CD08: Barriers to improvement: the role of tackifying agents in persisting continuous glucose monitoring-associated allergic contact dermatitis

Lauren Passby and Donna Thompson

Birmingham Skin Centre, City Hospital, Birmingham, UK

The advent of continuous glucose monitoring (CGM) for patients with type 1 diabetes (T1D) has resulted in an epidemic of allergic contact dermatitis (ACD) associated with these devices and adhesives involved in securing them. Patch testing has identified isobornyl acrylate, colophony and abitol as causative allergens in these patients (Ahrensbøll-Friis U, Simonsen AB, Zachariae C et al. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: results from a 5-year period. Contact Dermatitis 2021; 84: 75–81), with CGM-related allergen sources reported to include the device housing unit, tape attached to the device or additional tapes used to secure the device in place. Tac adhesive barrier wipes, made to aid adhesion of appliances and tape, can be used to better secure CGM devices to the skin. We present a novel case highlighting this as an alternative source of CGM-associated ACD. A 7-year-old boy with T1D was referred to the cutaneous allergy clinic with an 18-month history of a rash at the site of application of his CGM sensor. The device is comprised of the glucose sensor and transmitter, a plastic cannula to detect interstitial blood glucose and an adhesive tape to keep the sensor fixed in place. The rash persisted despite trialling different sensors (including MedTronic Guardian 3 and Dexcom G6) and adhesive tapes (including Oval Tape™ and Mepitel Film™). During the consultation, the patient’s mother replaced the sensor demonstrating the process and techniques involved and it was noted that Tac adhesive barrier products were additionally being used to further secure the device. Patch testing was performed to the British Society for Cutaneous Allergy standard, cosmetics and acrylate series, including isobornyl acrylate, as well as to components of the sensor, its adhesive tape, Cavilon no sting barrier film and Skin Tac™ adhesive barrier wipes (Torbot Group). After 2 days of occlusion, readings were performed on days 2 and 4 with positive patch test reactions to abitol (also known as hydroabietyl alcohol), an organic alcohol derived from wood rosin and used in adhesives, and to Skin Tac™ adhesive barrier wipes containing partially hydrogenated rosin as the tackifying agent. No positive reactions were seen to isobornyl acrylate, colophony or to tested components of the sensor. This case raises awareness of tackifying barrier products as an emerging source of allergen exposure in the context of CGM-related ACD in T1D. It further highlights the importance of reviewing all items involved in the application or removal of such devices particularly in the face of persistent or recurrent ACD despite multiple devices, and negative patch test to acrylates or adhesives in the device or tape itself.