Systematic Review and Meta Analysis of Allergic Contact Dermatitis from 2-Octyl Cyanoacrylate Adhesives.

Summary

This PRISMA systematic review and meta-analysis (74 studies; 25,442 patients meta-analyzed) estimates a 4% pooled incidence of allergic contact dermatitis to 2-octyl cyanoacrylate with substantial heterogeneity. Re-exposure dramatically increases risk (>20% in several cohorts), and rates are higher in plastic surgery than orthopedic cohorts; prior adhesive/contact allergy and cosmetic acrylate exposure are strong risk factors.

Key Findings

• Pooled ACD incidence after 2-OCA exposure was 4% (95% CI 3–5%) with high heterogeneity (I²=94.5%).
• Incidence varied by specialty: 8% in plastic surgery vs 4% in orthopedics (p=0.015 for subgroup differences).
• Re-exposure increased postoperative reactions to >20% in several cohorts.
• Prior adhesive/contact allergy and cosmetic acrylate exposure were strong risk factors.

Clinical Implications

Implement preoperative screening for prior adhesive/contact allergy and cosmetic acrylate exposure, avoid re-exposure when feasible, consider alternative closure methods in high-risk patients, and use selective patch testing to confirm diagnosis when needed.

Limitations

• Substantial heterogeneity (I²=94.5%) across studies.
• Diagnosis often based on clinical assessment with selective patch testing; variable criteria across reports.
• Many included studies were observational or case-based, increasing residual confounding and potential publication bias.

Future Directions

Prospective cohorts and trials with standardized diagnostic criteria and patch testing to refine risk estimates; development of hypoallergenic adhesive formulations; decision tools for repeat procedures.