Allergic contact dermatitis to detergents: A multicenter study to assess prevalence
Allergic contact dermatitis to detergents: A multicenter study to assess prevalence
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DOI：
10.1067/mjd.2002.119665
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发表时间：
2002-02-01
影响因子：
13.8
通讯作者：
Nethercott, JR
中科院分区：
文献类型：
--
作者：
Belsito, DV;Fransway, AF;Nethercott, JR
背景。对洗衣粉中荧光增白剂和酶的过敏性接触性皮炎 (ACD) 是 20 世纪 70 年代初期众多报道的焦点。随后，关于洗衣粉中化学物质过敏反应发生率的报道很少。尽管如此，消费者和医生仍然将过敏接触反应归因于洗衣粉。目的。本文报告了一项关于宝洁公司（俄亥俄州辛辛那提）提供的液体和颗粒洗衣粉斑贴试验反应发生率的多中心研究结果。方法：邀请北美接触性皮炎小组成员评估潜在 ACD 的患者参加该研究，其中涉及进行 2 次斑贴试验（颗粒洗衣粉的 0.1% 水稀释液和液体洗衣粉的 0.1% 水稀释液）。记录患者是否患有特应性皮炎，以及他们或他们的医生是否认为他们的皮炎可能与洗衣粉有关。对洗衣粉的反应与对以下化学物质的过敏反应相关：香料、镍和重铬酸钾。对至少一种洗衣剂有反应的患者可以进入研究的第二阶段，其中包括对洗衣剂的不同稀释度、0.1%十二烷基硫酸钠（作为刺激物对照）以及洗过的棉片进行测试。第二阶段呈阳性的患者可以进入第三阶段，其中涉及穿着用洗涤剂清洗的衣服。 II 期和 III 期是双盲的。结果：在这项研究的 21 年期间，北美接触性皮炎小组成员接诊了 3120 名患者，其中 738 名患者自愿参加。入组未进行统计学随机化。在这 738 名患者中，有 5 名（0.7%）对颗粒洗衣粉（0.1%，水性）有阳性斑贴试验反应；这 5 人中的 3 人也对液体洗衣粉（0.1%，水性）有阳性反应。 5 名患者中有 4 名对清洁剂的反应被认为与他们的皮炎有关；在这 5 项中，有 1 项反应被认为具有过去的相关性。这5名患者中有1名对香水过敏。没有患者镍或铬酸盐呈阳性。 5 个项目中的两个进入了第二阶段和第三阶段。在这两名患者中，我的重复稀释斑贴测试和“使用测试”基本上呈阴性，表明早期的反应模式可能具有刺激性。另一名患者对液体和颗粒洗衣粉均出现阳性稀释反应；然而，她对十二烷基硫酸钠和未经洗涤剂清洗的 T 恤样本也有阳性反应。在第三阶段的“使用测试”中，这位患者在用洗涤剂清洗的 T 恤和不用洗涤剂清洗的 T 恤的一半下都出现了弥漫性皮炎。结论：洗衣剂似乎是 ACD 的罕见原因，在 738 名皮炎患者中，有 5 名（0.7%）对 0.1% 洗衣剂水稀释液有反应。这 5 名患者中只有 2 名可以进行更详细的评估，以区分过敏和对清洁剂的刺激性斑贴试验反应。在对 2 名患者进行进一步测试后，2 名患者中的 I 中的反应无法重复，而另一名患者中的反应由去污剂和对照均引起。因此，我们的研究患者是否真的过敏，如果是，洗涤剂中的过敏物质可能是什么，仍然未知。因此，据报道，皮炎患者中洗涤剂引起的过敏发生率为 0.7%，这可能过高，可能是由于假阳性刺激反应所致。
Background. Allergic contact dermatitis (ACD) to optical brighteners and enzymes in laundry detergents was the focus of numerous reports in the early 1970s. Subsequently there has been little published on the incidence of allergic reactions to chemicals in laundry detergents. Nonetheless, consumers and physicians continue to ascribe allergic contact reactions to laundry detergents.Objective. This article reports the findings of a multicenter study on the prevalence of patch test reactions to a liquid and a granular laundry detergent provided by Procter & Gamble Company (Cincinnati, Ohio).Methods: Patients referred to members of the North American Contact Dermatitis Group for evaluation of potential ACD were invited to participate in the study, which involved the placement of 2 patch tests (a 0.1% aqueous dilution of a granular laundry detergent and a 0.1% aqueous dilution of a liquid laundry detergent). Whether the patients had atopic dermatitis and whether they or their physicians felt that their dermatitis might be related to laundry detergents were noted. Reactions to the laundry detergents were correlated with allergic reactions to the following screening chemicals: fragrances, nickel, and potassium dichromate. Patients who experienced a reaction to at least one of the laundry detergents could enter phase II of the study, which involved testing to varying dilutions of the laundry detergents, to 0.1% sodium lauryl sulfate (as an irritant control), and to laundered patches of cotton. Patients positive in phase II could enter phase III, which involved wearing a garment laundered with the detergent. Phases II and III were double blinded.Results: Of the 3120 patients seen by members of the North American Contact Dermatitis Group during the 21 years of this study, 738 patients volunteered to enroll. Enrollment was not statistically randomized. Of these 738, 5 (0.7%) had positive patch test reactions to granular laundry detergent (0.1%, aqueous); 3 of these 5 also had positive reactions to the liquid laundry detergent (0.1%, aqueous). in 4 of the 5 patients, the reaction to detergent was thought to have present relevance to their dermatitis; in 1 of the 5, the reaction was deemed to have past relevance. One of these 5 patients had allergy to fragrances. None of the patients was positive to nickel or chromate. Two of the 5 entered phases II and III. Of these 2 patients, I had essentially negative repeat dilutional patch testing and "use testing" suggesting that the earlier reaction patterns may have been irritant. The remaining patient had positive dilutional reactions to both the liquid and granular laundry detergent; however, she also had a positive reaction to sodium lauryl sulfate and to a swatch from a T-shirt laundered without detergent. Upon "use testing" in phase III, this latter patient experienced diffuse dermatitis under both the half of the T-shirt laundered with detergent and that laundered without detergent.Conclusion: Laundry detergents appear to be a rare cause of ACD, Among 738 patients with dermatitis, 5 (0.7%) reacted to a 0.1% aqueous dilution of a laundry detergent. Only 2 of these 5 patients could be evaluated in greater detail to differentiate allergic from irritant patch test reactions to detergents. Upon further testing in 2 patients, the reaction in I of 2 could not be reduplicated and the reaction in the other was invoked both by the detergents and the controls. Thus, whether our study patients were truly allergic and, if so, what the allergenic material(s) in detergents might be, remains unknown. Therefore the reported incidence rate for detergent-induced allergy, of 0.7% in dermatitic patients may be too high, possibly because of false-positive irritant reactions.