Cases and Research Letters
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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Barrientos, S. Vázquez, José D. Domínguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Barrientos" "email" => array:1 [ 0 => "nuriabarr@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José D." "apellidos" => "Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Alergología, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Urticaria de contacto a proteína hidrolizada de trigo contenida en crema cosmética" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1183 "Ancho" => 1585 "Tamanyo" => 121648 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reading at 96<span class="elsevierStyleHsp" style=""></span>hours showing a positive reaction to hydrolyzed wheat protein.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hydrolyzed wheat protein is used in cosmetic products for its hydrating properties.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cosmetics containing this protein can lead to infrequent—but occasionally severe—allergic reactions, and both urticaria<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–7</span></a> and allergic contact eczema<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8–10</span></a> have been reported.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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.<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 Contrôle-Jeunesse face cream (Kiotis). The rash involved highly pruritic wheals affecting the face and neck accompanied by bilateral palpebral edema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Labial edema and systemic symptoms did not develop. He attended the emergency department, where he was prescribed oral cetirizine (10<span class="elsevierStyleHsp" style=""></span>mg); symptoms resolved completely in 24<span class="elsevierStyleHsp" style=""></span>hours. 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.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">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 48<span class="elsevierStyleHsp" style=""></span>hours and 96<span class="elsevierStyleHsp" style=""></span>hours; 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 96<span class="elsevierStyleHsp" style=""></span>hours (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). 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<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm); cereal mix, positive (7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm); oats, positive (5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm); hydrolyzed wheat extract (18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>mm) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Total immunoglobulin (Ig) E was 136<span class="elsevierStyleHsp" style=""></span>U/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.</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. 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.<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, 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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These reports were followed by new cases involving reactions to hydrolyzed wheat protein, presenting as dermatitis<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8–10</span></a> or contact urticaria.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5–7</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> 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.<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.</p><p id="par0045" class="elsevierStylePara elsevierViewall">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.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Collaboration with the allergology department is important in order to detect sensitization or cross-reactivity with other cereals and thus prevent reactions to foods.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">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.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1189 "Ancho" => 951 "Tamanyo" => 160462 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Wheals and bilateral palpebral edema.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1183 "Ancho" => 1585 "Tamanyo" => 121648 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reading at 96<span class="elsevierStyleHsp" style=""></span>hours showing a positive reaction to hydrolyzed wheat protein.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2128 "Ancho" => 1585 "Tamanyo" => 204823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result of prick test with cereals.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydrolysed wheat proteins present in cosmetics can induce immediate hypersensitivities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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Mäkinen-Kiljuken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "294" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10753023" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact urticaria from protein hydrolysates in hair conditioners" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Niinimäki" 1 => "M. Niinimäki" 2 => "M. 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Leynadier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2002" "volumen" => "46" "paginaInicial" => "123" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11918616" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact dermatitis to hydrolyzed wheat protein" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Livideanu" 1 => "F. Giordano-Labadie" 2 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 16 | 41 |
| 2024 October | 118 | 66 | 184 |
| 2024 September | 129 | 36 | 165 |
| 2024 August | 111 | 78 | 189 |
| 2024 July | 137 | 38 | 175 |
| 2024 June | 128 | 40 | 168 |
| 2024 May | 86 | 31 | 117 |
| 2024 April | 83 | 37 | 120 |
| 2024 March | 136 | 40 | 176 |
| 2024 February | 92 | 33 | 125 |
| 2024 January | 88 | 36 | 124 |
| 2023 December | 85 | 26 | 111 |
| 2023 November | 94 | 22 | 116 |
| 2023 October | 96 | 34 | 130 |
| 2023 September | 95 | 21 | 116 |
| 2023 August | 100 | 29 | 129 |
| 2023 July | 96 | 51 | 147 |
| 2023 June | 96 | 28 | 124 |
| 2023 May | 81 | 27 | 108 |
| 2023 April | 76 | 20 | 96 |
| 2023 March | 96 | 23 | 119 |
| 2023 February | 88 | 19 | 107 |
| 2023 January | 75 | 24 | 99 |
| 2022 December | 72 | 42 | 114 |
| 2022 November | 43 | 30 | 73 |
| 2022 October | 74 | 21 | 95 |
| 2022 September | 83 | 28 | 111 |
| 2022 August | 36 | 38 | 74 |
| 2022 July | 68 | 29 | 97 |
| 2022 June | 32 | 37 | 69 |
| 2022 May | 75 | 42 | 117 |
| 2022 April | 63 | 47 | 110 |
| 2022 March | 76 | 58 | 134 |
| 2022 February | 50 | 40 | 90 |
| 2022 January | 52 | 68 | 120 |
| 2021 December | 33 | 60 | 93 |
| 2021 November | 72 | 47 | 119 |
| 2021 October | 75 | 58 | 133 |
| 2021 September | 71 | 39 | 110 |
| 2021 August | 50 | 20 | 70 |
| 2021 July | 45 | 27 | 72 |
| 2021 June | 44 | 24 | 68 |
| 2021 May | 36 | 47 | 83 |
| 2021 April | 100 | 53 | 153 |
| 2021 March | 60 | 34 | 94 |
| 2021 February | 65 | 28 | 93 |
| 2021 January | 34 | 22 | 56 |
| 2020 December | 22 | 13 | 35 |
| 2020 November | 28 | 19 | 47 |
| 2020 October | 24 | 16 | 40 |
| 2020 September | 25 | 12 | 37 |
| 2020 August | 18 | 21 | 39 |
| 2020 July | 29 | 20 | 49 |
| 2020 June | 47 | 28 | 75 |
| 2020 May | 20 | 15 | 35 |
| 2020 April | 26 | 20 | 46 |
| 2020 March | 30 | 20 | 50 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 4 | 5 | 9 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 14 | 18 |
| 2019 June | 4 | 22 | 26 |
| 2019 May | 5 | 53 | 58 |
| 2019 April | 2 | 28 | 30 |
| 2019 March | 2 | 9 | 11 |
| 2019 February | 0 | 5 | 5 |
| 2019 January | 2 | 4 | 6 |
| 2018 December | 4 | 2 | 6 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 5 | 1 | 6 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 1 | 1 |
| 2018 May | 0 | 4 | 4 |
| 2018 February | 64 | 2 | 66 |
| 2018 January | 88 | 11 | 99 |
| 2017 December | 97 | 9 | 106 |
| 2017 November | 58 | 5 | 63 |
| 2017 October | 56 | 4 | 60 |
| 2017 September | 36 | 10 | 46 |
| 2017 August | 41 | 17 | 58 |
| 2017 July | 39 | 5 | 44 |
| 2017 June | 43 | 14 | 57 |
| 2017 May | 45 | 10 | 55 |
| 2017 April | 40 | 15 | 55 |
| 2017 March | 33 | 28 | 61 |
| 2017 February | 50 | 11 | 61 |
| 2017 January | 34 | 10 | 44 |
| 2016 December | 59 | 7 | 66 |
| 2016 November | 55 | 6 | 61 |
| 2016 October | 69 | 12 | 81 |
| 2016 September | 146 | 15 | 161 |
| 2016 August | 83 | 18 | 101 |
| 2016 July | 65 | 18 | 83 |
| 2016 June | 10 | 18 | 28 |
| 2016 May | 10 | 22 | 32 |
| 2016 April | 4 | 1 | 5 |
| 2016 March | 10 | 2 | 12 |
| 2016 February | 6 | 5 | 11 |
| 2016 January | 6 | 20 | 26 |
| 2015 December | 9 | 2 | 11 |
| 2015 November | 15 | 2 | 17 |
| 2015 October | 22 | 2 | 24 |
| 2015 September | 13 | 1 | 14 |
| 2015 August | 16 | 8 | 24 |
| 2015 July | 58 | 12 | 70 |
| 2015 June | 57 | 10 | 67 |
| 2015 May | 75 | 26 | 101 |
| 2015 April | 64 | 13 | 77 |
| 2015 March | 80 | 17 | 97 |
| 2015 February | 57 | 13 | 70 |
| 2015 January | 78 | 11 | 89 |
| 2014 December | 39 | 15 | 54 |
| 2014 November | 49 | 10 | 59 |
| 2014 October | 60 | 23 | 83 |
| 2014 September | 21 | 6 | 27 |
| 2014 August | 24 | 4 | 28 |
| 2014 July | 20 | 9 | 29 |
| 2014 June | 31 | 7 | 38 |
| 2014 May | 41 | 6 | 47 |
| 2014 April | 43 | 5 | 48 |
| 2014 March | 41 | 9 | 50 |
| 2014 February | 22 | 13 | 35 |
| 2014 January | 35 | 17 | 52 |
| 2013 December | 35 | 7 | 42 |
| 2013 November | 16 | 11 | 27 |
| 2013 October | 15 | 8 | 23 |
| 2013 September | 22 | 12 | 34 |
| 2013 August | 10 | 14 | 24 |
| 2013 July | 9 | 27 | 36 |
| 2013 June | 8 | 32 | 40 |
| 2013 May | 18 | 20 | 38 |
| 2013 April | 13 | 19 | 32 |
| 2013 March | 18 | 20 | 38 |
| 2013 February | 26 | 6 | 32 |
| 2013 January | 36 | 8 | 44 |
| 2012 December | 53 | 8 | 61 |
| 2012 November | 3 | 4 | 7 |
| 2012 October | 1 | 0 | 1 |
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