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  • 1. Engfeldt, Malin
    et al.
    Hagvall, Lina
    Isaksson, Marlene
    Matura, Mihaly
    Mowitz, Martin
    Ryberg, Kristina
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Svedman, Cecilia
    Bruze, Magnus
    Patch testing with hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) - a multicentre study of the Swedish Contact Dermatitis Research Group2017In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 76, no 1, 34-39 p.Article in journal (Refereed)
    Abstract [en]

    Background. In 2014, the fragrance hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) was excluded from the Swedish baseline series. Objectives. To study (i) whether fragrance mix (FM) II with 5% HICC detects more positive reactions than usual FM II with 2.5% HICC, and (ii) the reproducibility of patch testing with HICC. Methods. Two thousand one hundred and eighteen dermatitis patients at five Swedish dermatology departments were consecutively tested with FM II 14% pet., FM II 16.5% pet., and duplicate preparations of HICC 5% pet. Results. Of the patients, 3.2% reacted to FMII 14%, and 1.5% reacted to HICC. Separate testing with HICC detected 0.3% reactions without concomitant reactivity to FM II. FM II with 5% HICC did not give rise to more irritant reactions or signs of active sensitization than FM II with 2.5% HICC. Patch testing with duplicate applications of HICC increased the overall prevalence of HICC contact allergy to 1.9%. Conclusion. FMII with5% HICC does not detect more positive reactions than FMII with 2.5% HICC. Separate testing with HICC does not detect a sufficient proportion of patients who react only to HICC, without concomitant reactions to FMII, to warrant its inclusion in a baseline series.

  • 2. Fall, Sofia
    et al.
    Bruze, Magnus
    Isaksson, Marlene
    Liden, Carola
    Matura, Mihaly
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindberg, Magnus
    Contact allergy trends in Sweden - a retrospective comparison of patch test data from 1992, 2000, and 20092015In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 72, no 5, 297-304 p.Article in journal (Refereed)
    Abstract [en]

    Background. Contact allergy prevalence rates change over time as a result of variations in allergen exposure. Data from patch test clinics are often used as markers for allergy trends.

    Objectives. The aim of the present retrospective study was to describe trends in rates of sensitization to allergens in the Swedish baseline series. Patients/materials/methods. Prevalence rates are described by comparing consecutive patch test data from 1992, 2000 and 2009 in Swedish patch test clinics. In total, 3680 patients were included in 1992, 3825 in 2000, and 3112 in 2009.

    Results. Among test substances with a sensitization rate above 2% in 2009, significant decreases were noted for nickel sulfate, cobalt chloride, colophonium, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), and a significant increase for p-phenylenediamine, as compared with 1992. Potassium dichromate reactions had increased among younger women, whereas reactions to nickel and cobalt had decreased in this group. Sensitization to chromium, cobalt and fragrance mix I had decreased among older men, and sensitization to nickel had decreased among younger men.

    Conclusions. It is probable that these changes in 1992-2009 reflect both changes in regulations for nickel, lower levels of chromium in cement and of MCI/MI in cosmetics, and increasing use of hair dyes.

  • 3.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stymne, Birgitta
    Department of Dermatology, Örebro University Hospital, Örebro .
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nickel allergy: prevalence in a population of Swedish youths from patch test and questionnaire data2008In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 58, no 2, 80-87 p.Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of body piercing and orthodontic treatment has increased during recent decades. Such changes in lifestyle may influence the occurrence of nickel allergy.

    Objectives: The aim of this study was to describe the prevalence of nickel allergy in a Swedish youth population.

    Methods: In a cross-sectional survey, 6095 adolescents answered a questionnaire on their lifestyle and medical history, and 4439 consented to patch testing for contact allergy. Patch test results were adjusted for dropouts by a missing value analysis.

    Results: The prevalence of self-reported dermatitis from contact with metal items was 14.8%. Patch testing showed nickel sensitization in 9.9% of the subjects, and in significantly more girls than boys, 13.3% versus 2.5%, respectively. Taking the dropout into account, the estimated true prevalence of nickel sensitivity evaluated by test reading at D4 is 11.8% in girls and 1.6% in boys.

    Conclusions: The prevalence of nickel sensitization was higher for girls and slightly lower for boys compared with previous Swedish data. Self-reported information on metal dermatitis as an estimate of nickel allergy has low validity. When possible, missing value analysis should be performed to account for dropouts.

  • 4.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Nickel allergy in relation to piercing and orthodontic appliances: a population study2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 67, no 6, 342-350 p.Article in journal (Refereed)
    Abstract [en]

    Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization. Objectives & Method. In a cross-sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records. Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi-containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel-releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization. Conclusion. High nickel-containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.

  • 5. Hamada, Haneen
    et al.
    Isaksson, Marléene
    Bruze, Magnus
    Engfeldt, Malin
    Liljelind, Ingrid
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Axelsson, Sara
    Jönsson, Bo
    Tinnerberg, Håkan
    Zimerson, Erik
    Dermal uptake study with 4,4'-diphenylmethane diisocyanate led to active sensitization2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 66, no 2, 101-105 p.Article in journal (Refereed)
    Abstract [en]

    Background. To investigate the dermal uptake of 4,4'-diphenylmethane diisocyanate (4,4'-MDI), a study was performed in which 2 female volunteers were exposed to 10 and 25 mg, respectively, of 4,4'-MDI by applying 2.0% 4,4'-MDI in petrolatum over areas where the surface concentration corresponded to 800 µg/cm(2) . Ten days later, they developed eczematous dermatitis at the area of application.

    Objectives. To investigate whether the dermal application caused active sensitization to 4,4'-MDI.

    Methods. Chemical analysis of the 4,4'-MDI preparation used in the application and the amount of 4,4'-MDI not absorbed by the skin was performed with liquid chromatography-mass spectrometry. The volunteers were tested with serial dilutions of 4,4'-MDI and the potentially cross-reacting substances 4,4'-diaminodiphenylmethane (4,4'-MDA), p-phenylenediamine (PPD), and dicyclohexylmethane-4,4'-diisocyanate (DMDI).

    Results. Patch test results suggested that the volunteers were actively sensitized to 4,4'-MDI following the dermal uptake study, as they reacted positively to 4,4'-MDA, a marker for 4,4'-MDI allergy. No positive reactions were seen to PPD or DMDI. Chemical investigation confirmed that the correct concentration had been used for the dermal uptake study, and showed that about 70% of the applied 4,4'-MDI was not absorbed.

    Conclusions. A dermal uptake study with 4,4'-MDI in 2.0% pet. with an occlusion time of 8 hr induced active sensitization to 4,4'-MDI and subsequently to 4,4'-MDA.

  • 6. Isaksson, Marlene
    et al.
    Inerot, Annica
    Liden, Carola
    Lindberg, Magnus
    Matura, Mihaly
    Moller, Halvor
    Stenberg, Berndt
    Bruze, Magnus
    Sodium metabisulfite in blue jeans: an unexpected cause of textile contact dermatitis2014In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 70, no 3, 187-189 p.Article in journal (Other academic)
  • 7. Isaksson, Marléne
    et al.
    Inerot, Annica
    Lidén, Carola
    Lindberg, Magnus
    Matura, Mihaly
    Möller, Halvor
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bruze, Magnus
    Multicentre patch testing with fragrance mix II and hydroxyisohexyl 3-cyclohexene carboxaldehyde by the Swedish Contact Dermatitis Research Group2014In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 70, no 3, 187-189 p.Article in journal (Refereed)
  • 8. Isaksson, Marléne
    et al.
    Inerot, Annica
    Lidén, Carola
    Matura, Mihaly
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Möller, Halvor
    Bruze, Magnus
    Multicentre patch testing with a resol resin based on phenol and formaldehyde2011In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 65, no 1, 34-37 p.Article in journal (Refereed)
    Abstract [en]

    Background. Contact allergy to phenol-formaldehyde resins (PFRs) based on phenol and formaldehyde is not detected by a p-tertiary-butylphenol-formaldehyde resin (PTBP-FR) included in most baseline patch test series.

    Objectives. To investigate the rate of contact allergy to PFR-2 (a mixture of monomers and dimers from a resol resin based on phenol and formaldehyde) in a Swedish population, and to investigate associated simultaneous allergic reactions.

    Methods. Five centres representing the Swedish Contact Dermatitis Research Group included PFR-2 in their patch test baseline series for a period of 1.5 years.

    Results. Of 2504 patients tested, 27 (1.1%) reacted to PFR-2. Of those 27 individuals, 2 had a positive reaction to formaldehyde and 2 to PTBP-FR. Simultaneous allergic reactions were noted to colophonium in 6, to Myroxylon pereirae in 14, and to fragrance mix I in 15.

    Conclusions. The contact allergy frequency in the tested population (1.1%) merits its inclusion in the Swedish baseline series and possibly also in other baseline series. Simultaneous allergic reactions were noted to colophonium, M. pereirae, and fragrance mix I.

  • 9. Röhrl, Kari
    et al.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lifestyle factors and hand eczema in a Swedish adolescent population2010In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 62, no 3, 170-176 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hand eczema risk factors are potentially associated with lifestyle, and changes in lifestyle may influence the prevalence of this condition.

    OBJECTIVES: To report potential lifestyle risk factors and their association with hand eczema.

    PATIENTS/MATERIALS/METHODS: Cross-sectional questionnaire survey and standard patch test among Swedish upper secondary school children. The participation rate was 81% (6095/7543) for the questionnaire and 59% (4439/7543) for the test.

    RESULTS: Girls reported piercing (84% versus 18%), tattooing (6% versus 3%), smoking (24% versus 16%) and vegetarianism (21% versus 7%) significantly more often than boys. Girls had significantly more hand eczema (7% versus 4%) than boys. Besides female sex (OR 2.0), allergic rhinitis (OR 1.8), flexural eczema (OR 4.5), and positive nickel test (OR 1.7) were significant risk factors in multivariate analysis. Piercing entailed a decreased risk (OR 0.6). Other lifestyle practices had no association with hand eczema. Vegetarian diet and dental braces which potentially increase oral nickel exposure were not associated with hand eczema prevalence in nickel sensitized individuals.

    CONCLUSIONS: The studied lifestyle practices were more prevalent in girls. Smoking, tattooing, and diet were not associated with the occurrence of hand eczema.

  • 10.
    Stenberg, Berndt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Bruze, Magnus
    Zimerson, Erik
    Is p-tert-butylphenol-formaldehyde resin (PTBP-FR) in TRUE Test® (Mekos test) sensitizing the tested patients?2015In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 73, no 6, 350-357 p.Article in journal (Refereed)
    Abstract [en]

    Background: In a population study using TRUE Test®, we noted late reactions to p-tert-butylphenol-formaldehyde resin (PTBP-FR) in 0.5% of subjects tested.

    Objectives: In order to explore possible test sensitization, differences in the contents of sensitizers within PTBP-FR in test preparations for TRUE Test® and Finn Chambers® were analysed. Subjects allergic to PTBP-FR and subjects with late reactions to PTBP-FR were retested in order to explore whether these groups reacted to different PTBP-FR sensitizers.

    Patients/materials/methods: Four individuals with late reactions and 5 subjects with established allergy to PTBP-FR were retested with defined PTBP-FR sensitizers. PTBP-FR constituents in patches from TRUE Test® were analysed with high-performance liquid chromatography. Previously analysed samples of PTBP-FR constituents served as a reference.

    Results: The pattern of reaction to PTBP-FR sensitizers was similar in both groups. Subjects with suspected sensitization had somewhat stronger reactions than controls. The concentrations of monomers, dimers and trimers were generally higher in the TRUE Test® resin than in reference substances.

    Conclusions: Retesting did not add information regarding causes of possible sensitization. Analysis showed that the resin used in TRUE Test® has a lower degree of polymerization or condensation, which may enhance its sensitizing properties. A follow-up of late reactions to PTBP-FR in TRUE Test® should be carried out.

  • 11.
    Stenberg, Berndt
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindberg, Magnus
    Meding, Birgitta
    Svensson, Ake
    Is the question 'Have you had childhood eczema?' useful for assessing childhood atopic eczema in adult population surveys?2006In: Contact Dermatitis, ISSN 0105-1873, Contact Dermatitis, Vol. 54, no 6, 334-337 p.Article in journal (Refereed)
  • 12.
    Tillberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
    Reactions to resin-based dental materials in patients-type, time to onset, duration, and consequence of the reaction.2009In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 61, no 6, 313-319 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the present study was to determine the types of side-effects occurring and for how long they lasted in a group of patients with side-effects assessed to be caused by resin-based materials. METHODS: A total of 618 reports were received by the Swedish National Register of Side-Effects to Dental Materials, among which 36 were on patients with reactions assessed to be caused by resin-based restorative materials. The group examined consisted of 25 women and 11 men, with a mean age of 47.8 +/- 15.6 years. A follow-up was done through a structured telephone interview. RESULTS: The majority of symptoms were intra-oral or a combination of intra-oral and extra-oral symptoms that appeared within the first 24 hr after treatment. The most common adverse effects reported were skin problems, oral ulcers, and burning mouth. Within less than a week, the reactions had disappeared in 50% of the patients. CONCLUSION: Immediate reactions to resin-based materials were more prevalent than delayed allergic reactions, and the mechanism of the immediate reactions is probably non-allergic in most cases. There is a need for developing provocation tests to verify the association between the reaction and the material, and also to identify the offending component.

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