2023 Allergen of the year: Lanolin
Dr. Schwarzenberger is the physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, June 1, 2023
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Blair A. Jenkins, MD, PhD, about her Dermatitis paper, ‘Lanolin.’
DermWorld: So, lanolin wins the “Allergen of the Year” title for 2023! How did a golden oldie like this rise to the occasion? Is there a reason we should be thinking about lanolin allergies today?
Dr. Jenkins: Because lanolin has been perceived as a “weak” allergen, it is used in many over-the-counter products including cosmetics and moisturizers. Nipple creams tout it as a “safe” alternative to petroleum jelly. As we discussed in the review, lanolin allergy has been a pertinent topic of discussion for decades and likely will continue to be for decades to come.
DermWorld: How does lanolin allergy usually present? Who gets lanolin allergy?
Dr. Jenkins: The presentation of lanolin allergy is “paradoxical.” In some, it will appear as eczematous areas within several days of contact with lanolin. In others, dermatitis will appear only in areas where the skin is inflamed or otherwise compromised and not in areas of normal skin that have been similarly exposed. Lanolin allergy seems to affect primarily vulnerable individuals (e.g., those with existing eczematous rash, the young, the elderly). These populations are also most likely to purchase a lanolin-containing product and present to a dermatologist with an “eczema flare.” Dermatologists need to have heightened awareness as to whether the new rash is truly a flare of their endogenous dermatitis or rather an exogenous allergic contact dermatitis to lanolin.
DermWorld: Is there a best practice for testing for lanolin allergy, and are these allergens readily available?
Dr. Jenkins: This is a topic that is also up for debate. Some groups swear by Amerchol L-101 (50% in petrolatum), while others favor lanolin alcohol (30% in petrolatum). Some centers always test both with and without other lanolin derivatives. There are no “best practices” or “gold standards” currently. The above allergens are commercially available, and centers can choose their own “gold standard” based on the local population’s habits and practices.
DermWorld: Can you offer any pearls of wisdom to share with our lanolin-allergic patients to help them avoid exposure?
Dr. Jenkins: For most lanolin-allergic individuals, the only exposure that they would encounter would be in a topical or mucosal preparation, including prescription topicals. As with all allergic patients, we would advise them to read labels carefully and consult contact allergy registries for lists of preferred products that do not contain lanolin. They also must alert their health care providers and pharmacists.
DermWorld: Many of my lanolin allergic patients ask about wool clothing and yarn. Any reason for them to avoid exposure?
Dr. Jenkins: Lanolin-allergic patients do not need to avoid wool due to their allergy. However, some dermatitic and “normal” individuals who wear wool may experience a pruritic sensation. But this is not mediated by the same mechanism as allergic contact dermatitis. The coarser fibers in some wools are thought to directly stimulate mechanical itch-sensing neurons in the skin.
DermWorld: Are there any known systemic implications of lanolin allergy?
Dr. Jenkins: Aside from a series published by Dr. Boen in 1959 that reported four cases of headaches after topical application of pure lanolin, I am not aware of any systemic implications. However, theoretically, someone with strong allergy, extensive dermatitis, and skin-barrier compromise who applies large amounts of lanolin topically could potentially absorb enough lanolin to cause a drug-related eruption such as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE).
Blair A. Jenkins, MD, PhD, is a PGY3 at Columbia University Vagelos College of Physicians and Surgeons. Her paper appeared in Dermatitis. Dr. Jenkins does not have any relevant financial and/or commercial conflicts of interest.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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