Sensitization to dimethyl fumarate with multiple concurrent patch test reactions.
BACKGROUND
Chairs and sofas imported from China to Europe were shown to contain dimethyl fumarate (DMF), a sensitizing, volatile chemical. Many of the sensitized patients also had positive patch test reactions to acrylates.


OBJECTIVE
To analyse the occurrence and strength of DMF sensitization and the appearance of concomitant reactions.


METHODS
Patch testing with DMF in concentrations of 0.1-0.00001% was carried out in 37 patients. Diethyl fumarate (DEF), diethyl maleate (DEM), dimethyl maleate (DMM), ethyl acrylate (EA), methyl acrylate (MA), and methyl methacrylate (MMA) were also tested with a dilution series at equimolar concentrations.


RESULTS
The lowest concentration of DMF eliciting a reaction varied between 0.0001% and 0.1% and all but four patients reacted concurrently to DEF. DEM elicited positive patch test reactions in 21/37 patients and DMM reactions were seen in all 9 patients tested. EA elicited positive reactions in 13/37 patients and a positive MA reaction was seen in 7/37 patients, 2 of whom also reacted to MMA.


CONCLUSIONS
The strength of the sensitization to DMF showed variation and concurrent reactions were common. Concurrent reactions to (meth)acrylates were seen in patients, who reacted to lower (0.001% or less) DMF concentration probably elicited by cross-reactivity.
Lammintausta
Kaija
K
Department of Dermatology, Turku University Hospital, Turku, Finland. kaija.lammintausta@tyks.fi
Zimerson
Erik
E
Winhoven
Sandra
S
Susitaival
Päivikki
P
Hasan
Taina
T
Gruvberger
Birgitta
B
Williams
Jason
J
Beck
Michael
M
Bruze
Magnus
M
D000179:Acrylates / Q000737:chemistry / Q000633:toxicity; D000328:Adult; D002681:China; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D000069462:Dimethyl Fumarate; D005260:Female; D005387:Finland / Q000453:epidemiology; D005650:Fumarates / Q000737:chemistry / Q000633:toxicity*; D006801:Humans; D007374:Interior Design and Furnishings; D008297:Male; D008298:Maleates / Q000737:chemistry / Q000633:toxicity; D020366:Methylmethacrylate / Q000737:chemistry / Q000633:toxicity; D008875:Middle Aged; D010328:Patch Tests; D006113:United Kingdom / Q000453:epidemiology
D000179:Acrylates; D005650:Fumarates; D008298:Maleates; D020366:Methylmethacrylate; C040833:ethyl acrylate; D000069462:Dimethyl Fumarate; C014476:diethyl maleate; C004780:dimethyl maleate; C035956:methyl acrylate