Occupational contact allergy to benzyl alcohol in epoxy hardeners

Benzyl alcohol (phenylmethanol, CAS 100-51-6, INCI: Benzyl Alcohol) is an aromatic alcohol commonly used as a fragrance component, preservative, solvent, food additive (E1519) and excipient in medicinal products.1-4 Despite its widespread use, contact allergy to benzyl alcohol is considered rare.5 We describe a case where occupational exposure to epoxy hardeners was the probable source of exposure and sensitization to benzyl alcohol. The patient is a 24-year-old painter who in her work is involved in the repair and coating of concrete floors and handles 2-component epoxy and polyurethane coatings. She has no history of atopic dermatitis or of dermatitis associated with use of cosmetic or topical medicinal products. For treatment of recalcitrant chronic spontaneous urticaria she currently uses cyclosporine at a daily dose of 200 mg. After 2 years in her present work, she developed eczema on her fingers, wrists, eyelids and anterior thighs where coatings were spilled. The eczema healed on holidays and recurred when at work. The patient was first patch tested at a regional central hospital and found strongly positive to diglycidyl ether of bisphenol A (DGEBA) and F (DGEBF) epoxy resins and 1,4-butanediol diglycidyl ether (BDDGE) and referred for further examinations at FIOH. At FIOH, the patient presented with mild hand and wrist eczema that had recurred at work and healed by the end of the patch tests. Instead, she developed a mild acute facial eczema during patch testing. Patch testing was performed with Finn Chambers (SmartPractice, Calgary, Canada) in accordance with ESCD guidelines6 with baseline series and a selection of FIOH patch test series including epoxy, isocyanate, acrylate, glues and plastics and rubber series. We routinely patch test benzyl alcohol along with the epoxy patch test series. The already diagnosed occupational contact allergens DGEBA and DGEBF were excluded. In addition, some of the patient's current worksite products were patch tested. Of note is that the cyclosporine treatment might have had a suppressing effect on the patch test reactions. The positive patch test results at day 4 are presented in Table 1. 1%, 0.32%, 0.1% ++, Neg, Neg 1%, 0.32%, 0.1% ++, +, Neg Contains benzyl alcohol and MXDA 1%, 0.32%, 0.1% ++, Neg, Neg Contains benzyl alcohol and MXDA 1%, 0.32%, 0.1% ++, +, Neg Contains benzyl alcohol and IPDA The patient had a strong allergic test reaction to benzyl alcohol. According to the safety data sheets, benzyl alcohol was present in seven of the patient's eight epoxy hardeners (concentration ≥25%–50% in each hardener) and in one epoxy resin part (≥10%), and it was present in all the patch test positive epoxy hardeners. As the epoxy hardeners 2 and 3 also contained m-xylylene diamine (MXDA) and epoxy hardener 4 contained isophorone diamine (IPDA), the patient's weak contact allergies to MXDA and IPDA might have contributed to patch test reactions to these hardeners. Benzyl alcohol was also present in a face cream the patient had taken into use shortly before the examinations at FIOH and continued to use it until the end of the patch tests. The use of a face cream that contained benzyl alcohol probably explains the patient's facial eczema that appeared during patch testing. Several of the patient's other cosmetic products were perfumed, but benzyl alcohol was not mentioned in their INCI lists. In this patient case, the regular occupational exposure to epoxy products that contained benzyl alcohol was considered the probable cause of sensitization to benzyl alcohol. The patient's work-related eczema was not only explained by contact allergy to benzyl alcohol but also by contact allergies to several epoxy compounds. Her contact allergies to diglycidyl ethers and MXDA and IPDA as well as the previously diagnosed contact allergies to DGEBA and DGEBF were attributed to regular skin exposure to epoxy coatings used at work. Patch test reaction to diaminodiphenyl methane (MDA) may indicate contact allergy to diphenylmethane diisocyanate (MDI) which was present in one of the patient's polyurethane coating products. Alternatively, it might be attributed to previous exposure to epoxy hardeners that may contain chemicals that structurally resemble MDA such as hydrogenated formaldehyde-benzenamine polymer (FBAP).7 Benzyl alcohol is common in epoxy products. According to the National Chemical Products Register,8 there are currently about 600 benzyl alcohol-containing products on the Finnish market. Most of them are epoxy products such as hardeners, coatings and adhesives. In conclusion, contact allergy to benzyl alcohol may be caused by occupational exposure to epoxy products that contain benzyl alcohol. Maria Pesonen: Data curation; writing – review and editing; writing – original draft; investigation; methodology; conceptualization. Katriina Ylinen: Investigation; methodology; writing – review and editing. Sari Suomela: Conceptualization; writing – review and editing; methodology. Katri Suuronen: Methodology; conceptualization; investigation; data curation; writing – review and editing. No exterior funding. Maria Pesonen has been a speaker of Leo Pharma. Other authors have no conflicts of interests to be declared.

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