Adding sorbitan sesquioleate to the European baseline series: necessary, reasonable, or unavoidable?
Anton de Groot Liesbeth Gilissen Johannes Geier David Orton An Goossens
First published: 08 June 2019 https://doi.org/10.1111/cod.13332
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13332.
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Summary
Positive reactions to fragrance mix I (FM I) are frequently found in consecutively patch tested patients suspected of allergic contact dermatitis. However, the FM I test preparations contain 5% of the emulsifier sorbitan sesquioleate (SSO) and it is well known that SSO can cause contact allergic reactions in its own right. Indeed, available data show that some patients with contact allergy to SSO react to FM I but are not allergic to fragrances. When SSO is not tested, this situation may go unnoticed, a wrong diagnosis of fragrance allergy may be given to the patient and an unjustified advice to avoid fragrances and fragranced products will often be issued. To avoid such suboptimal patient care, we postulate that testing SSO in all patch tested individuals is mandatory. As it is well known that only a minority of FM I‐reactive patients will undergo a breakdown test with the ingredients and SSO, testing SSO in all patients can only be achieved by adding it to the European baseline series. Not testing SSO may also result in misinterpretation of patch test reactions to Myroxylon pereirae resin and 2‐hydroxyethyl methacrylate (HEMA) in the baseline series, as both (may) contain SSO, and, for the same reason, of reactions to several other hapten test materials.
Anton de Groot Liesbeth Gilissen Johannes Geier David Orton An Goossens
First published: 08 June 2019 https://doi.org/10.1111/cod.13332
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13332.
ePDFPDFTOOLS SHARE
Summary
Positive reactions to fragrance mix I (FM I) are frequently found in consecutively patch tested patients suspected of allergic contact dermatitis. However, the FM I test preparations contain 5% of the emulsifier sorbitan sesquioleate (SSO) and it is well known that SSO can cause contact allergic reactions in its own right. Indeed, available data show that some patients with contact allergy to SSO react to FM I but are not allergic to fragrances. When SSO is not tested, this situation may go unnoticed, a wrong diagnosis of fragrance allergy may be given to the patient and an unjustified advice to avoid fragrances and fragranced products will often be issued. To avoid such suboptimal patient care, we postulate that testing SSO in all patch tested individuals is mandatory. As it is well known that only a minority of FM I‐reactive patients will undergo a breakdown test with the ingredients and SSO, testing SSO in all patients can only be achieved by adding it to the European baseline series. Not testing SSO may also result in misinterpretation of patch test reactions to Myroxylon pereirae resin and 2‐hydroxyethyl methacrylate (HEMA) in the baseline series, as both (may) contain SSO, and, for the same reason, of reactions to several other hapten test materials.
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