Contact Allergy to Ammonium Persulfate

Abstract

Background: Persulfate is an oxidizing agent used for multiple purposes, including bleaching hair, bleaching flour, and as pool/spa water disinfectant. Objective: To identify the prevalence and clinical characteristics of patients allergic to ammonium persulfate (APS) among patients who underwent patch testing in our clinic. Methods: A retrospective chart review of 2138 patients who underwent patch testing at Brigham and Women's hospital in Boston between July 2015 to November 2019. All patients were tested to our standard series including APS 2.5% petrolatum. Given the irritant nature of APS, we included for analysis only patients with 2+ or 3+ reactions. Results: Among 2138 patients, 61 (2.85%) had 2+ or 3+ reactions to APS. In this study, 72% were female. 75% had an atopic diathesis; 56% had 2+ reactions, and 44% had 3+ reactions. Clinical relevance was definite in 11%, probable in 10%, and unknown/possible in 79%. In patients with definite clinical relevance, 6/7 had occupational allergic contact dermatitis: 4 hairdressers, 1 hair salon cleaner, and 1 aquarium worker; 1/7 was bleaching her hair. Conclusion: Prevalence of 2+ or 3+ APS reactions in this single-center study was higher than that reported by the North American Contact Dermatitis Group, 2015–2016, (0.75% vs. 2.85% in our study). APS is an important occupational allergen, and clinicians should be aware of this when treating patients with exposure to APS.

An uncommon cause of swimmer's rash: Allergic contact dermatitis to persulfates in pools

“…2 In a single-center retrospective review of 2138 patients who underwent patch testing at Brigham and Women's Hospital from 2015 to 2019, 61 (2.85%) had 2+ or 3+ patch test reactions to APS. 13 In comparison, the NACDG study reported 0.75% of patients had 2+ or 3+ reactions. 2 Persulfate sensitivity can present as dermatitis of the hands, trunk, or face after exposure to spa water/swimming pools, hair-bleaching products, or disinfectants.…”

“…In a single‐center retrospective review of 2138 patients who underwent patch testing at Brigham and Women's Hospital from 2015 to 2019, 61 (2.85%) had 2+ or 3+ patch test reactions to APS 13 . In comparison, the NACDG study reported 0.75% of patients had 2+ or 3+ reactions 2 .…”

“…2 Persulfate sensitivity can present as dermatitis of the hands, trunk, or face after exposure to spa water/swimming pools, hair-bleaching products, or disinfectants. 2,[4][5][6][7][11][12][13] In adults, dermatitis from persulfate exposure tends to affect the hands, which may be explained by the adult predominance due to occupationally related exposure from hairdressing, pool maintenance, baking, and cleaning compared to children. In children, persulfate sensitivity may be more likely to present as a diffuse dermatitis following pool exposure.…”

“…Notably, Alajaji et al report 44 (72%) of APS-positive patients were female with an average age of 50 years 2. Of 7 patients found to have definite clinical relevance, 6 were exposed to hair cleaning products (hairdresser, hair salon cleaner), and one of these patients was an aquarium worker exposed to PPMS who developed dermatitis of the arms and hands 13. Currently, the prevalence of persulfate sensitivity in the pediatric population is poorly described.…”

Hair Product Allergy: A Review of Epidemiology and Management

“…Ammonium persulfate (APS) is an oxidizing agent used for multiple purposes including bleaching hair and bleaching flour. In 2020, We reviewed the prevalence of ammonium persulfate allergy among 2138 patients who underwent patch testing at Brigham and Women's Hospital in Boston, and we found that 2.85% of our study sample had positive allergic reactions to APS [30]. According to the North American Contact Dermatitis Group patch test study that included 10526 between 2015 to 2018, allergy to APS was found to be 1.8% among patch-tested patients [31].…”