Eosinophilic airway disease in a patient with a negative skin prick test, but a positive patch test with platinum salts ‐ implications for medical surveillance

Abstract

We present the case of a 52-year-old woman with a topic dermatitis since adolescence who developed work-related hand eczema, cough and runny nose 12 years after she had started working as a laboratory technician at a precious metals refinery. While skin prick test with sodium hexachloroplatinate (SPTPt ) was negative, patch testing with ammonium tetrachloroplatinate was positive after 24, 48, 72, and 96 hr. Inhalation challenge with sodium hexachloroplatinate yielded cough, mild shortness of breath, and a maximal decrease of FEV1 of 8% from baseline 24 hr after the challenge. Significant increases of bronchial hyperresponsiveness, exhaled nitric monoxide and sputum eosinophils were documented after the challenge. We conclude that eosinophilic airway disease due to platinum salts may occur in SPTPt negative subjects. Both, patch testing and inhalation challenge with platinum salts should be considered in SPT negative subjects with occupational exposure to precious metal salts and work-related allergic symptoms.

Metal Nanomaterials: Immune Effects and Implications of Physicochemical Properties on Sensitization, Elicitation, and Augmentation of Allergic Disease

“…The existence of ACD has been demonstrated to precede the development of immediate-type IgE-dependent asthmatic reactions induced by metals including nickel, cobalt, and chromium (288,414,454,1669). Established skin sensitivity has also been suggested to be risk factor for the development of delayed-type, T-cell-mediated mechanisms in the lungs as demonstrated by cases caused by nickel, platinum, chromium, and cobalt (294,295,400,403,422,428). These findings imply that gold may have potential to induce similar effects, wherein subjects with existing contact allergy to gold may develop delayed-type hypersensitivity reactions in the lung following respiratory exposure.…”