Roll out the Red Carpet....the winner is!

Each year the American Contact Dermatitis Society chooses an allergen of the year.  There's not as much pomp and circumstance as the Oscars but it's a big win.  This  award draws attention to allergens that are very common and/or under recognized.  Chemicals are chosen based on their prevalence in products and relevance of causing allergic reaction. 

The 2013 winner is..... 

Methylisothiazolinone

What is methylisothiazolone (MI)?

• MI was first introduced  in cosmetics, toiletry and suncreen products in 2005.
• It's used as a preservative to kill bacteria and fungus.
• In the 1980's, it was used in combination in high doses (15 ppm) with a preservative called methylcholoroisothiazolinine/methylisothiazolone in (MC/MI) "leave in" products like shampoo and conditioner
• After the MC/MI introduction about 8% of people had reactions to the recommended doses, and concentrations were reduced to 7.5 PPM in the late 80's and early 90's
• In 2000, MI was pulled out of the MC/MI combination with the hopes that it wouldn't be as strong of a cause of allergic reaction.  They thought it was a weaker sensitizer
• Even though they pulled it out, they didn't limit concentrations!  And concentrations increased by 25 X
• In 2004-5, the first case reports of MI allergy were described after wallpapering and using paint.
• Only 7 years ago, we started seeing reports of people developing allergic reactions in wet toilet paper
• Since 2007, the use of MI as a preservative has doubled along with reactions
• We currently don't know how common MI allergy is.

Where do you find  methylisothiazolone (MI)? - Almost any product that you'd put on your body.

• Cosmetics
• Baby products (lotions, oils, creams, and powder)
• Makeup
• Body Washes
• Hair care products (shampoo, conditioner, straighteners, rinses
• Hair coloring products 
• Nail care products
• Deodorants
• shaving products
• Skin care products
• Sunscreen
• Wet Wipes (babies, and moist towelettes)

When should you suspect you have a methylisothiazolone (MI) allergy?

• MI allergy is common but difficult to distinguish from other preservatives that are use in many personal care products.
• Consult an allergist/immunologist (Find an Allergist) or dermatologist if you have an itchy rash that won't go away.
• They'll perform patch testing and then you'll know!

Want more information?

• http://www.contactderm.org/i4a/pages/index.cfm?pageid=1
• http://www.allergeaze.com/PDFs/AP/AP123-124.pdf
• http://en.wikipedia.org/wiki/Methylisothiazolinone
• Info on Contact dermatitis

Kosher Food Allergy Blog Site

Many of my patients keep kosher and thought you'd be interested in a new blog dedicated to kosher food allergies. kosherfoodallergies.blogspot.com 

For persons with milk allergy, kosher products are an excellent resource, they are clearly labeled dairy free.

The blog is dedicated to specific issues kosher patients might face and tools to deal with them.  I hope you'll find it helpful and useful.

Good luck surviving the heat!

Methyldibromo glutaronitrile/phenoxyethanol Allergy

Could one product cause a rash on the eyes, hands and vagina?

Absolutely! Methyldibromo glutaronitrile/phenoxyethanol is a common preservative found in make-up, personal wipes, shower gels, shampoos, massage oils, and sunscreen, body, face and hand lotions. It’s composed of 80% phenoxyethanol and 20% methyldibromo glutaronitrile. The methyldibromo glutaronitrile is the principle agent causing sensitization.

Each of my patients admitted to using personal care wipes on a regular basis.

The incidence of sensitization is on the rise and repeated exposure to this product at low levels over time can cause an allergic contact dermatitis. This substance is monitored closely in Europe.

Methyldibromo glutaronitrile/phenoxyethanol is difficult to avoid and goes by many names on ingredient lists:

• 1,2-Dibromo-2,4-dicyanobutan

• 2-Bromo-2-(bromomethyl) glutaronitrile

• 2-Bromo-2-(bromomethyl) pentanedinitrile

• Glutaronitrile, 2-bromo-2-(bromomethyl)-

• Methyldibromo glutaronitrile

• Pentanedinitrile, 2-bromo-2-(bromomethyl)-

What should you do if you have this allergy?

Avoid the chemical! Simple avoidance of products containing this preservative will alleviate your rash.

What are some safe personal wipes without methyldibromo glutaronitrile?

Always-Wipes to go

Charmin-Freshmates Wipes

Seventh Generation-Free & Clear Baby Wipes

Visine-Soothing Wipes
Suspect you might be sensitive to methyldibromo glutaronitrile?

• See your local allergist for patch testing.
Want more information?
 http://householdproducts.nlm.nih.gov/index.htm is a great website that is easily searchable.

The Poison Sofa Incident

A true mystery...solved!

From 2006 to 2007, approximately 60 Fins presented to their dermatologists with a strange rash on the backs of their legs, buttocks, and backs. Symptoms were difficult to treat and pervasive. Testing revealed little information as to what was causing such a reaction and all involved were puzzled. The rash spread internationally throughout the UK and Sweden affecting 100's. It was a true mystery.

It was only through careful history by Dr. Rantanen, a Finish dermatologist, learned that each person had recently bought the same sofa from China. He methodically deconstructed the sofa testing approximately 40 component. Inside the sofa he discovered a small sachet containing dimethyl fumarate in crystal form. Sachets were included to inhibit mold growth during transport. It was a true eureka moment when he patch tested the individuals with the crystals & it caused a severe rash. And the so Dr. Rantanen cracked the case of the poison sofa incident!

What is dimethyl fumarate? Dimethyl fumarate (DF) is a profound sensitizing agent and able to cause reactions at levels <1 ppm. DF crystals are highly volatile and can vaporize after 6 weeks. Rashes are severe and very difficult to treat. This product is commonly placed in shoes, furniture and other items shipped from overseas. Dimethyl fumarate has achieved notoriety two times after the discovery was made that it was responsible for the rash landing on the cover of British Journal of Dermatology and as contact allergy of the year in 2011.

In 2009, levels <0.1 ppm were banned in products by the European Union, but occasionally they slip through.

There is one reported case from Canada, but luckily, we’ve not seen any cases of dimethyl fumarate allergy in the US yet (although what out because currently it's not regulated here).