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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 16 | 40 |
| 2024 Octubre | 118 | 66 | 184 |
| 2024 Septiembre | 129 | 36 | 165 |
| 2024 Agosto | 111 | 78 | 189 |
| 2024 Julio | 137 | 38 | 175 |
| 2024 Junio | 128 | 40 | 168 |
| 2024 Mayo | 86 | 31 | 117 |
| 2024 Abril | 83 | 37 | 120 |
| 2024 Marzo | 136 | 40 | 176 |
| 2024 Febrero | 92 | 33 | 125 |
| 2024 Enero | 88 | 36 | 124 |
| 2023 Diciembre | 85 | 26 | 111 |
| 2023 Noviembre | 94 | 22 | 116 |
| 2023 Octubre | 96 | 34 | 130 |
| 2023 Septiembre | 95 | 21 | 116 |
| 2023 Agosto | 100 | 29 | 129 |
| 2023 Julio | 96 | 51 | 147 |
| 2023 Junio | 96 | 28 | 124 |
| 2023 Mayo | 81 | 27 | 108 |
| 2023 Abril | 76 | 20 | 96 |
| 2023 Marzo | 96 | 23 | 119 |
| 2023 Febrero | 88 | 19 | 107 |
| 2023 Enero | 75 | 24 | 99 |
| 2022 Diciembre | 72 | 42 | 114 |
| 2022 Noviembre | 43 | 30 | 73 |
| 2022 Octubre | 74 | 21 | 95 |
| 2022 Septiembre | 83 | 28 | 111 |
| 2022 Agosto | 36 | 38 | 74 |
| 2022 Julio | 68 | 29 | 97 |
| 2022 Junio | 32 | 37 | 69 |
| 2022 Mayo | 75 | 42 | 117 |
| 2022 Abril | 63 | 47 | 110 |
| 2022 Marzo | 76 | 58 | 134 |
| 2022 Febrero | 50 | 40 | 90 |
| 2022 Enero | 52 | 68 | 120 |
| 2021 Diciembre | 33 | 60 | 93 |
| 2021 Noviembre | 72 | 47 | 119 |
| 2021 Octubre | 75 | 58 | 133 |
| 2021 Septiembre | 71 | 39 | 110 |
| 2021 Agosto | 50 | 20 | 70 |
| 2021 Julio | 45 | 27 | 72 |
| 2021 Junio | 44 | 24 | 68 |
| 2021 Mayo | 36 | 47 | 83 |
| 2021 Abril | 100 | 53 | 153 |
| 2021 Marzo | 60 | 34 | 94 |
| 2021 Febrero | 65 | 28 | 93 |
| 2021 Enero | 34 | 22 | 56 |
| 2020 Diciembre | 22 | 13 | 35 |
| 2020 Noviembre | 28 | 19 | 47 |
| 2020 Octubre | 24 | 16 | 40 |
| 2020 Septiembre | 25 | 12 | 37 |
| 2020 Agosto | 18 | 21 | 39 |
| 2020 Julio | 29 | 20 | 49 |
| 2020 Junio | 47 | 28 | 75 |
| 2020 Mayo | 20 | 15 | 35 |
| 2020 Abril | 26 | 20 | 46 |
| 2020 Marzo | 30 | 20 | 50 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 14 | 18 |
| 2019 Junio | 4 | 22 | 26 |
| 2019 Mayo | 5 | 53 | 58 |
| 2019 Abril | 2 | 28 | 30 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 0 | 5 | 5 |
| 2019 Enero | 2 | 4 | 6 |
| 2018 Diciembre | 4 | 2 | 6 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 1 | 6 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Febrero | 64 | 2 | 66 |
| 2018 Enero | 88 | 11 | 99 |
| 2017 Diciembre | 97 | 9 | 106 |
| 2017 Noviembre | 58 | 5 | 63 |
| 2017 Octubre | 56 | 4 | 60 |
| 2017 Septiembre | 36 | 10 | 46 |
| 2017 Agosto | 41 | 17 | 58 |
| 2017 Julio | 39 | 5 | 44 |
| 2017 Junio | 43 | 14 | 57 |
| 2017 Mayo | 45 | 10 | 55 |
| 2017 Abril | 40 | 15 | 55 |
| 2017 Marzo | 33 | 28 | 61 |
| 2017 Febrero | 50 | 11 | 61 |
| 2017 Enero | 34 | 10 | 44 |
| 2016 Diciembre | 59 | 7 | 66 |
| 2016 Noviembre | 55 | 6 | 61 |
| 2016 Octubre | 69 | 12 | 81 |
| 2016 Septiembre | 146 | 15 | 161 |
| 2016 Agosto | 83 | 18 | 101 |
| 2016 Julio | 65 | 18 | 83 |
| 2016 Junio | 10 | 18 | 28 |
| 2016 Mayo | 10 | 22 | 32 |
| 2016 Abril | 4 | 1 | 5 |
| 2016 Marzo | 10 | 2 | 12 |
| 2016 Febrero | 6 | 5 | 11 |
| 2016 Enero | 6 | 20 | 26 |
| 2015 Diciembre | 9 | 2 | 11 |
| 2015 Noviembre | 15 | 2 | 17 |
| 2015 Octubre | 22 | 2 | 24 |
| 2015 Septiembre | 13 | 1 | 14 |
| 2015 Agosto | 16 | 8 | 24 |
| 2015 Julio | 58 | 12 | 70 |
| 2015 Junio | 57 | 10 | 67 |
| 2015 Mayo | 75 | 26 | 101 |
| 2015 Abril | 64 | 13 | 77 |
| 2015 Marzo | 80 | 17 | 97 |
| 2015 Febrero | 57 | 13 | 70 |
| 2015 Enero | 78 | 11 | 89 |
| 2014 Diciembre | 39 | 15 | 54 |
| 2014 Noviembre | 49 | 10 | 59 |
| 2014 Octubre | 60 | 23 | 83 |
| 2014 Septiembre | 21 | 6 | 27 |
| 2014 Agosto | 24 | 4 | 28 |
| 2014 Julio | 20 | 9 | 29 |
| 2014 Junio | 31 | 7 | 38 |
| 2014 Mayo | 41 | 6 | 47 |
| 2014 Abril | 43 | 5 | 48 |
| 2014 Marzo | 41 | 9 | 50 |
| 2014 Febrero | 22 | 13 | 35 |
| 2014 Enero | 35 | 17 | 52 |
| 2013 Diciembre | 35 | 7 | 42 |
| 2013 Noviembre | 16 | 11 | 27 |
| 2013 Octubre | 15 | 8 | 23 |
| 2013 Septiembre | 22 | 12 | 34 |
| 2013 Agosto | 10 | 14 | 24 |
| 2013 Julio | 9 | 27 | 36 |
| 2013 Junio | 8 | 32 | 40 |
| 2013 Mayo | 18 | 20 | 38 |
| 2013 Abril | 13 | 19 | 32 |
| 2013 Marzo | 18 | 20 | 38 |
| 2013 Febrero | 26 | 6 | 32 |
| 2013 Enero | 36 | 8 | 44 |
| 2012 Diciembre | 53 | 8 | 61 |
| 2012 Noviembre | 3 | 4 | 7 |
| 2012 Octubre | 1 | 0 | 1 |
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