, prescribe medication and/or tell you how to modify your behavior to avoid contact with the offending chemical.

Want to read more?

•  http://www.truetest.com/PatientPDF/p-tert-Butylphenol-Formaldehyde-Resin-Patient-Info.pdf
• http://www.dermnetnz.org/dermatitis/paratertiarybutylphenolformaldehyde-allergy.html
• Check out this article in Dermatits: http://journals.lww.com/dermatitis/Abstract/2012/03000/p_tert_Butylphenol_Formaldehyde_Resin_and_Its.7.aspx