D3.18 - Allergy to Isobornyl Acrylate (IBOA) present in Sensors and Insulin Infusion Systems in Pediatric Population

Glucose sensor devices and insulin infusion systems contains allergens that may be present in both the adhesive and the device itself, leading to contact dermatitis that range from mild (localized erythema and pruritus) to severe (blistering, exudate, and generalized symptoms). Contact dermatitis is a relatively uncommon condition in the pediatric population; however, it has been increasingly reported in patients with type-1 diabetes who use these devices.

We present a series of 13 cases of dermatitis at the site of insertion of the insulin infusion system and/or glucose monitoring devices.

The median age of the patients was 13 years old (range 5-17). The patients were users of the Dexcom G6® (10), Freestyle3® (1), Freestyle Libre® (1), and Medtronic® (1) devices and the Ysopump insulin pump® (13).

The median time from device use initiation to lesion appearance was 8 months (range 1-14), 23.1% of the patients had previously used another device that also triggered dermatitis and 30.8% had a history of atopic dermatitis.

All patients received symptomatic treatment with topical corticosteroids and hydrocolloid dressings, achieving moderate control of symptoms.

Patch tests were conducted with post-application readings at 48-72- and 96-hours:

-Acrylate-Battery (MA-100 Series of (meth)acrylate, Chemotechnique Diagnostics®): 100% positive tests for IBOA were obtained at both 48 and 96 hours. Additionally, 38.5% (5/13) of patients tested positive for other acrylates (1,4-Butanediol-dimethacrilato, Tetrahydrofurfuryl-methacrilato, Ethyl-acrilato, BIS-EMA, 1,4-Butanediol-diacrilato, Di-(ethylene-glycol)-diacrilato, Triethylene-glycol-diacrilato and Butyl-acrilato).

-Standard-Battery (TruTest-36, Martí-Tor®): Tests were conducted in 23.1% (3/13) of patients, with 66.7% (2/3) of these showing positive results for colophonium and Cl+Me-Isothiazolinone at the 72-hour readings.

Patients monosensitized to IBOA received IBOA-free systems and devices with good tolerance.

Isobornyl acrylate (IBOA) has been identified as the most frequently (100% of cases) occurring causal allergen of contact dermatitis in our patients with type 1 diabetes who use glucose sensor devices and insulin infusion systems. To our knowledge, this is one of the largest series of pediatric patients described to date.

Other acrylates were also sensitizing in our series, but less frecquently (39%).

Early diagnosis by epicutaneous testing and the use of IBOA-free systems and devices contributed to the resolution of contact dermatitis.