Trends in the Prevalence of Methylchloroisothiazolinone/Methylisothiazolinone Contact Allergy in North America and Europe

Margo J. Reeder, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.
Erin Warshaw, Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota.
Srikanth Aravamuthan, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.
Donald V. Belsito, Department of Dermatology, Columbia University Irving Medical Center, New York, New York.
Johannes Geier, Information Network of Departments of Dermatology, Institute at the University Medical Center Göttingen, Göttingen, Germany.
Mark Wilkinson, Department of Dermatology, Leeds Teaching Hospitals National Health Service Trust, Chapel Allerton Hospital, Leeds, England.
Amber Reck Atwater, Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
Ian R. White, St John's Institute of Dermatology, Guy's Hospital, London, England.
Jonathan I. Silverberg, Department of Dermatology, George Washington University School of Medicine, Washington, DC.
James S. Taylor, Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
Joseph F. Fowler, Division of Dermatology, University of Louisville, Louisville, Kentucky.
Howard I. Maibach, Department of Dermatology, University of California, San Francisco.
Joel G. DeKoven, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Timo Buhl, Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany.
Nina Botto, Department of Dermatology, University of California, San Francisco.
Ana Maria Giménez-Arnau, Department of Dermatology, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
Rosella Gallo, Clinica Dermatologica, IRCCS-AOU San Martino-IST and Department of Health Sciences, University of Genoa, Genoa, Italy.
Christen Mowad, Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania.
Claudia C. Lang, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Vincent A. DeLeo, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.
Graham Johnston, Department of Dermatology, Leicester Royal Infirmary, Leicester, England.
Melanie D. Pratt, Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.
Knut Brockow, Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University Munich, Munich, Germany.
Brandon L. Adler, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.
Marie-Claude Houle, Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec, Quebec, Canada.
Heinrich Dickel, Department of Dermatology, Venereology and Allergology, St Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany.
Marie Louise Schuttelaar, Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
JiaDe Yu, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Radoslaw Spiewak, Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland.
Cory Dunnick, Department of Dermatology, University of Colorado, Denver.
Francesca Larese Filon, Department of Public Health, Occupational Medicine, University of Trieste, Trieste, Italy.
Skaidra Valiukeviciene, Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Document Type

Journal Article

Publication Date

1-18-2023

Journal

JAMA dermatology

DOI

10.1001/jamadermatol.2022.5991

Abstract

IMPORTANCE: The common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US. OBJECTIVE: To compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) combination and MI alone in North America and Europe from 2009 to 2018. DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis of North American Contact Dermatitis Group, European Surveillance System on Contact Allergies (ESSCA), and the Information Network of Departments of Dermatology (IVDK) databases included data from patients presenting for patch testing at referral patch test clinics in North America and Europe. EXPOSURES: Patch tests to MCI/MI and MI. MAIN OUTCOMES AND MEASURES: Prevalence of allergic contact dermatitis to MCI/MI and MI. RESULTS: From 2009 to 2018, participating sites in North America and Europe patch tested a total of 226 161 individuals to MCI/MI and 118 779 to MI. In Europe, positivity to MCI/MI peaked during 2013 and 2014 at 7.6% (ESSCA) and 5.4% (IVDK) before decreasing to 4.4% (ESSCA) and 3.2% (IVDK) during 2017 and 2018. Positive reactions to MI were 5.5% (ESSCA) and 3.4% (IVDK) during 2017 and 2018. In North America, the frequency of positivity to MCI/MI increased steadily through the study period, reaching 10.8% for MCI/MI during 2017 and 2018. Positive reactions to MI were 15.0% during 2017 and 2018. CONCLUSIONS AND RELEVANCE: The study results suggest that in contrast to the continued increase in North America, isothiazolinone allergy is decreasing in Europe. This trend may coincide with earlier and more stringent government regulation of MI in Europe.

Department

Dermatology

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