CLINICAL CASE
Aluminium allergy in a patient with occupational contact dermatitis
F. Purello-D''Ambrosio, S. Gangemi, P. L. Minciullo, G. Lombardo, L. Ricciardi, S. Isola and R. A. Merendino*
School of Allergy and Clinical Immunology. *Chair of Immunopatology. Department of Human Pathology. Policlinic "G. Martino". University of Messina. Italy.
Correspondence:
Francesco Purello D''Ambrosio, MD
University of Messina
Viale Principe Umberto, Complesso Le Terrazze, 49
98100 Messina (Italy)
E-mail: dambros@imeuniv.unime.it
SUMMARY
Case of a 57-year-old hospital attendant with hand eczema. Patch tests were read at 2 and 3 days using the 1+ to 3+ scoring system recommended by the Contact Dermatitis Research Group.
Key words: Aluminium allergy. Contact dermatitis. Finn chambers.
RESUMEN
Caso de un ayudante sanitario de 57 años con eczema en las manos. Se realizan pruebas cutáneas evaluadas a los dos o tres días utilizando el sistema de puntuación 1+ a 3+ recomendado por el Contact Dermatitis Research Group.
Palabras clave: Alergia al aluminio. Dermatitis de contacto. Cámaras de Finn.
CASE REPORT
We report the case of a 57-year-old hospital attendant who had a 2-year history of hand eczema.
He referred also an allergic oculorhinitis from pellitory pollen, for which he had undergone to specific immunotherapy (SIT) for 3 years.
He was patch tested with the European standard series with the addition of some substances that the patients was in contact with at work, using Finn Chambers on Scampors.
Patch tests were read at 2 and 3 days using the 1+ to 3+ scoring system recommended by the International Contact Dermatitis Research Group.
Tests showed marked erythema with widespread blisters under all the disks. In doubt of an aluminium reaction by Finn Chambers, new patch tests were carried out after 1 month utilizing the same substances and a 2% aq. aluminium chloride, using paper chambers.
D3 readings showed positive reactions to colophony (+++), thiomersal (+++), neomycin sulphate (++) and aluminium 2% aq. (+++).
Patient reasked, he referred that during the last year of SIT he showed nodules in the inoculum sites.
Therefore we found that the vaccine was adsorbed on aluminium hydroxide.
DISCUSSION
Aluminium, ubiquitarian element utilized for several uses, is also used in the medical field, mainly for medical equipment and vaccines.
In the last years some cases of delayed type allergic reaction caused by aluminium present in the prophylactic and therapeutic vaccines (1, 2), in antiperspirant (3) and in Finn Chambers (4, 5) have been reported.
The clinical features can be represented by nodules or eczema (3).
The sensitivity showed by our patient probably was related to previous SIT because of aluminium used as adjuvant. The other sensitivities showed with patch tests were explainable in considering of his job (6-8).
The clinical course and high positivity to the specific patch test suggest either a causative role of aluminium or a pathogenic mechanism of delayed-type hypersensitivity in our case report.
Moreover it should be considered in these cases to carry out a specific patch test with aluminium 2% aq. using a paper chamber, to make differential diagnosis between excited skin syndrome and aluminium allergy.
REFERENCES
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3.Bohler-Sommeregger K, Lindemayr H. Contact sensitivity to aluminium. Contact Dermatitis 1986;15:278-81.
4.Tosti A, Vincenzi C, Peluso AM. Accidental diagnosis of aluminium sensitivity with Finn Chambers. Contact Dermatitis 1990;23:48-9.
5.Dwyer CM, Kerr RE. Contact allergy to aluminium in 2 brothers. Contact Dermatitis 1993;29:36-8.
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8. Kalimo K, Lammintausta K. 24 and 48 h allergen exposure in patch testing. Comparative study with 11 common contact allergens and NiCl2. Contact Dermatitis 1984;10:25-9.
