Contact Dermatitis

2011, pp 137-153
Date: 12 Aug 2010
Immediate Contact Reactions
Abstract
Immediate contact reactions comprise a diverse spectrum of inflammatory skin reactions of both
immune and nonimmune origin and involving several often poorly characterized mechanisms
and which can be caused by an enormous variety of chemicals and proteins. Reactions range
from sensory effects through local weal and flare to a more generalized response, but all
generally characterized by a rapid onset after contact and relatively quick resolution over the
space of 12 h. Where the reaction is immunological (mediated by IgE), it merges into the
spectrum of responses caused by that antibody, including anaphylaxis. A wide range of
chemicals have been implicated in the causation of nonimmune immediate contact reactions
(including nicotinic acid esters, dimethylsulfoxide, benzoic and sorbic acid, cinnamic aldehyde,
methyl salicylate, and various alcohols), whereas proteinaceous materials are more commonly
associated with immediate immune-mediated reactions. Diagnosis is by clinical history, skin
testing, and, where appropriate, serological analysis, but particularly for nonimmune responses
may involve a considerable degree of clinical judgement.

http://link.springer.com/chapter/10.1007%2F978-3-642-03827-3_7

Menthol
Menthol is another common flavoring agent in cigarettes (see Table 2).
[10]
Menthol is derived
from plants in the Labiatae or Lamiaceae (mint) family. Menthol is a component of Menthe
piperita(peppermint) and is the main ingredient in peppermint oil.
[14]

Several case reports have highlighted menthol as a potent allergen. Camarasa and Alomar
reported on a 26-year-old female who presented with a 2-year history of scaly lesions with
erythema, concentrated around her mouth, upper lip, and dorsal central fingers.
[15]
She revealed
that she smoked various brands of menthol cigarettes but did not use any other products
containing mint. The authors stated that she had had positive patch-test reactions to menthol and
essence of mint, indicating ACD from menthol. After she stopped smoking menthol cigarettes,
her lesions completely cleared.
[15]

Wilkinson and Beck reported on a 64-year-old female who presented with a 2-year history of
cheilitis and a 62-year-old man who presented with an 18-month history of dermatitis on his
upper lip. In subsequent patch testing, the female subject had positive reactions at 48 hours to
menthol (in its natural and synthetic forms), peppermint, peppermint oil, colophony, balsam of
Peru, and fragrance mix. The male subject had positive patch-test reactions at 48 and 96 hours to
natural and synthetic menthol, synthetic and natural peppermint, and peppermint oil. Both
patients had negative patch-test results with other components of peppermint oil (i.e., cineole, a-
pinene, and l-limonene), leading the researchers to conclude that menthol and not some other
component of peppermint oil was the source of the patients' ACD.
[16]
These case reports indicate
that menthol could be a potential allergen in cigarettes
http://www.medscape.com/viewarticle/589970_3