title: The role of acrylic acid impurity as a sensitizing component in electrocardiogram electrodes.
abstract: BACKGROUND
  Allergic contact dermatitis caused by (meth)acrylates is well known, both in occupational and in non-occupational settings. Contact hypersensitivity to electrocardiogram (ECG) electrodes containing (meth)acrylates is rarely reported.
  
  
  OBJECTIVE
  To report the first case of contact dermatitis caused by acrylic acid impurity in ECG electrodes.
  
  
  METHODS
  Patch tests were performed with separate components of electrodes and some (meth)acrylates. This was followed by high-performance liquid chromatography of electrode hydrogel.
  
  
  RESULTS
  The patient was contact-allergic to electrode hydrogel but not to its separate constituents. Positive reactions were observed to 2-hydroxyethyl methacrylate (2-HEMA), 2-hydroxypropyl methacrylate (2-HPMA) and ethyleneglycol dimethacrylate (EGDMA). Subsequent analysis showed that the electrode hydrogel contained acrylic acid as an impurity. The latter was subsequently patch tested, with a positive result.
  
  
  CONCLUSIONS
  The sensitization resulting from direct contact with ECG electrodes was caused by acrylic acid, present as an impurity in ECG electrodes. Positive reactions to 2-HEMA, 2-HPMA and EGDMA are considered to be cross-reactions.
authors: Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, 06156, Perugia, Italy.
authors: Luca
authors: L
authors: Stingeni
authors: Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, 06156, Perugia, Italy.
authors: Emilia
authors: E
authors: Cerulli
authors: Department of Chemistry, Biology and Biotechnology, University of Perugia, 06156, Perugia, Italy.
authors: Anna
authors: A
authors: Spalletti
authors: Department of Chemistry, Biology and Biotechnology, University of Perugia, 06156, Perugia, Italy.
authors: Alessandra
authors: A
authors: Mazzoli
authors: R&D Department, Institute of Skin and Product Evaluation, 20125, Milano, Italy.
authors: Luigi
authors: L
authors: Rigano
authors: Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, 06156, Perugia, Italy.
authors: Leonardo
authors: L
authors: Bianchi
authors: Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, 06156, Perugia, Italy.
authors: Katharina
authors: K
authors: Hansel
mesh_terms: D000179:Acrylates / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D004340:Drug Contamination; D004562:Electrocardiography / Q000295:instrumentation*; D004566:Electrodes; D006801:Humans; D020100:Hydrogels / Q000737:chemistry*; D008875:Middle Aged; D010328:Patch Tests
chemical_list: D000179:Acrylates; D020100:Hydrogels; C036658:acrylic acid
keywords: ECG electrodes; acrylates; acrylic acid; allergic contact dermatitis; high-performance liquid chromatography; hydrogel; methacrylates; patch test