1. Introduction
Disperse dyes are used for the dyeing of synthetic textiles made from fibers composed exclusively of polyester, acetate, and nylon, or from a blend of these materials with other fiber types. However, they are not employed for dyeing natural fibers, such as wool, cotton, and linen [
1,
2,
3]. Unlike other dyes, disperse dyes can leach onto the skin, especially from low-quality textiles [
4]. This characteristic enhances their potential for causing allergic reactions. Indeed they are the most prevalent causes of textile-related allergic contact dermatitis [
2,
5].
Epidemiological studies have shown an increased prevalence of sensitization to disperse blue dyes among workers using uniforms treated with disperse blue [
6,
7,
8,
9,
10], textile industries workers [
11] and occupational groups exposed to cross-reacting dyes, such as hairdressers [
12].
Currently, textile dye mixes containing disperse blue 35, disperse orange 1 and 3, disperse red 1 and 17, disperse yellow 3, all at 1.0%, and disperse blue 106 and disperse blue 124, both at 0.3%, are included in the European baseline series [
13]. However, Nijman et al. [
13] assert that it is beneficial to test individual textile dyes in addition to dye mix in patients suspected of having a textile dye allergy.
Disperse orange 3, disperse orange 1, disperse blue 124, and disperse blue 106 are the main culprits [
2,
14,
15,
16]. However, both disperse oranges cross react with
p-phenylenediamine, while both disperse blues are the most important dye haptens. For that reason, it is important to verify the trend of disperse blue over time.
In the Triveneto patch test database, disperse blue 124 was tested regularly until 2021, after which it was replaced with textile dye mix.
Objectives of the Study
This paper aimed to analyze data from patch test databases in the Triveneto region from 1997 to 2021 to elucidate the patterns of sensitization to disperse blue 124 dye. By examining demographic factors and occupational exposure risks, this study seeks to give valuable insights into effective prevention strategies and enhance awareness of textile-related allergies.
3. Results
A total of 30,629 patients, including 9935 males and 20,694 females, were investigated. The mean age was 44.1 ± 17.3 years for males and 43.6 ± 17.2 years for females (p = 0.02), with a notable prevalence of individuals over 40 years of age (53.5% for both sexes). Occupational dermatitis was diagnosed in 2520 participants, 998 males (10.1%) and 1522 females (7.4%). A positive history of atopic dermatitis was reported by the 9.6% of males (856 cases) and 10.3% of females (1912 cases). The most frequently affected anatomical sites were the hands (39.9% among males and 34.6% among females) and face (12.5% for males and 22.9% for females), with leg involvement being secondary.
Table 1 reports the characteristics of the population in relation to sensitization to disperse blue 124, which was found to be positive in the 2.5% of patients (n. 780 individuals).
Individuals sensitized to disperse blue 124 were older (p = 0.053) and mainly women with facial dermatitis. The prevalence of hand dermatitis resulted lower in patients sensitized to disperse blue 124 than in non-sensitized patients (p < 0.008).
Table 2 reports the characteristics of subjects sensitized to disperse blue 124 in women and men. Women resulted significantly older than men with more facial dermatitis (
p = 0.008), while men presented more frequently hands dermatitis compared to women (
p = 0.025).
Table 3 reports disperse blue 124 dye sensitization prevalence in different age groups, considering individuals under 26 years old as a reference. Patients aged 36–65 years had a significantly higher prevalence of sensitization to disperse blue 124 compared to younger and older patients. Moreover, the groups 46–55 and 56–65 years old had the higher prevalence of strong reactions (+++) compared to other age classes. Comparing the intensity of reactions between sexes, men presented a significantly lower risk to having a strong reaction (+++) at unvariable logistic regression (OR 0.29; 95% CI 0.17–0.47).
Table 4 reports the prevalence of sensitization to disperse blue 124 dye in occupational categories.
Textile workers (5.88%) and painters (3.92%) had the higher prevalence of sensitization. We analyzed cases that tested positive for disperse blue 124 (
Table 5), of which only two cases were classified as occupational, due to contact with protective clothing.
Longitudinal analysis indicated a decreasing trend in sensitization prevalence over the study period (1996–2021) in both sexes (
Table 6 and
Table 7).
Table 8 provides data on significant concomitant sensitizations, revealing that many individuals sensitized to disperse blue 124 dye also exhibited sensitivities to other allergens, such as disperse yellow 3 dye (OR 16.1; 95% CI 12.0–21.7), quinoline sulfate 1% (OR 5.9; 95% CI 3.4–10.5) and many others.
4. Discussion
In the 30,629 patients tested, 780 (2.5%) resulted in being sensitized to disperse blue 124 with a declining trend from over 3.5% in the period 1996–2000 to below 2.0% in the period 2016–2021. This percentage of sensitization is similar to that reported in other EU studies: Heratizadeh et al. in 2017 [
14] reported a sensitization rate of 2.3% in Germany during the period 2007–2014, while Nijman et al. in 2023 [
13], analyzing individuals with suspected textile dermatitis between 2015 and 2021, found a higher prevalence (4.8%). Moreover, for both authors disperse blue 124 was the most important disperse allergen. Uter et al. [
23] (1995–1999) found a sensitization prevalence of 4.3% to disperse blue 124 and/or 106. In the USA, the prevalence of sensitization was higher, reaching 8% during the period 2000–2011 [
24]. In Australia, sensitization prevalence to disperse blue 124 was 11.2%, based on 2069 patients tested with a textile series before 2011 [
25]. In Italy, a 2014 study found that disperse blue 124 was the principal allergen in textile allergy [
26], although only individuals with textile dermatitis were considered. In a study by Uter at al. [
27] in 2003, high variability in sensitization to disperse blue 106/124 1% was observed among 3041 patients tested across 31 centers, with a prevalence of sensitization ranging from 0 to 6.2%. The study also identified an increase in women and older patients.
A decreasing trend in sensitization to disperse blue 124 was previously reported in the USA by the Mayo Clinic, comparing patch test results from the period 2006–2010 to 2001–2005 [
28].
However, sensitization to disperse blue 124, was lower than 1% (0.9% on 1854 patch tests in the period 2017–2021 and 0.7% on 5594 patch tests in the period 2015–2016), and it was tested in only a minority of cases [
29].
No recent EU data are available, as the standard series has included only Textile dye mix since 2015.
The declining trend in sensitization is likely attributed to the improved quality of textiles and the restricted use of disperse dyes in coloring synthetic textiles. An older study from 2012 found the presence of disperse dyes in only 3 out of 121 textile samples available in the market across Europe, Asia, and the United States, concluding that the use of disperse dyes is very limited [
30].
The observed mild sex disparity in sensitization rates may reflect higher contact with synthetic textiles in women. This finding is consistent with the existing literature [
31] which suggests a higher incidence of allergic contact dermatitis to textiles among females.
Age-related trends in sensitization suggest that middle-aged individuals may be at a higher risk, likely due to increased exposure to synthetic textiles. In contrast, younger individuals may be less exposed, owing to the reduced use of such disperse dyes in Italian textiles, given their known sensitization potential.
In patients sensitized to disperse blue 124, the sites most commonly affected were the hands and face, with a higher prevalence of sensitization on the face (23.3%) compared to non-sensitized individuals (19.4%). An increased prevalence of facial dermatitis was previously reported by Nijman et al. [
13], with 20.4% of cases, and by Ryberg et al. in 2006. [
32] Additionally, in textile allergy, other sites, such as the axilla, legs, and trunk, are frequently affected due to contact with textiles and sweating that can increase the leaching of the dye [
5].
In individuals sensitized to disperse blue 124, we did not observe an increased risk of occupational dermatitis (7.8% vs. 8.2% in individuals sensitized or non-sensitized to disperse blue 124, respectively) confirming a predominant extra-occupational role. In our study, an increased prevalence of sensitization was found among painters and textile workers, and two of the five cases were occupational, being related to contact with blue coveralls. The other cases were classified as non-occupational and sensitization to other haptens was observed. This finding aligns with the literature, where reports are primarily associated with contact with uniforms that release disperse blue [
8,
11,
12,
13,
14], with only a very old study reporting cases in workers involved in the textile industry [
11].
The analysis of concomitant associations permitted us to identify many haptens significantly related to disperse blue sensitization: as expected, these were disperse yellow, other coloring agents, such as paraphenyldiamine (with low association in accord with the literature [
33]), and cross-reactive substances belonging to the para-group (diaminodiphenylmethane, benzocaine, isopropylparaphenylenediamine [
34]).
For contact allergens with a higher prevalence of sensitization, high copositivity rates are expected (nickel, cobalt, chromium, and fragrance mix I) [
33]. Moreover, metals are potentially cross-reactive, though this co-sensitization has to be interpreted as related to the high prevalence of metals’ sensitization in our area [
35,
36].
An association was found with the rubber accelerators mercaptobenzothiazole and mercaptobenzothiazole mix, but not with other rubber accelerators, such as carbamates and thiurams. No available data in the literature are present, to the best of our knowledge, on this topic, suggesting that there is also a multiple exposure condition for other haptens.
This study has some limitations. Although it is based on a large sample of individuals, the populations included patients who sought healthcare services for suspected allergic dermatitis, which may introduce selection bias into the results. Additionally, the multi-centric design of the study could have influenced data collection practices across different centers, despite all participants adhering to a standardized protocol.
To the best of our knowledge, this study represents the largest and longest investigation reporting data on sensitization to disperse blue 124 in Italy.