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Published on: April 21, 2019
Common shoe allergens undetected by commercial patch-testing kits: dithiodimorpholine and isocyanates
1Division of Dermatology, University of Kansas Medical Center, Kansas City, KS, USA.
Summary
Diagnosing foot allergic contact dermatitis is difficult due to evolving shoe materials. New rubber allergens like dithiodimorpholine, not on standard tests, are increasingly common causes.
Area of Science:
- Dermatology
- Allergology
- Materials Science
Background:
- Allergic contact dermatitis of the feet presents diagnostic challenges.
- Shoe manufacturing involves evolving materials and technologies.
- Rubber allergens have historically been common causes of shoe dermatitis.
Purpose of the Study:
- To highlight the evolving landscape of shoe allergens.
- To emphasize the inadequacy of standard patch testing for shoe dermatitis.
- To inform clinicians about less common, yet significant, shoe allergens.
Main Methods:
- Review of historical and current literature on shoe dermatitis allergens.
- Analysis of changing allergen profiles in rubber and other shoe materials.
- Identification of allergens not typically included in standard patch test series.
Main Results:
- The prevalence of specific rubber allergens has shifted from 2-mercaptobenzothiazole to others.
- Dithiodimorpholine is identified as a potentially more common rubber sensitizer.
- Isophorone diisocyanate, dimethylaminoethyl ether, and mixed dialkyl thioureas are other relevant allergens.
- Standard patch testing may miss key causative agents for shoe dermatitis.
Conclusions:
- Physicians must consider allergens beyond standard screening series for foot dermatitis.
- Expanded patch testing is crucial for accurate diagnosis of shoe-induced allergic contact dermatitis.
- Awareness of novel and evolving shoe allergens is essential for effective patient management.
