Wearables may cause skin reactions in children with type 1 diabetes
A study presented at the European Academy of Allergy and Clinical Immunology’s annual meeting found that 62.2% of pediatric patients with type 1 diabetes had allergic reactions to at least one compound in a 15-allergen patch testing panel.
These patients had a continuous glucose monitor or continuous subcutaneous insulin infusion device
and the most common allergen was colophony, found in adhesives and surface coatings linked to sap of coniferous trees.
These ‘Repeat Offenders’ Trigger Most Contact Dermatitis From Wearable Diabetes Devices
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Contact dermatitis from wearable diabetes devices often involves the same common compounds found in their adhesives, a new study showed.
Among nearly four dozen youth with type 1 diabetes tested after having reactions to their continuous glucose monitors or continuous subcutaneous insulin infusion devices, 62.2% tested positive to at least one compound on a 15-allergen patch testing panel.
The most common sensitizing allergen was colophony, a common ingredient in adhesives and surface coatings that comes from the sap of coniferous trees such as pines and junipers. It surfaced as a factor in 57.1% of the allergic contact dermatitis cases, followed by nickel in 25%.
Other common allergens included ethyl cyanoacrylate — a common component of fast-acting glues (17.9%) — Balsam of Peru or Myroxylon pereirae resin (14.3%), and phenol-formaldehyde resin (10.7%).
Article Key Points
Common allergens in adhesives of wearable diabetes devices, like colophony and nickel, trigger contact dermatitis in many users. Identifying these allergens can guide device choice, improving patient comfort and glycemic control.
These substances previously have been found not just in adhesives that hold the devices onto the patient but also in the devices themselves, such as to bind tubes and needles.
“Application-site reactions are bothersome for patients and represent one of the reasons for discontinuing their use, resulting in poor glycemic control,” reported Paolo Del Barba, MD, of San Raffaele Hospital in Milan, Italy, and his colleagues at the European Academy of Allergy and Clinical Immunology (EAACI) 2026 Annual Congress.
https://www.medscape.com/c25/p14/european-academy-allergy-and-clinical-immunology-eaaci-2026-2026a1000hcx
“Identifying possible haptens can help choose the most appropriate device for the patient and, therefore, offer a better quality of life and better glycemic control,” the researchers reported.
Dermatologic complications have increasingly been recognized as the use of continuous glucose monitoring and continuous subcutaneous insulin infusion devices has expanded to wide use in both types 1 and 2 diabetes.
“Anyone who sees individuals with diabetes that wear a lot of wearable diabetes devices is not surprised by this,” said Kara Mizokami-Stout, MD, an endocrinologist at the University of Michigan in Ann Arbor, Michigan, who was not involved with the study.
While early reports suggested incidence of up to 50% of patients with diabetes using wearable devices for the condition had skin reactions, some studies now suggest irritation or reaction in up to 90% of individuals who wear the products, she said. Del Barba’s research is one of a spate of studies delving into what substances are responsible for the skin issues.
Adhesive compounds seem to be a common culprit, Mizokami-Stout said. “And a lot of the ones that they studied are the ones that have popped up as repeat offenders.”
Their pilot observational study included 45 pediatric patients with a diagnosis of type 1 diabetes who reported dermatitis associated with at least one diabetes-related wearable device. A 15-allergen panel skin patch test, selected according to commercially available devices, was applied and removed after 72 hours.
All patients reported replacing their device every 3-7 days. Longer duration of wear, up to 2 weeks for some devices, has been associated with greater risk for irritation, Mizokami-Stout said.
Patients who tested positive on patch tests had more late-onset reactions, defined as 1 month or more after initiating use of the devices (68.4% vs 28.6%). “Early-onset reactions tested negative more frequently than late-onset ones, suggesting irritant contact dermatitis and/or sensitization to nontested haptens, whereas late-onset reactions were more consistent with allergic contact dermatitis,” the researchers reported.
Lipodystrophies were more common in patch-negative patients (64.7% vs 28.6%), which Mizokami-Stout suggested could reflect longer duration of insulin use in patients who have been using their device consistently.
Even with more information about who gets dermatitis from these wearables and what components are causing it, what to do is not always clear, Mizokami-Stout acknowledged.
The specific “recipe” of adhesives used in and on the devices varies from manufacturer to manufacturer and even from one iteration of a specific device to the next, so it’s not easy to determine a safe device for a patient who has had a reaction, she said. Calling the manufacturer to ask about a specific compound that turns up as sensitized on patch testing could help, she said.
And sending everyone for patch testing prior to getting a device may not be practical or affordable, Mizokami-Stout said. A positive patch test is also not a guarantee a patient would develop symptoms from a device with the allergen. “It’s not necessarily a reason to not use these devices,” she said.
The first line of defense is good patient education to ensure that patients apply their device to clean, dry skin, potentially even preparing the skin with an alcohol wipe or antiperspirant spray, Mizokami-Stout said.
Other options are applying an antihistamine or a topical steroid-based spray or a barrier film, she said. “Most of the time those types of things work, but if they don’t work, that’s when we’re really looking at trying to switch the type of device.”
From www.medscape.com
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