Thomas Vogt, Michael Landthaler and Wilhelm Stolz. Generalized eczema in an 18-month-old boy due to phenoxyethanol in DPT vaccine


Department of Dermatology, University of Regensburg, Franz-Josef-Strauss
Allee 11, 93053 Regensburg, Germany.

Key words: contact hypersensitivity; phenoxyethanol; generalized eczema; drug
reactions; DPT vaccine; children; allergen replacement © Munksgaard, 1998.


Lovell et al. (1) reported a case of contact eczema due to 2-phenoxyethanol
(2-PE) in aqueous cream. The only other reported cases of 2-PE allergy were
seen in Italy (2 cases) (2), The Netherlands (3), and Germany (4). 2-PE has
been compared to other preservatives in the guinea pig maximization test (5).
All the aforementioned argues for a low risk of sensitization.

An 18-month-old boy was referred with a history of 2 episodes of generalized
eczema starting within 24 h of routine administration of DPT (diphtheria,
petussis and tetanus) vaccine (Infanrix®, SmithKline-Beecham.)

He had a strong family history of atopic eczema and immediate-type allergy.
The dermatitis was more severe the 2nd time, involving the whole body.
Treatment with topical corticosteroids cleared it within 1-12 days. However,
a 3rd booster vaccination was still required.

In addition to the DPT toxoids, Infanrix® vaccine contains polysorbate 80,
formaldehyde, aluminium chlorate hexahydrate, aluminium hydroxide, and 2-PE.
Patch testing was performed with the complete vaccine and all its individual
components in standardized concentrations and vehicles, after the skin of the
patient had completely cleared. The irritancy threshold of 2-PE has been
determined previously to be>10% (5). The patch test to 2-PE (2% pet.) was
positive, showing a crescendo reaction on D2 and D3. A DPT vaccine containing
thimerosal as a preservative was therefore used for the subsequent booster
(Merioux), to which no skin reaction occurred.

2-PE is effective against a broad spectrum of microorganisms, particularly
Pseudomonas aeuginosa (6). As early as 1944, 2-PE-soaked compresses were
recommended for skin infections (7), and more recently for gram-negative
cellutitis in neutropenic patients (8), and prophylaxis in burns (9). Since
1970, 2-PE has increasingly been added to cosmetics and pharmaceuticals,
including vaccines (10). The antimicrobial activity of 2-PE in vaccines is
well-documented (11), though it is still not widely used as such in Germany,
thimerosal being more commonly used.

2-PE is frequently combined with 1,2-dibromo-2,4-dicyanobutane (DBDCB), in a
ratio of 1 (DCDCP): 4 (2-PE), as Euxyl K 400 (12-14). The sensitizing
potential of Euxyl K 400 is low compared to Euxyl K 100 (Kathon CG).


References


1. Lovell CR, White IR, Boyle J. Contact dermatitis from phenoxyethanol in
aqueous cream BP. Contact               Dermatitis 1984: 11: 187.

2. Tosti A, Vincenzi C, Trevisi P, Guerra L. Euxyl K 400: incidence of
sensitization, patch test concentration and vehicle. Contact Dermatitis 1995:
33: 193-195.

3. De Groot A C, Bos JD, Jagtman BA. Contact allergy to preservatives  (II).
Contact Dermatitis 1986: 15: 218-222.

4. Fuchs  T, Estenders F, Przybilla B. Contact allergy to Euxyl K 400.
Dermatosen .1991: 39: 151-153

5.Hausen B.M. The sensitizing potency of Euxly K 400 and its components
1,2-dibromo-2,4-dicyanobutane and 2-phenoxyethanol. Contact Dermatitis 1993:
28: 149-153.

6. Fitzgerald KA, Davis A, Russell AD. Mechanism of action of chlorhexidine
diacetate and phenoxyethanol singly and in combination against gram-negative
bacteria. Microbios 1992: 70: 215-230.

7. Gough J, Berry H, Stil BM. Phenoxyethanol in the treatment of pyocyanea
infections. Lancet 1944: 2: 176-178.

8. Mitchell P, Powles R, Rege K, Treleaven J. Catovsky D, Mehta J, Jameson B.
Phenoxyethanol is effective topical therapy of gram-negative cellutitis in
neutropenic patients. J Hosp Infect 1993: 25: 53-56.

9. Lawrence JC, Cason JS, Kidson A. Evaluation of
phenoxyethanol-chlorhexidine cream as a prophylactic antibacterial agent in
burns. Lancet 1982: 1: 1037-1040.

10. DeGroot AC, Van Ginkel CJ, Weijland JW. Methyldibromoglutaronitrile (Euxl
K 400): an important "new" allergen in cosmetics. J Am Acad Dermatol 1996:
35: 743-747.

11. Lowe I, Southern J. The antimicrobial activity of phenoxyethanol in
vaccines.  Lett Appl Microbiol 1994: 18: 115-116.

12.Bruze M, Gruvberger B, Agrup G. Sensitization studies in the guinea pig
with the active ingredients of Euxyl K 400. Contact Dermatitis 1988: 18:
37-39.

13. DeGroot AC,  DeCock  PA, Coenradds PJ, Van Ginkel CJ,  Jagtman BA, Van
Joost T, Vander Kley AM, Meinardi MM,  Smeenk C, VanderValk PG, Vander Walle
HB, Weyland JW. Methyldibromoglutaronitrile is an important contact allergen
in The Netherlands. Contact Dermatitis 1996: 34: 118-120.

14 Van Ginkel CJ W, Rundervoort GJ. Increasing incidence of contact allergy
to the new preservative 1,2-dibromo-2-dicyanobutane
(methyldibromoglutaronitrile). Br J Dermatol 1995: 132: 918-920.


 
Vogt T, Landthaler M, Stolz W.Generalized eczema in an 18-month-old boy due to phenoxyethanol in DPT vaccine.
Contact Dermatitis. 1998 Jan;38(1):50-1. No abstract available.
PMID: 9504254 [PubMed - indexed for MEDLINE]