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Nitrile is an organic compound most commonly used to produce nitrile rubber. Nitrile rubber is a large synthetic rubber, a copolymer of acrylonitrile and butadiene, used in the production of latex-free gloves. Nitrile rubber is also used to produce transmission belts, seals, and hoses.
Nitrile is also used in the production of insecticides and as a raw material for the production of synthetic fibres and resins [1].Allergic contact dermatitis to nitrile is usually due to allergy to rubber accelerators used to manufacture nitrile rubber gloves [2]. These include thiurams, dithiocarbamates, and mercaptobenzothiazole [3].
In the rare case of an allergy to acrylonitrile, butyl rubber gloves have been found to limit its permeability and may be considered as an alternative for mechanics and factory workers [4,5]. These gloves are generally not practicable for healthcare workers, hairdressers, or laboratory technicians.
Hypersensitivity may also be due to acrylonitrile, but this is extremely rare, and acrylonitrate more commonly causes an irritant contact dermatitis. Acrylonitrile is a small molecule that can easily penetrate the skin, and has been recognised as a potent toxin and sensitiser [1,4,5,7].
Patch testing should include the local baseline series and rubber accelerators.
Treatment of contact dermatitis involves avoiding exposure to nitrile and topical medical treatment.
Avoidance of exposure to rubber accelerators requires the use of disposable nitrile accelerator-free gloves, such as Ansell Micro-Touch Nitrafree®, Showa N-dex free®, and Sensicare Free Accelerator Free Blue Nitrile Gloves®.
Barrier creams have not been found to protect sufficiently against acrylonitrile penetration and are not recommended [4].
In the acute phase, treatment is as for any acute dermatitis or eczema including the use of a soap substitute, moisturizing cream, and topical corticosteroids.
The prognosis after diagnosis of contact dermatitis to nitrile is dependent on patient education and avoidance of the allergen. Approximately 10&#;15% of people with occupational contact dermatitis continue to experience dermatitis with no obvious cause [6].
References
1. Le Coz CJ, Lepoittevin J-P. Dictionary of contact allergens: chemical structures, sources, and references. In: Johansen JD, Frosch PJ, Lepoittevin J-P (eds). Contact dermatitis. Berlin, Heidelberg: Springer Berlin Heidelberg, : &#;248.
2. Gonzalo-Garijo MA, Caballero ML, Gil-Micharet MS, Moneo I, Pérez-Calderón R, García-Borruel L. Hypersensitivity reactions due to nitrile gloves. J Allergy Clin Immunol. ;129(2):562&#;4. doi:10./j.jaci..09.016.
3. Isaksson M. Dental materials. In: Johansen JD, Frosch PJ, Lepoittevin J-P (eds). Contact dermatitis. Berlin, Heidelberg: Springer Berlin Heidelberg, : 763&#;91.
4. Bakker J, Jongen SMJ, Neer FCJv, Neis JM. Occupational contact dermatitis due to acrylonitrile. Contact Dermatitis. ;24(1):50&#;3. doi:10./j.-..tb.x.
5. Chu C-Y, Sun C-C. Allergic contact dermatitis from acrylonitrile. Am J Contact Dermat. ;12(2):113&#;4. doi:10./ajcd... PubMed
6. Wall LM, Gebauer KA. A follow-up study of occupational skin disease in Western Australia. Contact Dermatitis. ;24(4):241&#;3. doi:10./j.-..tb.x.
7. Aerts O, Mortelmans D, Bracke A, Romaen E, Dendooven E. Occupational allergic contact dermatitis from acrylonitrile, a highly toxic industrial chemical. Contact Dermatitis. Jun;88(6):493-494. doi: 10./cod.. Epub Mar 14. PMID: .
Carla M. Davis, MD, FAAAAI
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