Rare case of type I hypersensitivity reaction to sodium hypochlorite solution in a healthcare setting
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Abstract:
Sodium hypochlorite is a clear yellowish solution with a characteristic odour of chlorine and is commonly used as a disinfectant and a bleaching agent. It is used in various healthcare settings for its fast-acting and broad-spectrum antimicrobial activity. It is a known irritant and there are some reports that it can also cause allergic contact dermatitis of type IV hypersensitivity. We report a case of work-related type I hypersensitivity to sodium hypochlorite, presenting with recurrent urticarial rash and a positive prick test reaction to this chemical. He was subsequently excused from further exposure with no further recurrences of the urticarial rash. To the best of our knowledge, this is the first such reported case due to work in the healthcare setting.Keywords:
Sodium hypochlorite
Disinfectant
Hypersensitivity reaction
Patch test
Nickel allergy
Patch test
Contact Allergy
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Occupationally related dermatitis is a common problem in nurses, who are exposed to a wide variety of allergenic and irritant substances. In a group of 44 nurses with hand dermatitis (40 female, 4 male), 18 were thought to have a predominantly allergic contact dermatitis, 15 an irritant dermatitis, 7 other form of eczema, 3 atopic dermatitis and one pompholyx. 10 of the 15 irritant cases were diagnosed as occupational. Of the 18 patients with allergic contact dermatitis, the allergens were thought to be occupationally relevant in 8 cases. In 6 of these 8 the dermatitis was due to natural rubber latex (3) or other rubber chemicals (3). 2 had additional evidence of immediate‐type hypersensitivity to natural rubber latex (one was patch test allergic to latex, the other to thiuram mix). Natural rubber latex allergy, both delayed and immediate, is a significant problem, and nurses at risk should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and medicaments series.
Irritant contact dermatitis
Hand dermatitis
Patch test
Patch Testing
Occupational Dermatitis
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Abstract Background p ‐Phenylenediamine ( PPD ) is the primary patch test screening agent for hair dye contact allergy, and approximately 100 different hair dye chemicals are allowed. Objectives To examine whether PPD is an optimal screening agent for diagnosing hair dye allergy or whether other clinically important sensitizers exist. Methods Two thousand nine hundred and thirty‐nine consecutive patients in 12 dermatology clinics were patch tested with five hair dyes available from patch test suppliers. Furthermore, 22 frequently used hair dye ingredients not available from patch test suppliers were tested in subgroups of ∼ 500 patients each. Results A positive reaction to PPD was found in 4.5% of patients, and 2.8% reacted to toluene‐2,5‐diamine ( PTD ), 1.8% to p ‐aminophenol, 1% to m ‐aminophenol, and 0.1% to resorcinol; all together, 5.3% (n = 156). Dying hair was the most frequently reported cause of the allergy (55.4%); so‐called ‘temporary henna’ tattoos were the cause in 8.5% of the cases. p ‐Methylaminophenol gave a reaction in 20 patients (2.2%), 3 of them with clinical relevance, and no co‐reaction with the above five well‐known hair dyes. Conclusions Hair dyes are the prime cause of PPD allergy. PPD identifies the majority of positive reactions to PTD , p ‐aminophenol and m ‐aminophenol, but not all, which justifies additional testing with hair dye ingredients from the used product.
Hair dyes
Contact Allergy
Patch test
p-Phenylenediamine
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Abstract Background Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer. Objective To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients. Methods We conducted a single‐center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019. Results Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear. Conclusion Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID‐19) pandemic is likely to further expose people to BAK.
Benzalkonium chloride
Antiseptic
Disinfectant
Irritant contact dermatitis
Contact Allergy
Patch test
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In patients with vulval or anogenital dermatitis, irritant contact dermatitis is more common than allergic contact dermatitis. The reported frequency and relevance of contact sensitivity in anogenital dermatitis varies greatly.To determine the frequency and relevance of contact sensitization in a Dutch group of female patients with chronic anogenital complaints.We reviewed patch test results of 53 women with chronic anogenital complaints, with sole vulval symptoms in 29 women and sole perianal in 5, in whom inflammatory skin diseases like lichen sclerosus, lichen planus, psoriasis, as well as infectious diseases were unlikely or excluded as a cause of their symptoms. All women were tested with the European baseline series plus additional test series according to their personal history.Thirty-five patients (66%) showed one or more positive test reactions. Seven of these patients (20%) had one or more clinically relevant positive reactions, most often to flavours and spices.A considerable number of patients with anogenital dermatitis have a contact sensitization. Clinically relevant reactions were mainly found to spices and flavours. This is in contrast to the data reported in the literature that shows most contact allergies in vulval patients to ingredients of topical medication.
Patch test
Contact Allergy
Irritant contact dermatitis
Clinical Significance
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A 36‐year‐old female patient was treated with PUVA for dyshidrotic eczema that had not shown sufficient response to topical therapy over the previous months. PUVA therapy caused acute aggravation of the eczema. Patch testing demonstrated Type IV sensitization to 8‐methoxypsoralen in Meladinine solution.
Contact Allergy
Patch Testing
PUVA therapy
Methoxsalen
Patch test
Hand eczema
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Neben atopischen Augenekzemen sind Kontaktallergien die häufigsten Ursachen rezidivierender periorbitaler Ekzeme. Über Kontaktekzeme im Zusammenhang mit der Glaukomtherapie, insbesondere durch die Anwendung von Cholinergika, liegen nur wenige Veröffentlichungen vor. Es wird eine 69-jährige Patientin mit einem periorbitalen Ekzem vorgestellt, die aufgrund eines Glaukoms über mehrere Jahre mit diversen Antiglaukomatosa behandelt wurde. In der allergologischen Abklärung findet sich im Epikutantest eine positive Testreaktion auf das Cholinergikum Aceclidin (Glaukotat®). Trotz der sehr selten auftretenden allergischen Reaktionen auf Cholinergika sollte besonders bei der exponierten Gruppe der Glaukompatienten die Rolle der Substanz als Allergen nicht unterschätzt werden.
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Contact allergy to and allergic contact dermatitis from methyldibromo glutaronitrile (MDBGN) have frequently been reported. As there has been no agreement on which MDBGN test preparation to use, a study was initiated to help determine the optimal patch test preparation for MDBGN. 2661 consecutively patch tested patients at 11 test clinics representing 9 European countries participated. Petrolatum preparations with MDBGN at 1.0%, 0.5%, 0.3% and 0.1% were inserted in the standard series. Contact allergy rates were noted in the range 4.4–1.1% following decreasing test concentrations. Reactions not fulfilling all criteria to be classified as allergic reactions could represent either weak allergic or irritant reactions, and such reactions were noted in the range 8.2–0.5% with decreasing concentrations. A significant number of these reactions represented weak allergic reactions, as allergic reactions were obtained to higher patch test concentrations in the same individual. Morphologically irritant reactions were noted only for the highest test concentrations. In summary, the contact allergy rates and frequencies of doubtful and irritant reactions vary with the patch test concentration. The final decision on patch test concentration for MDBGN should not only rely on these factors but also include information on patch test concentrations required to diagnose individual cases with allergic contact dermatitis from MDBGN as well as results of repeated open application tests.
Patch test
Contact Allergy
Patch Testing
Irritant contact dermatitis
Skin reaction
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To study the clinical features and to identify the molecules responsible for contact-allergic reactions following ocular use of corticosteroid (CS) preparations.Observational case series.We reviewed the clinical data, the patch test results, and sensitization sources in patients with a CS contact allergy, who have been patch tested in the K.U. Leuven Dermatology department during an 18-year period.Eighteen subjects (out of 315 with CS delayed-type hypersensitivity) presented with allergic manifestations (conjunctivitis, eczema of the face, periocular skin or eyelids) of delayed-type hypersensitivity reactions to the use of CS-containing ocular preparations. The most common allergen was hydrocortisone, but most patients presented with multiple positive tests, not only to other CSs, but also to other active principles, preservatives, and vehicle components.Ophthalmic CSs, despite their anti-inflammatory and antiallergic properties, may produce contact-allergic reactions.
Patch test
Contact Allergy
Patch Testing
Allergic conjunctivitis
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