Do some adhesives in diabetic devices cause allergic dermatitis?

Isocyanate adhesives found in polyurethane (PU)-based diabetes treatment devices and wound dressings can cause allergic contact dermatitis (ACD), according to findings from a small case series.

“Isocyanates, widely used in the production of paints, coatings, glues,

PU adhesives and foams are well-known causes of occupational allergic and asthmatic reactions,” the study authors write, and they recommend patch testing with isocyanates.

“In the workup of patients with suspected DKA from diabetes devices and wound dressings, patch testing with isocyanates may be helpful because these devices may actually contain these skin sensitizers, particularly MDI. [4,4′-methylene diphenyl diisocyanate]and to a lesser extent IPDI [isophorone diisocyanate] and TDI [2,4-toluene diisocyanate],” they write.

“In addition to MDA [4,4′-diaminodiphenylmethane] and PMDI [polymeric methylene diphenyl diisocyanate]perhaps TDI could also be useful in detecting sensitization to MDI,” they add.

Documenting isocyanate sensitization

The study’s lead author, Ella Dendooven, RPharm, PhD, and her colleagues at the University of Antwerp in Belgium conducted a retrospective review of 19 patients who were patch tested at a clinic for a series of isocyanates. The patients ranged in age from 9 to 71 years old and had suspected DKA from antidiabetic devices, dressings, or both.

Using gas chromatography and mass spectrometry to analyze six diabetes devices, four commercial wound dressings and four isocyanate monomer patch test preparations, the researchers found:

  • 5 out of 6 diabetes device models contained MDI, and 1 device also contained IPDI; no medical device contained 1,6-hexamethylene diisocyanate (HDI).

  • 3 out of 4 commercial dressings contained one or more isocyanates: MDI, TDI or IPDI.

  • During patch tests, eight patients reacted to isocyanates and the corresponding amines: three to IPDI, four to MDA, four to TDI and one to PMDI; none responded to MDI.

Specialized patch test panels needed for isocyanates

Susan Massick, MD

“Diabetes devices, such as continuous blood glucose monitors and insulin pumps, have been a game-changer for our diabetic patients,” said Susan Massick, MD, dermatologist and associate professor of internal medicine at Wexner Medical Center. Ohio State University in Westerville. Medscape Medical News.

“Because these devices must remain in place and in contact with the skin for long periods of time, people can develop contact dermatitis, either allergic (true allergy) or irritant (sensitivity) contact dermatitis,” he said. she explained in an email. “The rash can be related to any part of the device, the cannula or tube, the dressing or the adhesive on the dressing itself.”

Massick noted that isocyanates can cause ACD rashes but escape detection on typical patch test panels.

“Current patch testing panels are limited to the most common allergens, but they are not comprehensive,” said Massick, who was not involved in the study. “If a person has a negative patch test on standard panels, you may need to do more investigation to find the culprit. Consider other potential allergens, such as isocyanates.”

“When people continue to get rashes or irritation from their devices, we shouldn’t dismiss or ignore them,” she advises. “We have to keep looking until we find the cause or at least control the associated symptoms.”

Consider isocyanates in ACD Rash

James R. Baker, Jr, MD, professor emeritus and founding director of Michigan Medicine’s Mary H. Weiser Food Allergy Center in Ann Arbor, wasn’t surprised by the results.

James R. Baker, Jr, MD

“These adhesives are known to cause sensitivity reactions in the workplace,” he said in an email, “and related adhesives, such as ‘super glues’, are also known to cause reactions. of sensitivity.

“However, in this study, many patients also reacted to other chemicals, so it is not definitive that isocyanates are the cause in all cases,” added Baker, who also did not no longer participated in the study.

With the proliferation of glucometers and other devices that attach to the skin, clinicians should be aware that isocyanates may be the cause of their patients’ DKA, Baker advises.

“Patients with reactions could be switched to different types of adhesives to avoid reactions,” he added.

The researchers recommend future larger studies.

The authors, Massick and Baker declare no conflict of interest. No funding information was provided.

Contact dermatitis. Published online July 11, 2022. Summary

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