Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre
Anne Herman  Martin Mowitz  Olivier Aerts  Jeroen Pyl  Laurence de Montjoye  An Goossens Magnus Bruze  Marie Baeck
First published: 05 June 2019 https://doi.org/10.1111/cod.13330 Cited by: 1
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Abstract
Background
Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series.

Objectives
To compile patch test results of subjects affected, and provide potential explanations for this association.

Patients and Methods
Fifty‐three Freestyle Libre‐allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM.

Results
Thirty‐three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography‐mass spectrometry (GC‐MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA.

Conclusion
Significant co‐sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC‐MS analysis. Cross‐reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist.

Highlights
Of the diabetic patients sensitized to the glucose sensor FreeStyle Libre and/or IBOA, 62.3% reacted positively to SLM.
Cross‐reactions between IBOA and the three components of SLM (alantolactone, costunolide, and dehydrocostus lactone) seem unlikely, because of their different spatial structures.
Co‐sensitization between IBOA and SLS can be explained by the fact that there is a common precursor, such as camphene, between these two molecules.
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