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Medical Device Contact Allergy: Glucose Monitors and Insulin Pumps

  • Contact Dermatitis (Brandon Adler and Vincent Deleo, Section editors)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To describe contact allergy to diabetes devices and recommend steps for evaluation and management of these complex cutaneous complications.

Recent Findings

Allergens reported in glucose monitors include isobornyl acrylate (IBOA), colophony, N,N-dimethylacrylamide, 2,2’-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate and ethyl cyanoacrylate. Recently described insulin pump allergens include IBOA, colophony, and ethyl cyanoacrylate.

Summary

Contact allergy to diabetes devices has become more prevalent in recent years, particularly given their increasing use in patients with type I and type II diabetes. Most reports are for glucose monitors, and IBOA is frequently implicated, although the allergens contained within devices may continue to evolve. Comprehensive patch testing is necessary for evaluation of potential diabetes device contact allergy. Management ideally centers on allergen avoidance; however, if not feasible, topical and barrier products can be used with varying degrees of success.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Federation ID: IDF Diabetes Atlas. https://diabetesatlas.org/en/ (2019). Accessed May 18 2021.

  2. Karges B, Schwandt A, Heidtmann B, Kordonouri O, Binder E, Schierloh U, et al. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA. 2017;318(14):1358–66. https://doi.org/10.1001/jama.2017.13994.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Oppel E, Kamann S, Heinemann L, Reichl FX, Hogg C. The implanted glucose monitoring system Eversense: an alternative for diabetes patients with isobornyl acrylate allergy. Contact Dermatitis. 2020;82(2):101–4. https://doi.org/10.1111/cod.13392.

    Article  CAS  PubMed  Google Scholar 

  4. Jadviscokova T, Fajkusova Z, Pallayova M, Luza J, Kuzmina G. Occurence of adverse events due to continuous glucose monitoring. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(2):263–6. https://doi.org/10.5507/bp.2007.044.

    Article  PubMed  Google Scholar 

  5. Conwell LS, Pope E, Artiles AM, Mohanta A, Daneman A, Daneman D. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr. 2008;152(5):622–8. https://doi.org/10.1016/j.jpeds.2007.10.006.

    Article  CAS  PubMed  Google Scholar 

  6. Berg AK, Olsen BS, Thyssen JP, Zachariae C, Simonsen AB, Pilgaard K, et al. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr Diabetes. 2018;19(4):733–40. https://doi.org/10.1111/pedi.12652.

    Article  CAS  PubMed  Google Scholar 

  7. Berg AK, Norgaard K, Thyssen JP, Zachariae C, Hommel E, Rytter K, et al. Skin problems associated with insulin pumps and sensors in adults with type 1 diabetes: a cross-sectional study. Diabetes Technol Ther. 2018;20(7):475–82. https://doi.org/10.1089/dia.2018.0088.

    Article  PubMed  Google Scholar 

  8. Binder E, Lange O, Edlinger M, Meraner D, Abt D, Moser C, et al. Frequency of dermatological side effects of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2015;123(4):260–4. https://doi.org/10.1055/s-0034-1394381.

    Article  CAS  PubMed  Google Scholar 

  9. Herman A, Darrigade AS, de Montjoye L, Baeck M. Contact dermatitis caused by glucose sensors in diabetic children. Contact Dermatitis. 2020;82(2):105–11. https://doi.org/10.1111/cod.13429.

    Article  CAS  PubMed  Google Scholar 

  10. Lombardo F, Salzano G, Crisafulli G, Panasiti I, Alibrandi A, Messina MF, et al. Allergic contact dermatitis in pediatric patients with type 1 diabetes: an emerging issue. Diabetes Res Clin Pract. 2020;162: 108089. https://doi.org/10.1016/j.diabres.2020.108089.

    Article  PubMed  Google Scholar 

  11. • Hyry HSI, Liippo JP, Virtanen HM. Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients. Contact Dermatitis. 2019;81(3):161-166. https://doi.org/10.1111/cod.13337. Colophony identified as a sensitizer in glucose sensor.

  12. • Dendooven E, Foubert K, Goossens A, Gilles P, De Borggraeve W, Pieters L, Lambert J, Aerts O. Concomitant positive patch test reactions in FreeStyle‐allergic patients sensitized to isobornyl acrylate. Contact Dermatitis.  2021;84(3):166 174. https://doi.org/10.1111/cod.13706. This study identifies that isobornyl acrylate-allergic FreeStyle Libre patients also commonly co-react to sesquiterpene lactones and fragrances.

  13. Boom BW, van Driel LM. Allergic contact dermatitis to epoxy resin in infusion sets of an insulin pump. Contact Dermatitis. 1985;12(5):280. https://doi.org/10.1111/j.1600-0536.1985.tb01137.x.

    Article  CAS  PubMed  Google Scholar 

  14. Busschots AM, Meuleman V, Poesen N, Dooms-Goossens A. Contact allergy to components of glue in insulin pump infusion sets. Contact Dermatitis. 1995;33(3):205–6. https://doi.org/10.1111/j.1600-0536.1995.tb00554.x.

    Article  CAS  PubMed  Google Scholar 

  15. Aerts O, Herman A, Mowitz M, Bruze M, Goossens A. Isobornyl acrylate. Dermatitis. 2020;31(1):4–12. https://doi.org/10.1097/DER.0000000000000549.

    Article  PubMed  Google Scholar 

  16. • Mowitz M, Herman A, Baeck M, Isaksson M, Antelmi A, Hamnerius N, et al. N, N-dimethylacrylamide—a new sensitizer in the FreeStyle Libre glucose sensor Contact Dermatitis 2019;81(1):27-31. https://doi.org/10.1111/cod.13243. This study identifies N,N-dimethylacrylamide as more recent sensitizer in glucose sensors.

  17. • Herman A, Aerts O, Baeck M, Bruze M, Block De C, Goossens A, et al. Allergic contact dermatitis caused by isobornyl acrylate in Freestyle(R) Libre, a newly introduced glucose sensor. Contact Dermatitis. 2017;77(6):367-373. https://doi.org/10.1111/cod.12866. This study identified isobornyl acrylate as a sensitizer in the FreeStyle Libre glucose sensor.

  18. Kamann S, Aerts O, Heinemann L. Further evidence of severe allergic contact dermatitis from isobornyl acrylate while using a continuous glucose monitoring system. J Diabetes Sci Technol. 2018;12(3):630–3. https://doi.org/10.1177/1932296818762946.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ulriksdotter J, Svedman C, Bruze M, Glimsjo J, Kallberg K, Sukakul T, et al. Contact dermatitis caused by glucose sensors-15 adult patients tested with a medical device patch test series. Contact Dermatitis. 2020;83(4):301–9. https://doi.org/10.1111/cod.13649.

    Article  CAS  PubMed  Google Scholar 

  20. Herman A, Mowitz M, Aerts O, Pyl J, de Montjoye L, Goossens A, et al. Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre. Contact Dermatitis. 2019;81(5):354–67. https://doi.org/10.1111/cod.13330.

    Article  CAS  PubMed  Google Scholar 

  21. DeKoven JG, Shear NH. Cutaneous contact allergy to a glucose monitor. CMAJ. 2020;192(11):E286. https://doi.org/10.1503/cmaj.191216.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ahrensboll-Friis U, Simonsen AB, Zachariae C, Thyssen JP, Johansen JD. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: results from a 5-year period. Contact Dermatitis. 2021;84(2):75–81. https://doi.org/10.1111/cod.13664.

    Article  CAS  PubMed  Google Scholar 

  23. Oppel E, Kamann S, Heinemann L, Klein A, Reichl FX, Hogg C. Freestyle libre 2: the new isobornyl acrylate free generation. Contact Dermatitis. 2020;83(5):429–31. https://doi.org/10.1111/cod.13638.

    Article  CAS  PubMed  Google Scholar 

  24. Herman A, Baeck M, de Montjoye L, Bruze M, Giertz E, Goossens A, et al. Allergic contact dermatitis caused by isobornyl acrylate in the Enlite glucose sensor and the Paradigm MiniMed Quick-set insulin infusion set. Contact Dermatitis. 2019;81(6):432–7. https://doi.org/10.1111/cod.13374.

    Article  CAS  PubMed  Google Scholar 

  25. Hamnerius N, Mowitz M. Intense skin reaction to a new glucose monitoring and insulin pump system. Contact Dermatitis. 2020;83(6):524–7. https://doi.org/10.1111/cod.13663.

    Article  CAS  PubMed  Google Scholar 

  26. Oppel E, Kamann S, Reichl FX, Hogg C. The Dexcom glucose monitoring system—an isobornyl acrylate-free alternative for diabetic patients. Contact Dermatitis. 2019;81(1):32–6. https://doi.org/10.1111/cod.13248.

    Article  CAS  PubMed  Google Scholar 

  27. Svedman C, Bruze M, Antelmi A, Hamnerius N, Hauksson I, Ulriksdotter J, et al. Continuous glucose monitoring systems give contact dermatitis in children and adults despite efforts of providing less “allergy-prone” devices: investigation and advice hampered by insufficient material for optimized patch test investigations. J Eur Acad Dermatol Venereol. 2021;35(3):730–7. https://doi.org/10.1111/jdv.16981.

    Article  CAS  PubMed  Google Scholar 

  28. • Svedman C, Ulriksdotter J, Lejding T, Bruze M, Mowitz M. Changes in adhesive ingredients in continuous glucose monitoring (CGM) systems may induce new contact allergy pattern? Contact Dermatitis. 2021;84(6):439-46. https://doi.org/10.1111/cod.13781. Identifies 2,2’-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate as a more recent sensitizer in a continuous glucose monitor.

  29. Passanisi S, Lombardo F, Barbalace A, Caminiti L, Panasiti I, Crisafulli G, et al. Allergic contact dermatitis and diabetes medical devices: 2 clinical cases. Contact Dermatitis. 2018;79(2):115–7. https://doi.org/10.1111/cod.13012.

    Article  PubMed  Google Scholar 

  30. Schwensen JF, Friis UF, Zachariae C, Johansen JD. Sensitization to cyanoacrylates caused by prolonged exposure to a glucose sensor set in a diabetic child. Contact Dermatitis. 2016;74(2):124–5. https://doi.org/10.1111/cod.12503.

    Article  PubMed  Google Scholar 

  31. Gisin V, Chan A, Welsh JB. Manufacturing process changes and reduced skin irritations of an adhesive patch used for continuous glucose monitoring devices. J Diabetes Sci Technol. 2018;12(3):725–6. https://doi.org/10.1177/1932296817738076.

    Article  CAS  PubMed  Google Scholar 

  32. McDonald BS, Buckley DA. Severe dermatitis from Dermabond (R) surgical glue. Br J Dermatol. 2014;170(3):739–41. https://doi.org/10.1111/bjd.12684.

    Article  CAS  PubMed  Google Scholar 

  33. Morin CB, Sasseville D. Expanding patch testing beyond the baseline series: usefulness of customized antimicrobials, vehicles, and cosmetics series. Dermatitis. 2020;31(6):367–72. https://doi.org/10.1097/DER.0000000000000674.

    Article  PubMed  Google Scholar 

  34. Oppel E, Hogg C, Summer B, Rueff F, Reichl FX, Kamann S. Isobornyl acrylate contained in the insulin patch pump OmniPod as the cause of severe allergic contact dermatitis. Contact Dermatitis. 2018;79(3):178–80. https://doi.org/10.1111/cod.13017.

    Article  PubMed  Google Scholar 

  35. Jolanki R, Kanerva L, Estlander T, Henriks-Eckerman ML, Suhonen R. Allergic contact dermatitis from phenoxyethoxy ethylacrylates in optical fiber coating, and glue in an insulin pump set. Contact Dermatitis. 2001;45(1):36–7. https://doi.org/10.1034/j.1600-0536.2001.045001036.x.

    Article  CAS  PubMed  Google Scholar 

  36. 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(2):76–80. https://doi.org/10.1111/cod.12995.

    Article  CAS  PubMed  Google Scholar 

  37. Aschenbeck KA, Hylwa SA. A diabetic’s allergy: ethyl cyanoacrylate in glucose sensor adhesive. Dermatitis. 2017;28(4):289–91. https://doi.org/10.1097/DER.0000000000000281.

    Article  PubMed  Google Scholar 

  38. Peeters C, Herman A, Goossens A, Bruze M, Mowitz M, Baeck M. Allergic contact dermatitis caused by 2-ethyl cyanoacrylate contained in glucose sensor sets in two diabetic adults. Contact Dermatitis. 2017;77(6):426–9. https://doi.org/10.1111/cod.12873.

    Article  PubMed  Google Scholar 

  39. Schalock PC, Dunnick CA, Nedorost S, Brod B, Warshaw E, Mowad C, et al. American Contact Dermatitis Society Core Allergen Series: 2020 Update. Dermatitis. 2020;31(5):279–82. https://doi.org/10.1097/DER.0000000000000621.

    Article  PubMed  Google Scholar 

  40. Atwater AR. Personal Communication. 2021.

  41. SmartPractice: T.R.U.E. Test. https://www.smartpractice.com/shop/category?id=581719&m=SPA .Accessed September 26, 2021.

  42. Pyl J, Dendooven E, Van Eekelen I, den Brinker M, Dotremont H, France A, et al. Prevalence and prevention of contact dermatitis caused by FreeStyle Libre: a monocentric experience. Diabetes Care. 2020;43(4):918–20. https://doi.org/10.2337/dc19-1354.

    Article  PubMed  Google Scholar 

  43. Messer LH, Berget C, Beatson C, Polsky S, Forlenza GP. Preserving skin integrity with chronic device use in diabetes. Diabetes Technol Ther. 2018;20(S2):S254–64. https://doi.org/10.1089/dia.2018.0080.

    Article  PubMed  Google Scholar 

  44. Navarro-Trivino FJ, Sierra Cerdan MJ, Ruiz-Villaverde R. Tegaderm (TM) I.V. Advanced can prevent eczematous reaction caused by Dexcom glucose monitoring system. Int J Dermatol. 2020;59(5):e166-e8. https://doi.org/10.1111/ijd.14772.

  45. Mowitz M, Lejding T, Ulriksdotter J, Antelmi A, Bruze M, Svedman C. Further evidence of allergic contact dermatitis caused by 2,2’-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate, a new sensitizer in the dexcom G6 glucose sensor. Dermatitis. 2021. https://doi.org/10.1097/DER.0000000000000767.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Dr. Joel DeKoven for providing a photo for Figure 1.

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Authors and Affiliations

  1. Department of Dermatology, Duke University Medical Center, 5324 McFarland Dr #210, Durham, NC, 27707, USA

    Raina Bembry, Adam K. Brys & Amber Reck Atwater

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  1. Raina Bembry
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Correspondence to Amber Reck Atwater.

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Bembry, R., Brys, A.K. & Atwater, A.R. Medical Device Contact Allergy: Glucose Monitors and Insulin Pumps. Curr Derm Rep 11, 13–20 (2022). https://doi.org/10.1007/s13671-021-00352-3

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