Diabetes devices can give children contact dermatitis

Devices that help children with their diabetes mellitus and living fuller lives can also give them contact dermatitis, report the authors of a new study that calls for mandatory ingredient labeling for allergy patch testing.

“A large proportion of patients showed positive reactions to isobornyl acrylate glue (IBOA) and/or their medical devices (insulin pumps or glucose devices),” the study authors write. Contact dermatitis† “A third of patients showed positive reactions to benzoyl peroxide (BP)”, used in adhesives.

“The presence of additional unidentified allergens cannot be ruled out,” they add. “Overall, our experience reaffirms the importance of having access to a complete description of the chemical composition of diabetes devices and related medical devices in order to efficiently treat patients (including children) experiencing adverse skin reactions from such devices. “

Lead study author Catarina Alves da Silva, MD, of the Department of Dermatology and Venereology at Aarhus University Hospital, and her colleagues conducted a retrospective study of 15 referred patients under the age of 18 who received a type 1 diabetes† The children were patch tested at the university’s dermatology clinic between 2018 and 2020 in a study of skin reactions associated with diabetes devices.

Contact dermatitis from device-related allergens can be common

Many children in the study reacted to chemical compounds associated with their devices.

  • Of the 15 patients, seven showed positive patch test responses to IBOA and five showed positive responses to BP.

  • Ten children had positive patch test responses to glucose sensor materials and insulin pumping.

  • Three showed positive reactions to adhesive removal wipes.

  • Five responded to plasters or cream with lidocaine and prilocaine

Marcia Hogeling, MD, a pediatric dermatologist at UCLA Health in Santa Monica, California, told: Medscape Medical News that she expected acrylates to cause problems, but was surprised that BP caused positive patch test responses.

BP is known to be a strong irritant but a weak allergen, the authors write.

“It was important to identify the allergens in these devices. Hopefully, this information will be used by manufacturers to create safer products for patients,” Hogeling, who was not involved in the study, said in an email.

Hogeling acknowledged that the small sample size is a weakness of the study, although she added that the findings could help providers select devices that do not contain contact allergens from their patients.

Dr Ryan McDonough

Ryan J. McDonough, DO, a pediatric endocrinologist and co-director of the Children’s Mercy Kansas City Diabetes Center, said in an email that, despite the small sample size, the study “highlights important device-related experiences of people living with type 1 diabetes who often encountered by clinicians.

“We often spend a lot of time helping patients and their families find ways to reduce reactions,” he explained. “A broader understanding of these chemical compositions would help clinicians choose the right devices for their patients and prevent and treat these types of reactions.”

McDonough, who was also not involved in the study, noted that the patients in the study were in Denmark and they could easily switch between insulin pumps and glucose monitoring devices.

“In the US, switching between devices is often more challenging due to insurance-related concerns.

“The true rate of response in the broad type 1 diabetes population is difficult to assess,” McDonough said. “The study participants were from patients who were referred to a dermatology clinic for response evaluation. Many patients do not develop reactions or are treated locally by their endocrinologist for mild symptoms.

“This study should serve as a call to action for continued improvements in the transparency of the components that make up the devices and adhesives, and may provide an opportunity to develop additional interventions to prevent these reactions,” he advised.

No information was provided on the funding of the study. The authors, Hogeling and McDonough, do not report any relevant financial relationships.

Contact dermatitis. Published online May 30, 2022. Abstract

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