Contact urticaria syndrome from copper

Abstract

Hot tubs, spas, and pools are typically cleaned in two ways. First, daily sanitization with a chlorine or bromine product helps prevent microbial growth. Second, periodic “shocking” is performed with oxidizing agents for removal of irritating chloramines and bromamines, resulting from organic material interacting with daily chlorine/bromine sanitizers. Saltwater systems forego the need for daily sanitization by utilizing electrolysis to continually generate free chlorine. However, chloramines are still generated and, therefore, periodic shock treatments are still necessary. PPMS and NaPS are two examples of oxidizing agents used in shock treatments. There are nine previously reported cases of ACD to PPMS used in hot tub shock treatments. Eight were in adult men, ages 45–80, and one in an 11-year-old boy. Each case presented with a diffuse pruritic eruption on the extremities and trunk. Eight had a positive patch test to APS; the last was positive to PPMS but not APS. Patch testing with APS is considered useful for detecting ACD to PPMS in hot tub shock treatments. Here, we present NaPS as a novel cause of ACD from an aquatic shock treatment. As with the reports of PPMS-induced ACD, in this case, patch testing was positive for APS. Interestingly, our case also aligns with the trend described in Gilligan and Horst that hot tub ACD has primarily been reported in adult men. It is unclear currently why such a phenomenon exists.