Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016

• Published in: Journal of the American Academy of Dermatology Vol. 84; no. 4; pp. 965 - 976
• Main Authors: Atwater, Amber Reck, Petty, Amy J., Liu, Beiyu, Green, Cynthia L., Silverberg, Jonathan I., DeKoven, Joel G., Belsito, Donald V., Reeder, Margo J., Sasseville, Denis, Taylor, James S., Maibach, Howard I., Zirwas, Matthew J., Marks, James G., Zug, Kathryn A., Fowler, Joseph F., Pratt, Melanie D., DeLeo, Vincent A., Warshaw, Erin M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021
• Subjects: Age Distribution; allergic contact dermatitis; benzyl alcohol; Canada - epidemiology; contact dermatitis; Cross-Sectional Studies; Dermatitis, Allergic Contact - diagnosis; Dermatitis, Allergic Contact - epidemiology; Dermatitis, Allergic Contact - etiology; Dermatitis, Occupational - epidemiology; Dermatitis, Occupational - etiology; Female; formaldehyde; formaldehyde releaser; Hand Dermatoses - epidemiology; Humans; Hypersensitivity, Immediate - epidemiology; iodopropynyl butylcarbamate; Linear Models; Male; methylchloroisothiazolinone/methylisothiazolinone; methyldibromo glutaronitrile/phenoxyethanol; methylisothiazolinone; Middle Aged; NACDG; Organ Specificity; paraben; patch test; Patch Tests; phenoxyethanol; preservative; preservative allergy; Preservatives, Pharmaceutical - adverse effects; Retrospective Studies; Sex Distribution; United States - epidemiology; Canada; United States; PP; formaldehyde releaser; benzyl alcohol; contact dermatitis; IPBC; FR; methylchloroisothiazolinone/methylisothiazolinone; NACDG; PPTR; MI; pet; paraben; preservative; OP; formaldehyde; SPIN; allergic contact dermatitis; iodopropynyl butylcarbamate; methylisothiazolinone; ppm; preservative allergy; CIR; MDBGN; ACDS; aq; DMDM; MCI; phenoxyethanol; methyldibromo glutaronitrile/phenoxyethanol; patch test
• ISSN: 0190-9622; 1097-6787; 1097-6787
• DOI: 10.1016/j.jaad.2020.07.059

Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited.
To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group.
We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016.
A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time.
Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias.
This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016.