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and both urticaria<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#8211;7</span></a> and allergic contact eczema<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#8211;10</span></a> have been reported&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous contact reactions to proteins are clinically relevant disorders of which the dermatologist should be aware&#44; since&#44; in some cases&#44; they can indicate occupational disease&#44; especially in individuals who handle food&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A 23-year-old man with no history of atopy was referred from the allergology department with a rash that started immediately after application of Contr&#244;le-Jeunesse face cream &#40;Kiotis&#41;&#46; The rash involved highly pruritic wheals affecting the face and neck accompanied by bilateral palpebral edema &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Labial edema and systemic symptoms did not develop&#46; He attended the emergency department&#44; where he was prescribed oral cetirizine &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; symptoms resolved completely in 24<span class="elsevierStyleHsp" style=""></span>hours&#46; The patient reported having experienced a similar reaction the previous summer after using a house brand sunscreen&#44; although he did not consult for it&#46; He did not report food-induced symptoms or intolerance&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The result of a nonblinded skin test with his cream was negative&#46; Patch testing was then performed with the True Test panel&#44; a cosmetics panel &#40;Chemotechnique Diagnostics&#41;&#44; and the patient&#39;s own products&#46; Readings were positive &#40;&#43;&#43;&#41; to the patient&#39;s own Contr&#244;le-Jeunesse cream at 48<span class="elsevierStyleHsp" style=""></span>hours and 96<span class="elsevierStyleHsp" style=""></span>hours&#59; all other readings were negative&#46; The results of patch testing with the individual components of the cream &#40;supplied by the manufacturer&#41; were positive &#40;&#43;&#43;&#41; for hydrolyzed wheat protein at 1&#37; in water at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; We performed 10 tests on controls using hydrolyzed protein at 1&#37;&#59; all the results were negative&#46; The patient was referred back to the allergology department&#44; where he underwent prick tests with flours and cereals &#40;Leti&#44; Diater&#44; Stallerg&#232;nes&#44; and Aristegui&#41;&#46; The results were as follows&#58; malt&#44; positive &#40;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#59; cereal mix&#44; positive &#40;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#59; oats&#44; positive &#40;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#59; hydrolyzed wheat extract &#40;18<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>mm&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Total immunoglobulin &#40;Ig&#41; E was 136<span class="elsevierStyleHsp" style=""></span>U&#47;mL &#40;reference range&#44; 1-100 U&#47;mL&#41;&#59; the results of specific IgE testing with buckwheat&#44; rice&#44; oats&#44; barley&#44; rye&#44; corn&#44; common millet&#44; soy&#44; and wheat were negative&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Hydrolyzed proteins are added to cosmetic products for their emollient properties&#46; After the bovine spongiform encephalopathy epidemic&#44; animal proteins such as collagen&#44; keratin&#44; and elastin began to be replaced by vegetable proteins such as almond&#44; wheat&#44; and soy&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Contact urticaria induced by cosmetics is uncommon&#44; although reports of cases caused by the proteins contained in cosmetics are increasing in frequency&#46; The first cases were reported in 1998 and involved hairdressers affected by contact urticaria induced by hair conditioners&#46; The culprit allergen was hydrolyzed collagen protein&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These reports were followed by new cases involving reactions to hydrolyzed wheat protein&#44; presenting as dermatitis<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#8211;10</span></a> or contact urticaria&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;5&#8211;7</span></a> The mechanism by which the same agent can cause one type of reaction or another is unknown&#46; Contact urticaria is usually localized&#44; although some cases involve more severe symptoms such as angioedema&#44; generalized urticaria&#44; bronchospasm&#44; or even anaphylaxis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a> It should be noted that most of these patients were able to tolerate wheat-derived foods&#44; as in our case&#44; although some patients reacted to foods containing the hydrolyzed protein&#46; The reason for this finding seems to be that hydrolysis entails the appearance of new epitopes&#44; which are responsible for the allergic reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We present a new case in order to make this disease more widely known and to help direct the patient towards appropriate diagnostic tests&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We stress the importance of performing patch tests using the patient&#39;s own products&#44; 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Journal Information
Vol. 103. Issue 8.
Pages 750-752 (October 2012)
Vol. 103. Issue 8.
Pages 750-752 (October 2012)
Cases and Research Letters
Full text access
Contact Urticaria Induced by Hydrolyzed Wheat Protein in Cosmetic Cream
Urticaria de contacto a proteína hidrolizada de trigo contenida en crema cosmética
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N. Barrientosa,
Corresponding author
nuriabarr@yahoo.com

Corresponding author.
, S. Vázquezb, José D. Domíngueza
a Departamento de Dermatología, Hospital Universitario del Henares, Coslada, Madrid, Spain
b Departamento de Alergología, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Wheat flour proteins are composed of a complex mix of soluble proteins (albumin and globulin) and insoluble structural proteins. The latter are divided into gliadins, which are monomeric, and glutenins, which are polymeric. Gluten is composed of both these types of protein and is widely used in both modified and unmodified forms in industry. The most important modification of gluten is hydrolysis.1

Hydrolyzed wheat protein is used in cosmetic products for its hydrating properties.2 Cosmetics containing this protein can lead to infrequent—but occasionally severe—allergic reactions, and both urticaria1,3–7 and allergic contact eczema2,8–10 have been reported.

Cutaneous contact reactions to proteins are clinically relevant disorders of which the dermatologist should be aware, since, in some cases, they can indicate occupational disease, especially in individuals who handle food.11

A 23-year-old man with no history of atopy was referred from the allergology department with a rash that started immediately after application of Contrôle-Jeunesse face cream (Kiotis). The rash involved highly pruritic wheals affecting the face and neck accompanied by bilateral palpebral edema (Fig. 1). Labial edema and systemic symptoms did not develop. He attended the emergency department, where he was prescribed oral cetirizine (10mg); symptoms resolved completely in 24hours. The patient reported having experienced a similar reaction the previous summer after using a house brand sunscreen, although he did not consult for it. He did not report food-induced symptoms or intolerance.

Figure 1.

Wheals and bilateral palpebral edema.

(0.15MB).

The result of a nonblinded skin test with his cream was negative. Patch testing was then performed with the True Test panel, a cosmetics panel (Chemotechnique Diagnostics), and the patient's own products. Readings were positive (++) to the patient's own Contrôle-Jeunesse cream at 48hours and 96hours; all other readings were negative. The results of patch testing with the individual components of the cream (supplied by the manufacturer) were positive (++) for hydrolyzed wheat protein at 1% in water at 48 and 96hours (Fig. 2). We performed 10 tests on controls using hydrolyzed protein at 1%; all the results were negative. The patient was referred back to the allergology department, where he underwent prick tests with flours and cereals (Leti, Diater, Stallergènes, and Aristegui). The results were as follows: malt, positive (5×4mm); cereal mix, positive (7×5mm); oats, positive (5×5mm); hydrolyzed wheat extract (18×14mm) (Fig. 3). Total immunoglobulin (Ig) E was 136U/mL (reference range, 1-100 U/mL); the results of specific IgE testing with buckwheat, rice, oats, barley, rye, corn, common millet, soy, and wheat were negative.

Figure 2.

Reading at 96hours showing a positive reaction to hydrolyzed wheat protein.

(0.12MB).
Figure 3.

Result of prick test with cereals.

(0.2MB).

Hydrolyzed proteins are added to cosmetic products for their emollient properties. After the bovine spongiform encephalopathy epidemic, animal proteins such as collagen, keratin, and elastin began to be replaced by vegetable proteins such as almond, wheat, and soy.4

Contact urticaria induced by cosmetics is uncommon, although reports of cases caused by the proteins contained in cosmetics are increasing in frequency. The first cases were reported in 1998 and involved hairdressers affected by contact urticaria induced by hair conditioners. The culprit allergen was hydrolyzed collagen protein.6 These reports were followed by new cases involving reactions to hydrolyzed wheat protein, presenting as dermatitis2,8–10 or contact urticaria.1,3,5–7 The mechanism by which the same agent can cause one type of reaction or another is unknown. Contact urticaria is usually localized, although some cases involve more severe symptoms such as angioedema, generalized urticaria, bronchospasm, or even anaphylaxis.1,6 It should be noted that most of these patients were able to tolerate wheat-derived foods, as in our case, although some patients reacted to foods containing the hydrolyzed protein. The reason for this finding seems to be that hydrolysis entails the appearance of new epitopes, which are responsible for the allergic reaction.1

We present a new case in order to make this disease more widely known and to help direct the patient towards appropriate diagnostic tests.

We stress the importance of performing patch tests using the patient's own products, since in cases such as ours, tests using standard panels could yield false-negative results. Diagnostic testing in patients with contact urticaria should be performed with the utmost caution and in a specialized center with full resuscitation facilities. The product should be applied first in an open test; if the result is negative, a prick test should be performed before the closed patch tests. Ours is the first reported case in which both patch tests and the prick test were positive, indicating that the same agent could cause both immediate and delayed hypersensitivity, thus explaining the occurrence of eczema and contact urticaria in the same patient.

Collaboration with the allergology department is important in order to detect sensitization or cross-reactivity with other cereals and thus prevent reactions to foods.

References
[1]
M. Laurière, C. Pecquet, I. Bouchez-Mahiout, J. Snègaroff, O. Bayrou, N. Raison-Peyron, et al.
Hydrolysed wheat proteins present in cosmetics can induce immediate hypersensitivities.
Contact Dermatitis, 54 (2006), pp. 283-289
[2]
J. Sánchez-Pérez, T. Sanz, A. Carcía-Díez.
Allergic contact dermatitis from hydrolyzed wheat protein in cosmetic cream.
Contact Dermatitis, 42 (2000), pp. 360
[3]
A. Olaiwan, C. Pecquet, P. Mathelier-Fusade, C. Francès.
Contact urticaria induced by hydrolyzed wheat proteins in cosmetics.
Ann Dermatol Venereol, 137 (2010), pp. 281-284
[4]
C. Pecquet, O. Bayrou, M. Vigan, N. Raison, M. Lauriere.
Hydrolysed wheat protein: a new allergen in cosmetics and food.
Contact Dermatitis, 50 (2004), pp. 182-183
[5]
E. Varjonen, L. Petman, S. Mäkinen-Kiljuken.
Immediate contact allergy from hydrolyzed wheat in cosmetic cream.
Allergy, 55 (2000), pp. 294-296
[6]
A. Niinimäki, M. Niinimäki, M. Mäkinen-Kiljunen Hannuksela.
Contact urticaria from protein hydrolysates in hair conditioners.
Allergy, 53 (1998), pp. 1078-1082
[7]
C. Pecquet, M. Lauriere, S. Huet, F. Leynadier.
Is the application of cosmetics containing protein-derived products safe?.
Contact Dermatitis, 46 (2002), pp. 123
[8]
C. Livideanu, F. Giordano-Labadie, C. Paul.
Contact dermatitis to hydrolyzed wheat protein.
Contact Dermatitis, 57 (2007), pp. 283-284
[9]
S. Hann, M. Hughes, N. Stone.
Allergic contact dermatitis to hydrolyzed wheat protein in a cosmetic cream.
Contact Dermatitis, 56 (2007), pp. 119-120
[10]
O. Bordalo.
Allergic contact dermatitis from hydrolyzed wheat protein.
Contact Dermatitis, 50 (2004), pp. 183-184
[11]
P. Hernández-Bel, J. De la Cuadra, R. García, V. Alegre.
Dermatitis de contacto por proteínas. Revisión de 27 casos.
Actas Dermosifiliogr, 102 (2011), pp. 336-343

Please cite this article as: Barrientos N, Vázquez S, Domínguez JD. Urticaria de contacto a protein hidrolizada de trigo contenida en crema cosmética. Actas Dermosifiliogr.2012;103:750-752.

Copyright © 2011. Elsevier España, S.L. and AEDV
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