Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre

• Published in: Contact dermatitis Vol. 81; no. 5; pp. 354 - 367
• Main Authors: Herman, Anne, Mowitz, Martin, Aerts, Olivier, Pyl, Jeroen, Montjoye, Laurence, Goossens, An, Bruze, Magnus, Baeck, Marie
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2019; Wiley Subscription Services, Inc
• Subjects: Acrylates - adverse effects; Adolescent; Adult; Aged; allergic contact dermatitis; Blood Glucose Self-Monitoring - adverse effects; Blood Glucose Self-Monitoring - instrumentation; Camphanes - adverse effects; Camphene; chemical analysis; Child; Child, Preschool; Clinical Medicine; Dermatitis, Allergic Contact - diagnosis; Dermatitis, Allergic Contact - etiology; Dermatologi och venereologi; Dermatology and Venereal Diseases; Diabetes mellitus; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - immunology; Eczema; Female; FreeStyle Libre; Gas chromatography; Gas Chromatography-Mass Spectrometry; GC-MS; Glucose; glucose sensor; Humans; isobornyl acrylate; Klinisk medicin; Lactones; Male; Mass spectroscopy; Medical and Health Sciences; medical device; Medicin och hälsovetenskap; Middle Aged; Patch Tests; Sensors; Sesquiterpene lactones; Sesquiterpenes - adverse effects; simultaneous reactions; Young Adult; GC-MS; FreeStyle Libre; glucose sensor; allergic contact dermatitis; isobornyl acrylate; simultaneous reactions; diabetes mellitus; sesquiterpene lactones; medical device; chemical analysis
• ISSN: 0105-1873; 1600-0536; 1600-0536
• DOI: 10.1111/cod.13330

Background Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series. Objectives To compile patch test results of subjects affected, and provide potential explanations for this association. Patients and Methods Fifty‐three Freestyle Libre‐allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM. Results Thirty‐three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography‐mass spectrometry (GC‐MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA. Conclusion Significant co‐sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC‐MS analysis. Cross‐reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist.