What's New In Skin Allergy in NYC?

I just returned from the American Contact Dermatitis Society 27th Annual Meeting  in Washington DC. This entire day was focused on new and emerging trends in skin allergy including hot topics in contact dermatitis. I was surrounded by experts from around the world in contact dermatitis- we shared patient stories and brainstormed about difficult cases.  I learned so much and am excited to bring back this information to you my patients in NYC.

One exciting new development for my patients with contact dermatitis is the introduction of the American Contact Dermatitis Society's new app for CAMP.   It's a free and easy way of using your product list in stores.

If I've created a safe product list for you, put your search codes (found in the upper left hand corner) and you're set to go.  A word of caution, as products formularies are updated, the list won't automatically update.  This app is easy to use and you can create favorite lists of your "safe" products.  I  know you'll find this helpful and a welcome addition to your safe list.


Some of the topics discussed were: 
Emerging sensitizers in contact dermatitis
The role of the skins microbiome in the development of contact dermatitis
Phenylenediamine allergy
Patch testing in pediatric patients
Food patch testing

Announcing the Contact Allergen of 2016!Announcing the Contact Allergen of the Year

There they announced the 2016 contact allergen of the year- Gold Sulfate.   More on this from the blog coming soon.  These contact allergens are important sensitizers in our personal care products. One in four people are sensitized to commonly used products like shampoos, soaps, make ups and lotions.

Past winners have included:

• 2015 - Formaldehyde^[2]
• 2014 - Benzophenones^[3][4]
• 2013 - Methylisothiazolinone^[5] - This chemical is used as a preservative in many cosmetics, lotions, and makeup removers; some of its side effects include flaky or scaly skin, breakouts, redness or itchiness, and moderate to severe swelling in the eye area.
• 2012 - Acrylate^[6][7]
• 2011 - Dimethyl fumarate^[8][9] - Dimethyl fumarate is the chemical associated with 'poisoned chairs' and 'toxic sandals'.
• 2010 - Neomycin (antibiotic)^[10][11]
• 2009 – Mixed dialkyl thiourea^[12][13] - Neoprene rubber is a common source.
• 2008 – Nickel^[14][15]
• 2007 – Fragrance^[16]
• 2006 – p-Phenylenediamine^[17][18] - PPD is the hair dye chemical that is used to augment black henna tattoos. It has been shown to cause severe blistering and scarring, and its topical use is banned in some countries.
• 2005 – Corticosteroids^[19]
• 2004 – Cocamidopropyl betaine ^[20][21]
• 2003 – Bacitracin^[22][23]
• 2002 – Thimerosal^[24]
• 2001 – Gold^[25][26]
• 2000 – Disperse Blue Dyes^[27]

I also learned that VMW hypoallergenics is introducing a Superskin-starts-here Set for people recently diagnosed with contact dermatitis.  This is designed to get you started with sample size products to reduce the possibility of irritation.@VMVinNYC

I'm brought back all of this information back to the practice and am excited to help those with skin allergy.

Schedule an appointment if you need help with your difficult to treat skin with our office.  Schedule an appointment here

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@gramercyallergy.com

What is Paraben Allergy?

The FDA doesn’t regulate the chemicals in cosmetics and it’s up to consumers to be aware of the chemicals we put on and in our bodies on daily basis.  More and more, people are experience allergy to their cosmetics and personal care products.  These reactions cause itchy red swollen skin. As a cosmetic allergist, I have many patients who are a loss for what’s triggering the reaction. They know that certain lipsticks make their lips dry and irritated or sometimes a shampoo will trigger itchy dry irritated skin, but are confused about the exact cause.  This type of allergic reaction is called contact dermatitis.  

One common allergen in personal care products that triggers an itchy eczematous rash is parabens. 

What are Parabens?

• Parabens first introduced in the 1920’s are preservatives to help prevent bacterial and fungal growth.  Since their introduction, they’ve become some of the most common preservatives uses. 
•  Parabens come from an aromatic organic acid naturally found in fruits and vegetables called 4-hydroxybenzoic acid.  This forms the basis for parabens.
•  There are many types of parabens, but the most commonly used ones are methylparaben, propylparabens and butyl parabens.  These types of parabens are often mixed into one product type to provide broad spectrum protection against microorganisms.  Manufacturers do these to reduce the concentration of each one individually but provide the same type of preservative effect.

• Parabens can also cross react with chemical commonly used in sunscreens – para-aminobenzoic acid (PABA) esters, and in hair dye (paraphenylenediamine).

·      Parabens may also go by these names:

o   Methylparaben

o   Ethylparaben

o   Propylparaben

o   Butylparaben

o   Benzyl-parahydroxybenzoate (p-hydroxybenzoate)

o   Methyl-parahydroxybenzoate (p-hydroxybenzate)

o   Ethyl-parahydroxybenzoate (p-hydroxybenzoate)

o   Propyl-parahydroxybenzoate (p-hydroxybenzoate)

o   Butyl-parahydroxybenzoate (p-hydroxybenzoate)

o   Parahydroxybenzoate (p-hydroxybenzoate)

Where do you find Parabens?

• Parabens in personal care products:
• According to the American Chemical Society, they are used in almost 85% of all personal care products.  Common products like toothpaste, shampoo, lotions, sunscreens, moisturizers and lipsticks contain parabens.  They are also found in some topical medications like corticosteroid creams and anti-itch sprays. 
• Parabens in food products:
• You might be surprised to learn that parabens are added to food products like: pancake syrup, mayonnaise, salad dressing, baked goods, candy, food dye, soft drinks and fruit juices, spiced sauces, processed vegetables, and jams/jellies
• Parabens are also found naturally in food products like mango, blueberry, mango, strawberries, cocoa beans, carrots, vanilla, and onions.
• You can also find parabens naturally in some wine and beer products.

What is Paraben Allergy?

• Repeat exposure to skin, particularly damaged skin, but parabens can trigger an allergic reaction called contact dermatitis.
•  According to a 2015 study by Warshaw et al, parabens caused anywhere from 1.4% of of all contact reactions. Exposure to parabens can cause your skin to become dry, itchy and swollen.

What Should you Do if You Suspect You Are Allergic to Parabens?

• If you suspect you have paraben allergy, speak with your allergist about having a special chemical allergy test done called patch testing. 

How Can you Avoid Parabens?

• If you have paraben allergy, then you should strictly avoid any product or food that contains these chemicals
• Reading ingredient lists on your personal care products and food labels will be essential to preventing a future reaction.
• Using products that are oil based will help limit your exposure
• Be especially careful with sunscreens, processed foods, topical medications and other unexpected sources of parabens.  
• If you visit gramercyallergy, we will generate a paraben free list of products you can safely use. 

Have further questions regarding paraben allergy or suspect you have paraben allergy?  Visit GramercyAllergy. We are experts in cosmetic allergy.  We will help identify which cosmetic product is triggering your allergy. 

Book an appointment here on-line 

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@gramercyallergy

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!

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).