Department of Dermatology, University Hospital Antwerp (UZA) and Research Group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium.
Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium.
Contact Dermatitis. 2022 Nov;87(5):414-419. doi: 10.1111/cod.14187. Epub 2022 Jul 21.
Isocyanates are well-known occupational allergens, but can also be present in medical devices.
To highlight that contact sensitization to isocyanates might contribute to allergic contact dermatitis (ACD) from polyurethane (PU)-containing diabetes devices and wound dressings.
Nineteen patients with suspected ACD from diabetes devices and/or wound dressings were patch tested to an isocyanate series. Four wound dressings, six diabetes devices and four monomeric isocyanate patch test preparations were analysed with gas chromatography - mass spectrometry.
Eight patients reacted to isocyanates and corresponding amines: 3 to isophorone diisocyanate (IPDI), 4 to 4,4'-diaminodiphenylmethane (MDA), 4 to 2,4-toluene diisocyanate (TDI) and 1 to polymeric methylene diphenyl diisocyanate (PMDI). Three of four wound dressings contained isocyanates (methylene diphenyl diisocyanate [MDI], TDI and/or IPDI), whereas five of six diabetes devices contained 4,4'-MDI, and one of them also IPDI. None of the medical devices contained 1,6-hexamethylene diisocyanate. Contrary to IPDI, and especially MDI, only the concentration of the TDI patch test preparation corresponded approximately (80%) to its label.
Patch tests with isocyanates may be worth-while in patients with suspected ACD from PU-containing medical devices. Besides MDA, and PMDI, also TDI might potentially be a marker for MDI-sensitization.
异氰酸酯是众所周知的职业过敏原，但也可能存在于医疗器械中。
强调接触异氰酸酯可能会导致含聚氨酯（PU）的糖尿病设备和伤口敷料引起过敏性接触性皮炎（ACD）。
19 名疑似来自糖尿病设备和/或伤口敷料的 ACD 患者接受了异氰酸酯系列斑贴试验。用气相色谱-质谱法分析了四种伤口敷料、六种糖尿病设备和四种单体异氰酸酯斑贴试验制剂。
8 名患者对异氰酸酯和相应的胺类物质产生反应：3 名对异佛尔酮二异氰酸酯（IPDI）、4 名对 4,4'-二氨基二苯甲烷（MDA）、4 名对 2,4-甲苯二异氰酸酯（TDI）和 1 名对多亚甲基二苯基二异氰酸酯（PMDI）。四种伤口敷料中有三种含有异氰酸酯（亚甲基二苯基二异氰酸酯 [MDI]、TDI 和/或 IPDI），而六种糖尿病设备中有五种含有 4,4'-MDI，其中一种还含有 IPDI。这些医疗器械均未含有 1,6-己二异氰酸酯。与 IPDI 不同，特别是 MDI，只有 TDI 斑贴试验制剂的浓度与其标签大致相符（80%）。
对于疑似因含 PU 的医疗器械引起 ACD 的患者，进行异氰酸酯斑贴试验可能是值得的。除 MDA 和 PMDI 外，TDI 也可能是 MDI 致敏的标志物。
