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SHORT COMMUNICATION
Patch Testing with Isobornyl Acrylate in 16 Swedish Patients with Contact Dermatitis from Glucose
Sensors and/or Insulin Pumps
Martin MOWITZ 1 , Louise FORNANDER 2 , Sara HOSSEINY 3 , Kristina RYBERG 4 and Magnus BRUZE 1
Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, 2 Department of Dermatology
and Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, 3 Department of
Dermatology, Uppsala University Hospital, Uppsala, and 4 Department of Dermatology, Uddevalla Hospital, Uddevalla, Sweden
1
Accepted Jul 9, 2019; E-published Jul 10, 2019
Medical devices for insulin infusion and monitoring of
blood glucose levels have been reported to cause severe
contact allergic reactions in diabetic patients. Isobor-
nyl acrylate (IBOA) has been identified as a sensitizer
in both the FreeStyle ® Libre glucose sensor (Abbott
Diabetes Care, Witney, Oxfordshire, UK) (1) and the
OmniPod ® insulin pump (Insulet Corporation, Billerica,
MA, USA) (2) by chemical investigations performed
at the Department of Occupational and Environmental
Dermatology, Malmö, Sweden. In this report we present
the results from patch testing with IBOA in 4 Swedish
dermatology clinics.
METHODS AND RESULTS
Between May 2017 and February 2018, 16 patients suffering from
diabetes mellitus type 1 were referred to the participating centres
due to suspected contact allergic reactions to glucose sensors
and/or insulin pumps. Cases 1–4 were seen in Uppsala, case 5 in
Uddevalla, case 6 in Örebro and cases 7–16 in Malmö. Six of the
patients were children (age 6–13 years) and 10 were adults (age
19–53 years). Patch test preparations of IBOA (Sigma-Aldrich,
Steinheim, Germany) were prepared in petrolatum (Vaselin Vitt,
APL, Stockholm, Sweden) at the Department of Occupational and
Environmental Dermatology, Malmö, and were then distributed
to the other centres. All patients were patch-tested with IBOA at
0.1% and 0.01% (w/w) in petrolatum. Thirteen of the patients
were also patch-tested with the Swedish baseline series. Six of
the patients were tested with parts from the glucose sensors and/
or insulin pumps either as is or as extracts (Table I).
Information on the patients, including the devices causing der-
matitis and patch test results is presented in Table I. The majority of
the patients (12 of 16) had a history of skin reactions to FreeStyle
Libre, while 7 had a history of skin reactions to OmniPod. Eleven
patients had a positive reaction to 0.1% IBOA and of these 4 were
also positive to 0.01% IBOA. In the patients with skin reactions to
FreeStyle Libre, 10 of 12 were positive to IBOA. In the patients
with skin reactions to OmniPod 4 of 7 were positive to IBOA and
one had a doubtful reaction.
DISCUSSION
High frequencies of skin reactions have been reported
in patients using glucose sensors and/or insulin pumps
(3, 4). Initially irritant reactions were suspected (5)
but later IBOA was identified as a culprit allergen in
FreeStyle Libre and OmniPod (1, 2). Furthermore, N,N-
dimethylacrylamide has been identified as a sensitizer
in FreeStyle Libre (6). There are also reports on contact
allergic reactions to 2-ethyl cyanoacrylate (ECA) in the
doi: 10.2340/00015555-3256
Acta Derm Venereol 2019; 99: 1286–1287
Dexcom G4 Platinum ® sensor (Dexcom, Inc, SanDiego,
CA, USA) (7–9), but ECA is no longer used in these
sensors (10). Colophony has been reported to be con-
tained both in OmniPod and in Enlite glucose sensors
(Medtronic Minimed, Northridge, CA, USA) (11).
The majority of our patients with reactions to FreeStyle
Libre and/or OmniPod were allergic to IBOA. In these
patients, the onset of dermatitis after the first use of the
first product, giving skin reactions, ranged from 1 to 24
months. Once a reaction had occurred, new reactions to
the devices developed within a few days, which suggests
that the patients have been sensitized to IBOA when using
the glucose sensor/insulin pumps. Some patients have
reacted to more than one medical device. For example
case 14 developed reactions to OmniPod after using the
pump for 2 years and then reacted to FreeStyle Libre
after 3 days the first time it was used.
As we have not been able to get any detailed informa-
tion regarding the composition of materials used in the
devices from the manufacturers, chemical investigations
have been necessary to identify allergens causing skin
reactions. The lack of information also makes it difficult
to give advice on possible alternatives for the sensitized
individuals. However, recently glucose sensors from
Dexcom have been suggested as an IBOA free alternative
for patients sensitized to IBOA (12).
Some patients have been able to continue using their
sensors despite their contact allergies by using barrier
creams, patches and sprays between the skin and the sen-
sor (6, 13). However, the use of barrier materials under
FreeStyle Libre sensors has been advised against as it
may affect the performance of the device (14). Freestyle
Libre sensors with a revised formulation of the adhesive
will be available to UK customers from April 2019 (14).
Whether this leads to fewer patients being sensitized and
whether already sensitized patients will be able to use
the new sensors remains to be seen.
REFERENCES
1. Herman A, Aerts O, Baeck M, Bruze M, De Block C, Goossens
A, et al. Allergic contact dermatitis caused by isobornyl acry-
late in Freestyle®Libre, a newly introduced glucose sensor.
Contact Dermatitis 2017; 77: 367–373.
2. Raison-Peyron N, Mowitz M, Bonardel N, Aerts O, Bruze
M. Allergic contact dermatitis caused by isobornyl acrylate
in OmniPod, an innovative tubeless insulin pump. Contact
Dermatitis 2018; 79: 76–80.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.