Allergy data 2009
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The following figures and graphs derive from patients tested at skin clinics and skin departments which constitute the national allergy network. Two new specialist clinics entered the network in 2009, which may affect comparisons with previous years for some of the allergens.
The figures are from the period January to December 2009, during which 4843 patients, 3162 women and 1681 men, were tested.
Updated 15.04.2010 |
Metal allergy
Nickel allergy is the most frequent form of contact allergy among eczema patients. This also applies in the general population. In 2009 20.7 % of female eczema patients against 19.8 % in 2008, and 5.7% of the men against 4.8 % in 2008, had nickel allergy. In 2007 the corresponding figures were 20 % and 5.5 % of the tested eczema patients. This was more or less unchanged in relation to 2003-2006.
In 1991 legislation was introduced to restrict exposure to nickel via imitation jewellery, buttons, etc.
In 24.1 % of the cases in 2009 it was found that there continued to be exposure to nickel resulting in eczema. Jewellery and clasps were the most frequently registered causes of current nickel eczema and constituted 41 % of those cases. Mobile telephones were registered as a cause in 2 cases (1 %) and tools accounted for 9% of the current cases of nickel eczema.
There continues to be a high incidence of nickel allergy among eczema patients, as nickel allergy occurs early in life and will still be demonstrable many years later. However, recent Danish population studies indicate that the anti-nickel legislation has reduced the number of young women who become allergic to nickel.
Read more about nickel allergy
Cobalt is a metal that occurs together with nickel. Persons in whom cobalt allergy is detected are as a rule allergic to nickel. Cobalt allergy derives from the same exposures as nickel, i.e. blank metal in the form of imitation jewellery, buttons, watches, etc.
Chrome allergy was found in 3.7 % of the tested women and 3.0 % of the tested men in 2009, which is an increase in relation to 2008, when the corresponding figures were 2.5 % of the tested women and 2.8 % of the tested men. This is also an increase in relation to 2007, when the figures were 2.6 % and 3.1 % respectively. This may represent a real rise as the result of exposure to chrome via leather products, especially in women, as seen in other recent Danish studies of eczema patients, or it may be a consequence of random fluctuations brought about by the inclusion in the data material of two new clinics.
Chrome allergy chiefly derives from leather products such as shoes, gloves or watch straps, since chrome is used for tanning leather. The tanning process makes the leather more durable, but there may be a residue of chrome in the leather, which is released and may cause allergy. This may give rise to very severe foot and/or hand allergy. In 2009 leather products like shoes and gloves were registered as the most frequent cause of chrome allergy and constituted 58% of the cases in which the cause of the chrome allergy was identified.
The raw materials used in producing cement contain chrome. Chrome allergy was formerly very common among construction workers in Denmark, but in 1981 legislation was introduced reducing the content of allergenic chrome in cement, and the incidence of chrome allergy has fallen substantially. Cases of chrome allergy continue to be found in construction workers, but these occur almost always in patients with chronic eczema from before the legislation was introduced or have been caused by imported cement that was not subject to the same legislation. In 2003 the Danish legislation was implemented throughout the EU.
Read more about chrome allergy
Allergy to preservatives
Preservatives are substances that are added to products such as cosmetics and cleaning agents to prevent the growth of bacteria and other microorganisms in the products. There is a wide range of cleaning agents that are more or less effective. Their effectiveness is often linked with their capacity to cause allergy in such a way that the effective preservatives are usually the most allergenic. The problem with the least allergenic preservatives, e.g. parabens, is that they usually have to be combined with other preservatives in order to be effective.
Formaldehyde and formaldehyde releasers are a group of preservatives that consist both of the substance formaldehyde and also of a group of substances that can release formaldehyde when they are added to a product. There are a large number of formaldehyde releasers.
The graph below shows data for formaldehyde and for the formaldehyde releasers: quaternium 15, diazolidinyl urea and imidiazolidinyl urea. In 2009 formaldehyde allergy was found in 1.8 % of the tested women and 1.5% of the tested men. These figures are almost identical with those for 2008, when allergy to formaldehyde was found in 1.7 % of the tested women and 1.0 % of the men. In 2007 the corresponding figures were 1.6 % for women and 1.7 % for men. It is possible that there has been a decrease in relation to 2005 and 2006, when the corresponding figures for men were 2.1 % and 2.6 % respectively and for women 3.3 % and 2.3 %. This concurs with an apparent fall in allergy in men to the two formaldehyde releasing substances: diazolidinyl urea and imidazolidinyl urea. Thus, in 2009 allergy to diazolidinyl urea was found in 0.8% the tested men, the same as in 2008 against 1.7 % in 2007 and 1.4 % in 2006, while the incidence for women was unchanged in the period with a frequency between 0.5 % and 0.9 %. A corresponding fall was seen in men for imidazolidinyl urea from 1.2-1.5 % in 2006-2007 to 0.5% in 2008 and 0.8% in 2009, while the frequency for women remained unchanged at 0.4% over the same 4 years.
The allergy can derive from cosmetics, cleaning agents, paper or industrial products.
Read more about formaldehyde and formaldehyde releasers
Methyldibromo glutaronitrile is a preservative that has been used since the beginning of the 1980s. In recent years a substantial increase in allergy to methyldibromo glutaronitrile has been found among eczema patients in Europe. The increase has mainly been ascribed to the use of excess concentrations of this preservative in cosmetic products. This especially applies to products designed for prolonged contact with the skin such as creams and lotions (stay-on products), and products that are used many times a day like liquid soap.
On this background the European Commission has prohibited the use of methyldibromo glutaronitrile in stay-on products. The ban entered into force in September 2005. The Scientific Committee on Cosmetic Products, which advises the European Commission, has recommended that the substance should also be prohibited in wash-off products like liquid soap, and this ban was adopted in February 2007 and entered into force in June 2008.
In 2009 allergy to methyldibromo glutaronitrile was found in 2.9% of the tested eczema patients. In 2008 the figure was 2.7 % and in 2007 2.6 %. There has been a decrease in the incidence of this allergy in relation to the period 2003-2005. Thus, in 2003 allergy to methyldibromo glutaronitrile was found in 4.5 % of the tested patients (4.3 % of the women and 4.8 % the men). In 2004 the corresponding figures were 3.9 % (3.5 % of the women and 4.8 % of the men), in 2005 the figures were 3.5 % (3.0 % of the women and 4.5 % of the men) and in 2006 2.5 % (2.4 % of the women and 2.8 % the men). In recent years, from 2006 onwards, no further decrease in allergy to methyldibromo glutaronitrile has been registered, but the proportion for which a current cause of the allergy has been found is low (11 %). This indicates that in most cases the allergy derives from earlier exposures.
There has been considerable public focus on allergy to methyldibromo glutaronitrile, which probably led to the voluntary removal of methyldibromo glutaronitrile from many products in Denmark before the entry into force of the legislation mentioned above.
Read more about allergy to methyldibromo glutaronitrile
MCI/MI (Kathon®) consists of a mixture of two substances, methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI), the former of which is more allergenic than the latter. The two sub-stances are sold in a mixture, and they are also tested as such in an allergy test.
Allergy to MCI/MI has been known since the 1980s, when there was an epidemic of allergy cases caused by this preservative in cosmetics. When they were marketed, it was erroneously concluded that the substances were not allergenic. The many cases of allergy led to a limitation in the use of MCI/MI. In 2009 allergy to MCI/MI was found in 1.5 % of the patients. The corresponding figure was slightly lower in 2008, when 1.3 % had MCI/MI allergy while this was the case for 0.9 % in 2007. In 2006 the figure was 1.5 %, which roughly corresponds to the annual average for 2003-2005. The incidence of this allergy has thus relatively stable over the past 7 years.
Parabens are only very slightly allergenic and rarely give rise to allergy. In 2009, as in 2008, only 0.3 % of the tested eczema patients had an allergy to parabens, which corresponds to the level from 2007, when a total of 0.4 % had paraben allergy. Paraben allergy is especially found in persons who have had severe chronic eczema and/or leg lesions, where the skin is sensitive, and more easily penetrated by allergenic substances. The frequency of this allergy has thus remained stable.
Perfume allergy
Perfumes are added to a wide range of consumer goods such as cosmetics, cleaning agents and toys and are also used in industrial production. Perfume is added to many products to conceal unpleasant odours from the other substances used and to give the product individual character.
Perfumes are furthermore sold as products in themselves in the form of eau de parfum, eau de toilette, eau de cologne, aftershave lotion and the like. A perfume is a mixture of a numbers of fragrances, chemical substances and natural extracts. There may be between 10 and 300 substances in a perfume, sometimes more.
Three substances/mixtures of substances are used to identify perfume allergy: Fragrance Mix I (FM I), which is a mix of 7 chemically well-defined fragrances and a natural extract, Peru balsam, which is a natural extract, and Fragrance Mix II (FM II),.which is a mix of 6 chemically well-defined fragrances. This is a more recent diagnostic test that the National Allergy Research Centre for Allergy has contributed to developing in collaboration with researchers from other countries. In 2009 5.0 % of eczema patients were allergic to FMII. In 2008 the figure was 4.8 %, in 2007 4.4 % and in 2006 4.0 %. There has thus been a stable rise in the frequency of this allergy.
The substance that most frequently gives rise to allergy among the substances in FM II is hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) also known by the trade name Lyral®. In 2009 it was the cause of allergy in 2.3 % of the tested patients against 2.5 % in 2008, 2.8 % in 2007 and 2.2 % in 2006. Thus the incidence of the allergy was by and large unchanged in the period 2006-2009. It continues to be most frequent in women.
Allergic reactions to the fragrance mix (FM I) were found in 6.2 % of the eczema patients in 2009 against 5.3 % in 2008, 5.7 % in 2007 and 6.1 % in 2006. This is a decrease from approx. 7.5 % in 2003/2004.
Taken as a whole, however, perfume allergy is almost as frequent as nickel allergy and is more often of importance for the current eczema disorder. All in all perfume allergy, defined as allergy to one or more of the 4 substances or mixes, was found in 11.7% of the eczema patients (12.8 % of the women and 9.8% of the men).
The chief cause of perfume allergy is the addition of allergenic substances in cosmetics. An amendment to the EU Directive regulating cosmetics has been adopted, so that it now comprises a wide range of allergenic perfume substances.
Read more about perfume allergy
Allergy to black dyes (PPD)
p-Phenylenediamine (PPD) is used as a dye agent in permanent hair dyes. It is known as strongly allergenic. It may also occur in some temporary, so-called henna tattoos that are often sold at tourist spots. Allergic reactions to hair dyes can be very serious and require hospitalisation because of severe facial swelling.
In 2009 PPD allergy was found in 1.9 % of all patients. In 2008 the figure was 2.0 % against 1.7 % in 2007 and 2.1 % in 2006, which was at the same level as 2004-2005.
Read more about temporary tattoos and hair dyes
Allergy to rubber chemicals
A wide range of additives are used in rubber production to give natural rubber elasticity and durability. There may be a residue of these substances in the rubber after production, and this may give rise to allergy.
These chemicals have different compositions, and both individual substances like mercaptobenzothiazol (MBT) and mixtures of substances like mercapto mix and thiuram mix are used for the diagnosis of allergy to rubber chemicals. It may be necessary to supplement an allergy test with further rubber chemicals to determine whether there is allergy.
In 2009 the frequency of thiuram allergy was 1.9 % among men and 2.2 % among women, and in 2008 1.8 % for men and 1.9 % for women. The corresponding figures in 2007 were 1.0 % for men and 2.2 % for women and in 2006 1.3 % for men and 2.1 % for women. This was at the same level as 2004.
Read more about:
Allergy to rubber chemicals
Gloves and eczema
Other additives are used in black rubber since these are often products, like car tires, that need to have high durability.
These additives may also cause allergy. The substance IPPD (N-isopropyl-N-phenyl-p-phenylenediamine) is used either alone or in a mix with other similar substances (black rubber mix) to identify this form of allergy.
Allergy to plants
There are allergenic substances in certain plants. This is the case for the asteraceae family, which includes flowers like chrysanthemums and daisies. Tests for plant allergy use a mix of the allergenic substances in asteraceae (sesquiterpenlacton mix). Allergy to these flowers is found most frequently in (leisure) gardeners and florists.
Earlier, Primula obconica was formerly a frequent cause of plant allergy, but other types are now being produced that do not contain the allergenic substance Primin.
The occurrence of plant allergy has remained more or less unchanged since 2004-2008.
Read more about allergy to plants
Allergy to adhesives
Epoxy is a two-component adhesive that is used in many occupations and at home. It contains strongly allergenic combinations, and in 2009 1.2 % of the eczema patients tested were found to be allergic to epoxy, 1.8 % of the men and 0.9 % of the women. The overall figure for 2008 was 1.3 %, preponderantly men, and in 2007 1.5%.
Colophonium is a natural resin used as an adhesive in plaster, cosmetics, e.g. mascara, in handball, etc. There may be a chemical affinity with some perfume substances, and persons who have colophonium allergy may have problems in tolerating perfume.
In 2009 2.2% of the tested eczema patients were allergic to colophonium. In 2008 the figure was 2.7% and in 2007 2.6%. This makes colophonium one of the most frequent allergenic substances.
PTBFR, p-tert.butylphenolformaldehyde resin is an adhesive that is very frequently used in gluing shoes and other leather products. This means that this form of allergy is particularly frequent in per-sons with foot eczema. In 2009 0.6 % of the tested patients had PTBFR allergy against 0.9% in 2008. The frequencies of allergy to these adhesive substances is roughly at the same level as for 2005-2007.
Allergy to treatment preparations
Neomycin is used in certain medicinal products to combat bacteria, for instance in ointment for the treatment of infected eczema, in eye and ear drops against inflammation and in haemorrhoid cream. In 2009 1.3 % of the tested eczema patients had neomycin allergy against 1.6 % in 2008 and 1.7 % in 2007.
Clioquinol is also found in medicinal products for eczema and is effective against bacteria and fungus. In 2009 0.7 % of the tested patients were allergic to clioquinols. In 2008 the figure was 0.5 % and in 2007 0.8 %.
Benzocaine is a local anaesthetic, to which 0.5 % were allergic in 2009 against 0.9 % in 2008.
Tixocortol pivalate and budesonide are markers for allergy to certain steroid hormones used to treat eczema.
