isobornyl-acrylate and Diabetes-Mellitus--Type-1

Topics: Acrylates; Blood Glucose Self-Monitoring; Camphanes; Cross Reactions; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Humans; Lactones; Male; Molecular Structure; Patch Tests; Sesquiterpenes; Young Adult

The number of patients with contact dermatitis from glucose sensors and insulin infusion sets is increasing. Patch testing is challenging because of a lack of information concerning the constituent materials of medical devices.. To report on products and causes of allergic reactions to glucose sensors or insulin infusion sets over a 5-year period and suggest a short screening series.. Analysis of patch test data from consecutive patients suspected of allergic contact dermatitis (ACD) to glucose sensors and/or insulin infusion sets from 2015-2019.. Patient numbers increased from 4 to 15 per year; 30/38 (78.9%) were children. In 29 (76.3%), a diagnosis of allergic/probable ACD was established, mostly due to the tapes of the device or allergens in these tapes (n = 23) followed by allergens in the device housing (n = 10). Isobornyl acrylate, abitol, and colophonium were the most common allergens. Information from manufacturers was often difficult to obtain and, if accessible, inadequate. For this reason, the diagnosis was delayed for more than 1.5 years in 12 (31%) patients.. The increasing number of patients, mostly children, with ACD from devices used in treatment of type 1 diabetes demonstrates the importance of this problem. Allergies can easily be overlooked, due to the lack of mandatory labeling of the constituent materials of the devices.

Topics: Abietanes; Acrylates; Adolescent; Adult; Allergens; Blood Glucose Self-Monitoring; Camphanes; Child; Child, Preschool; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Humans; Insulin Infusion Systems; Male; Middle Aged; Patch Tests; Resins, Plant; Retrospective Studies; Surgical Tape; Young Adult

Topics: Acrylates; Blood Glucose; Blood Glucose Self-Monitoring; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Humans

Allergic contact dermatitis from glucose sensors may interfere with their ongoing application.. To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results, and outcomes from the ongoing use of the device.. A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain (epidemiological features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results).. Thirty patients were evaluated (mean age 20.9 years). A total of 66.7% were children and 66.7% female. Ninety per cent used Freestyle Libre (FSL). Eight of 26 (30.8%) reacted to isobornyl acrylate (IBOA) and two of 20 (10.0%) to N,N dimethylacrylamide (DMAA). The mean latency time to develop dermatitis was 9 months. Sixteen of 29 (55.2%) patients continued using the same sensor causing the reaction. Thirteen of 29 (44.8%) patients were unable to continue using the sensor because of severe reactions. Of these, five were positive to IBOA, one to IBOA and DMAA, one to DMAA, one to colophony, and one to isopropyl alcohol wipes. In one patient, the outcome was unknown.. The frequency of sensitisation to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding the composition of medical devices and cooperate with the investigations into contact dermatitis is urgently needed.

Topics: Acrylates; Adult; Allergens; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Humans; Insulin Infusion Systems; Male; Patch Tests; Spain; Young Adult

Continuous glucose monitoring (CGM) systems replace more and more capillary self-monitoring of blood glucose by patients with diabetes. However, at least a subset of patients experience adverse skin reactions such as severe allergic contact dermatitis (ACD) after prolonged usage of CGM systems. A major allergen isobornyl acrylate (IBOA) has been identified recently.. After developing an ACD, patients have difficulties in continuing the usage of their CGM system (and also of, eg, certain patch pumps). Most of such patients look for possibilities to continue the usage of, eg, a CGM system that requires intermittent scanning (iscCGM, Freestyle Libre).. Eight patients with a known ACD were supplied with different hydrocolloid-based plasters (. All patients were able to continue the usage of this iscCGM system when using such plasters.. Patients with ACD benefit from the usage of such plasters; however, some limitations have to be acknowledged.

Topics: Acrylates; Adult; Bandages, Hydrocolloid; Biomarkers; Blood Glucose; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Equipment Design; Female; Humans; Male; Middle Aged; Patch Tests; Predictive Value of Tests; Risk Assessment; Risk Factors; Treatment Outcome

Allergic contact dermatitis caused by glucose sensors has been recently described in diabetics, mostly in adult patients. Isobornyl acrylate and N-N dimethylacrylamide are the potent causative agents.. To describe a child population with contact dermatitis caused by glucose sensors, determine the causative allergen, and assess the prevalence of isobornyl acrylate (IBOA) sensitization.. Overall, 12 children with a reaction to medical devices, either glucose sensors or insulin sets, were patch tested with the European baseline series, glues and rubber, (meth) acrylates series, and with piece of the adhesive part of the glucose sensor FreeStyle Libre. Isobornyl acrylate 0.1% pet. was patch tested in 11 patients, and N-N dimethylacrylamide in two. Some patients were tested with adhesive parts of the infusion set.. Overall, 10 children reacted to the adhesive part of the sensor FreeStyle Libre, and 10 children were sensitized to IBOA. One patient turned out to be negative in all patch tests.. Allergic contact dermatitis caused by glucose sensors is common in the pediatric diabetic patient population. Like in the adult patient population, IBOA was the culprit allergen, with 83.3% sensitization prevalence in children exhibiting adverse cutaneous reactions caused by FreeStyle Libre.

Topics: Acrylates; Adhesives; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Humans; Male

Topics: Acrylates; Adolescent; Allergens; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Disposable Equipment; Female; Humans; Male; Patch Tests

Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported. Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens.. To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications.. A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series. IBOA and DMAA were tested at 0.1% and 0.3% in petrolatum (pet.). Readings were performed on day (D) 3 and D7. Background data, details on skin reactions, and associated implications were assessed using a questionnaire.. Thirteen patients were sensitized to IBOA and four to DMAA. Two positive reactions to IBOA and one to DMAA were seen only at 0.3% concentration on D7. Median duration of sensor use before dermatitis onset was 6 months. Half the number of the patients took precautions in everyday life due to sensor-related skin reactions. Six patients discontinued sensor usage.. Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA. Adding the 0.3% pet. concentration is recommended. The reading on D7 is necessary.

Topics: Acrylamides; Acrylates; Administration, Cutaneous; Adult; Allergens; Blood Glucose Self-Monitoring; Camphanes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Patch Tests

Topics: Acrylates; Arm; Blood Glucose Self-Monitoring; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Disease Management; Equipment and Supplies; Humans; Male; Middle Aged; Patch Tests

We present the case of an 8-year-old girl with type 1 diabetes who developed severe allergic contact dermatitis by using FreeStyle

Topics: Acrylates; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Humans; Hypoglycemic Agents; Prognosis

Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series.. To compile patch test results of subjects affected, and provide potential explanations for this association.. Fifty-three Freestyle Libre-allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM.. Thirty-three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography-mass spectrometry (GC-MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA.. Significant co-sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC-MS analysis. Cross-reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist.

Topics: Acrylates; Adolescent; Adult; Aged; Blood Glucose Self-Monitoring; Camphanes; Child; Child, Preschool; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Patch Tests; Sesquiterpenes; Young Adult

Allergic contact dermatitis caused by glucose sensors has become an increasing problem. Contact allergies to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide have been reported. However, there is a paucity of information regarding the prevalence of sensor-related dermatitis and detailed patient histories.. To evaluate diabetes patients who have developed allergic contact dermatitis caused by glucose sensors.. Seventy patients with suspected contact allergy to glucose sensors referred to university hospital dermatology clinics in southern Finland were patch tested with the baseline series, an isobornyl acrylate dilution series, and a number of other acrylates. Atopic constitution, contact allergies, the severity of the dermatitis and the ability to continue with the same or another type of sensor were recorded.. Positive patch test reactions to isobornyl acrylate were seen in 51 of 63 (81%) Freestyle Libre users. Colophonium or its derivatives gave positive reactions in five of seven Medtronic Enlite users. The median duration of sensor use before dermatitis was 6 months. The estimated prevalences of contact allergy to sensor adhesives were 0.7% for Freestyle Libre and 0.8% for Enlite.. We suggest that patients who have difficulties in finding a tolerable glucose sensor or an insulin pump should be patch tested.

Topics: Acrylates; Adolescent; Adult; Aged; Blood Glucose Self-Monitoring; Camphanes; Child; Child, Preschool; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Disposable Equipment; Female; Humans; Male; Middle Aged; Patch Tests; Resins, Plant; Young Adult

Topics: Acrylates; Adult; Blood Glucose Self-Monitoring; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Disposable Equipment; Female; Humans; Middle Aged; Patch Tests

In the past decade, new diabetes technologies, including continuous glucose monitoring (CGM) systems, support patients with diabetes in their daily struggle with achieving a good glucose control. However, shortly after the first CGM systems appeared on the market, also the first concerns about adverse skin reactions were raised. Most patients claimed to suffer from (sometimes severe) skin irritation, or even allergy, which they related to the (acrylate-based) adhesive part of the device. For a long time the actual substance that caused these skin reactions with, for example, the Flash Glucose Monitoring system (iscCGM; Freestyle® Libre) could not be identified; however, recently Belgian and Swedish dermatologists reported that the majority of their patients that have developed a contact-allergic while using iscCGM react sensitively to a specific acrylate, that is, isobornyl acrylate (IBOA). Subsequently they showed by means of gas chromatography-mass spectrometry that this substance is present in the case of the glucose sensor attached by an adhesive to the skin. We report three additional cases from Germany, including a 10-year-old boy, suffering from severe allergic contact dermatitis to IBOA.

Topics: Acrylates; Adhesives; Blood Glucose Self-Monitoring; Camphanes; Child; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Humans; Male

The frequency of allergic contact dermatitis caused by (meth)acrylates is increasing worldwide, and isobornyl acrylate (IBOA) has been identified as a culprit sensitizer in FreeStyle Libre, a medical device used by diabetic patients.. To report on 4 patients sensitized to IBOA contained in OmniPod, a new, tubeless insulin pump, and to describe the clinical and chemical analytical work-up.. Four patients with eczematous skin eruptions after using OmniPod, including 2 with previous adverse skin reactions to FreeStyle Libre, were patch tested with a baseline series and additional (meth)acrylates, including IBOA in several concentrations and/or vehicles. Gas chromatography-mass spectrometry (GC-MS) was used to identify the presence of IBOA in OmniPod.. All patients were shown to be sensitized to IBOA. GC-MS identified IBOA in OmniPod, with the highest concentrations being found in the unit itself and not in the adhesive patch.. The OmniPod tubeless insulin pump is another source of IBOA, and its use may lead to primary sensitization to this acrylate, or may provoke elicitation of allergic contact dermatitis in previously sensitized patients. Our cases highlight the need to obtain satisfactory cooperation from pharmaceutical companies involved in the manufacture of these widely used medical devices.

Topics: Acrylates; Adhesives; Adolescent; Adult; Aged; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Female; Humans; Insulin Infusion Systems; Middle Aged; Patch Tests

Topics: Acrylates; Adult; Blood Glucose Self-Monitoring; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Equipment and Supplies; Humans; Male

Glucose sensors, such as FreeStyle® Libre, are innovative medical devices developed for diabetes patients as a replacement for classic glucose meters, ensuring continuous glucose monitoring without the disadvantage of regular skin finger pricks.. To report several cases of allergic contact dermatitis caused by FreeStyle® Libre, and to report on isobornyl acrylate as a culprit allergen.. Fifteen patients presented with allergic contact dermatitis caused by FreeStyle® Libre. All but 1 were patch tested with a baseline series, and with pieces and/or ultrasonic bath extracts of (the adhesive part of) the glucose sensor. Isobornyl acrylate was patch tested, in various concentrations and vehicles, in 13 patients. Gas chromatography-mass spectrometry (GC-MS) of the sensors was performed.. All patients reacted to the adhesive part of the sensor, and 12 patients were shown to be sensitized to isobornyl acrylate. Simultaneous reactions to other allergens were rarely observed. GC-MS showed the presence of isobornyl acrylate in the sensors.. Cases of allergic contact dermatitis caused by FreeStyle® Libre are increasingly being observed, and isobornyl acrylate is a relevant culprit allergen. Cross-reactivity to other acrylates was infrequently observed, but other, hitherto unidentified, contact allergens may still be present in the device.

Topics: Acrylates; Administration, Cutaneous; Blood Glucose; Blood Glucose Self-Monitoring; Camphanes; Dermatitis, Allergic Contact; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Gas Chromatography-Mass Spectrometry; Humans