Dear BSCA members,

We have two proposals to change the BSCA constitution, to be voted for at the AGM in July:

Proposal one

The roles and time required to undertake them have increased significantly over the last decade. The committee proposes splitting the previous treasurer and membership and now website responsibilities into two:

“There will be a Committee consisting of a President, Committee Secretary, Meetings Secretary, Treasurer”

Is changed to:

“There will be a Committee consisting of a President, Committee Secretary, Meetings Secretary, Treasurer, Membership and Website Secretary”

Proposal two

The BSCA regularly receives high quality applications to join the BSCA but due to the current constitutional rules they have had to be declined. The President’s aim is to increase membership, increase accessibility to BSCA resources for nurses and SAS doctors and increase support for centres trying to establish or improve patch test services. Applicants report that it can be difficult to find 2 members of the BSCA to propose them.  

It is proposed an  amendment be made to the constitution.

“Prospective applicants for membership of the society must be proposed by 2 members of the British Society of Cutaneous Allergy who are on the Dermatology specialist register. The application must be approved by the committee who will take into account the training and competency of the individual.”

Is changed to

“Prospective applicants for membership of the society must be proposed by 2 individuals. One a member of the British Society of Cutaneous Allergy who is on the Dermatology specialist register,  and the other a BAD Ordinary Member. The application must be ratified by the President and the Membership secretary before being approved by the committee who will take into account the training and competency of the individual.”

Notes

• Alterations of the constitution can only be at an Annual General Meeting.
• Notice of the proposals above by Dr G A Johnston and duly seconded by Dr DA Buckley have been sent to the Committee Secretary Dr NJ Stone two months before the meeting and will be circulated with the notice of that meeting one month before the meeting.
• For adoption a two-thirds majority of those voting will be necessary.

 Both will be voted for at the AGM in July.

The BSCA has two vacancies on the BSCA committee – one for the wider Oxford area and one for the Bristol/South West of England area. Please email Graham Johnston graham.johnston@uhl-tr.nhs.uk before the end of May if you are interested.

Dear all

Detailed minutes from the recent committee meeting will be published on the website.

1) Dates for diaries
BSCA Update meeting – 7th May 2021 combined with the Dowling club meeting, online.
BAD Annual Meeting 6-8 July 2021 (BSCA Meeting Tuesday 6th July 2021), online.
ESCD Congress – 8th-10th June 2022, Amsterdam.

2) Series updates
Our last snippet detailed the addition of tree moss absolute (Evernia furfuracea), hydroxyethyl methacrylate (2-HEMA), linalool hydroperoxide 1% & 0.5% pet, limonene hydroperoxide 0.3% & 0.2% pet and finally benzisothiazolinone (BIT) 0.1% pet and octylisothiazolinone (OIT) 0.1% pet to the British standard series. Further new additions to the standard series:

Decyl glucoside 5% pet. & Lauryl glucoside 3% pet
Alkyl glucosides are a family of mild non-ionic surfactants (1). They are completely biodegradable and considered less irritant and less allergenic than anionic surfactants and have therefore regained favour in recent years (1,2).

They have cleaning, foaming and emulsifying properties. They are found in rinse-off products such as shower gels, shampoos, soaps, cleansers and hair dyes, and in leave-on cosmetics such as sunscreens, fragrances, tanning products, emollients, deodorants and baby products including wipes.

There has been a steady increase in the frequency of sensitization since the first described case in 2003, with alkyl glucosides named “Allergen of the Year” in 2017 by the American Contact Dermatitis Society (2). Allergic Contact Dermatitis (ACD) induced by alkyl glucosides is known to be more common in patients with a history of atopy (2).

Decyl glucoside is the most common alkyl glucoside causing ACD. Patch testing to multiple glucosides is recommended, where allergy is suspected, as concomitant reactions with other alkyl glucosides cannot be relied upon to detect sensitisation (1). There have been multiple reports of ACD caused by decyl glucoside in the sunscreen ingredient Tinosorb M (organic UV filter) (2). Alkyl glucosides have also been identified as culprit allergens in wound dressings (2).

Soriano and colleagues investigated the frequency of contact allergy to decyl glucoside and lauryl glucoside in consecutive patients in the UK and Ireland and presented relatively high positive patch tests to these glucosides (1.6% & 1.8% respectively) along with frequent irritant reactions (2.2% & 2.0% respectively) (Data presented at the BAD annual meeting 2020). Concomitant reactions between the two occurred in less than half of patients (3).

3) Winners of the BSCA presentation and poster awards from the virtual BAD annual 2020 meeting:

(a) Presentation Joint Winner: Dr S. Arianayagam. Updating the British Association of Cutaneous Allergy medicament series: just what the doctor ordered (£100)

(b) Presentation Joint Winner: Dr S. Morrow. Out with the old and in with the new? Getting the British Society for Cutaneous Allergy corticosteroid series up to scratch (£100)

(c) Poster Winner: Dr Y. Khan. Immediate and delayed hypersensitivity reaction to para-phenylenediamine (£50)

References
(1) Bhoyrul B, Solman L, Kirk S, Orton D, Wilkinson M. Patch testing with alkyl glucosides: Concomitant reactions are common but not ubiquitous. Contact Dermatitis. 2019;80:286-290.
(2) Monteiro A, Paulino M, Maquina A, Amaro C, Viana I. Allergic contact dermatitis to decyl glucoside: Still an important allergen in Tinosorb M. Contact Dermatitis.2020;82:126-128.
(3) LF Soriano, CG Bertram, MMU Chowdhury, P Cousen, P Divekar, SA Ghaffar, C Green, A Havelin, CR Holden, GA Johnston, AA Mughal, E Nic Dhonncha, RA Sabroe, NM Stone, DA Thompson, M Wilkinson, DA Buckley. Prevalence of allergic contact dermatitis to decyl and lauryl glucoside in the UK and Ireland. Br J Dermatol. 2020 Oct 14. doi: 10.1111/bjd.19603. Online ahead of print. PMID: 33090453.



We moved the BSCA website to a more powerful server. You should see quicker loading times.

Background (Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. To date, (meth)acrylates have not been routinely tested in the baseline patch test series in the U.K. and Europe.

Read the full paper here:
Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series

An allergy that is missed frequently. Read the research letter here: Research letter. (meth)acrylate allergy. frequently missed?

Ethylenediamine allergy – a historical problem?

Mansoor N1, Howard L1, Bertram CG2, Chowdhury MMU3, Cooper S4, Abdul Ghaffar S5, Green C5, Holden C6, Johnston GA7, Mughal A8, Reckling C9, Sabroe R6, Sansom J10, Stone NM11, Thompson D12, Buckley DA1
1. Department of Dermatology, Royal United Hospital, Bath
2. Department of Dermatology, NHS Lothian, Edinburgh
3. Department of Dermatology, Welsh Institute of Dermatology, University Hospital of Wales, Cardiff
4. Department of Dermatology, Oxford Radcliffe Hospitals NHS Trust
5. Department of Dermatology, Ninewells Hospital and Medical School, Dundee.
6. Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust
7. Department of Dermatology, University Hospitals of Leicester NHS Trust
8. Department of Dermatology, Singleton Hospital, Swansea.
9. Department of Dermatology East Kent Hospitals University NHS Foundation Trust, Canterbury
10.Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol
11.Dermatology Department, Aneurin Bevan University Health Board, Newport 12.Department of Dermatology, Sandwell and West Birmingham Hospitals NHS Trust

Ethylenediamines are a structural class of antihistamines developed in the 1940s, which have other useful functions. Ethylenediamine dihydrochloride (EDA) is currently a constituent of parenteral aminophylline, insecticides, lubricants, herbicides, metal polishes, detergents, floor polish removers, waxes, rubbers, dyes, freezing/cooling solutions, epoxy curing agents and bleach accelerators (Dittmar D, Politiek KM, Coenraads P-J et al. Contact Dermatitis 2017; 76: 310-12). EDA is no longer present in any prescribed cream in the U.K.
The first case report of cutaneous allergy to EDA was in 1958 (Tas J, Weissberg D. Allergy to aminophylline. Acta Allergol. 1958; 12: 39-42). From 1968, routine patch testing to EDA in baseline series was recommended due to the high frequency of sensitisation. In recent years allergy to EDA has declined. It was removed from the European Baseline Series in 1995. Tri-Adcortyl® cream (containing EDA as a preservative, emulsifier and stabiliser), the most common source of allergy to EDA in the U.K., was discontinued in 2009. The resulting decrease in the frequency of

positive patch tests led EDA to be removed from the BSCA baseline series in March 2018.
We wished to assess the current prevalence of sensitisation to EDA, and its relevance. We performed a retrospective audit using data from 12 patch test centres in the U.K., examining the rate of sensitisation to EDA in consecutively tested patients between 2013 and 2018 and the relevance of any positive patch tests, where known. 20,456 consecutive patients were tested and 127 (0.62%) had a positive patch test to EDA. Demographics were available for 112 of these patients. Two-thirds (70%) were female (n=78); the mean age was 59.4 years (median 60). 41 of the 127 patients sensitised to EDA (32%) had positive tests deemed to be of current (19) or past (22) relevance. Tri-adcortyl® was the source of sensitisation in 16 of these 41 cases. Other sources of exposure included rubber, aminophylline and topical nystatin. In some cases, sensitisation was thought to reflect exposure to cross-reacting oral antihistamines, including hydroxyzine. Only one case was thought to be occupational.
EDA is now a rare sensitizer, and in most patients with positive patch tests relevance cannot be determined. In the last decade, reported cases have largely been due to occupational exposure. We suggest that EDA be reserved for occasional testing in selected patients with a history of relevant occupational exposure, or in those with severe dermatitis after exposure to intravenous aminophylline.

The CTPA has produced an ingredient labelling help note for dermatologists. This note explains the standardisation of cosmetic ingredient (INCI) labelling, with further detail specifically on hair colorants, fragrance allergens and methylisothiazolinone (MIT). The note enables dermatologists to inform their patients what ingredient names to look for on-pack and avoid if diagnosed as allergic to them.

Tables of INCI names of ingredients which are more commonly associated with sensitisation are provided, along with the chemical names and some trade names of the ingredients.

The INCI names of nut-derived ingredients and the INCI names of the 26 fragrance allergens which must be labelled on the product packaging if present above a certain threshold, have also been provided.

The Ingredient Labelling Help Note for Dermatologists may be found under the Ingredient Labelling section on the CTPA website.

In order for dermatologists to contact the correct personnel responsible for Cosmetovigilance within cosmetic companies, CTPA holds a list of contact details for the relevant contact within each company. Cosmetovigilance is the name given to the legal obligations for companies to address undesirable effects to cosmetic products.

To request the contact details for a manufacturer, please email patchtesting@ctpa.org.uk.

CTPA has issued a set of patch test guidelines to its member companies to help provide a greater understanding of what is required by dermatologists, and to establish a dialogue on this matter.

Dr Donna Thompson ran a hugely successful meeting in Stratford in September. Over 70 delegates attended. Lectures from Dr Mike Beck and Prof Ian White were particularly well received. The next update will take place in 2y time on the 4th Friday/Sat of September 2019.