Bert Björkner

High frequency of contact allergy to gold sodium thiosulfate : an indication of gold allergy ?

When gold sodium thiosulfate was added to the patch test standard series, positive reactions were obtained in 8.6% of 823 consecutive patients with suspect contact allergy. The test reactions were clinically of an allergic type and, in several cases, long‐lasting. There was no correlation with other allergens in the standard series. In a special study on 38 patients with contact allergy to gold sodium thiosulfate, the following principal findings were obtained: positive patch tests to the compound itself in dilute concentration; positive patch tests to potassium dicyanoaurate; negative patch tests to gold sodium thiomalate, sodium thiosulfate, and metallic gold; positive intradermal tests to gold sodium thiomalate. Our findings make gold sodium thiosulfate the 2nd most common contact allergen after nickel sulfate. It is suggested that a positive skin test to gold sodium thiosulfate represents gold allergy.

Clinical relevance of contact allergy to gold sodium thiosulfate

BACKGROUND In our routinely patch tested patients with dermatitis gold was shown to be the second most common sensitizer. In most patients it was difficult to explain the source of sensitization to gold and to see any clinical relevance. OBJECTIVE Our purpose was to elucidate the clinical relevance of contact allergy to gold sodium thiosulfate. METHODS A questionnaire on gold exposure and gold sensitivity was answered by 156 consecutive patients with dermatitis. In another group of 1056 routinely tested patients data were collected and analyzed regarding factors such as profession, atopy, localization of the dermatitis, and presence of contact allergies. RESULTS Gold allergy was overrepresented in those having dental gold. In persons with contact allergy to gold a dermatitis on the ears, fingers, or eye area was most frequent. CONCLUSION Exposure to gold jewelry and to dental gold may be important in the sensitization and elicitation of dermatitis.

Contact Allergy to Gold is Correlated to Dental Gold

Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

The flare-up reactions after systemic provocation in contact allergy to nickel and gold.

In a controlled double‐blind experimental study, patients with contact allergy to nickel or gold were exposed systemically to their contact allergen. Nickel sulfate was given orally, gold sodium thiomalate intramuscularly, and placebo by both routes. Clinical reactions including body temperature were followed and 7 plasma cytokines and acute phase reactants were assayed before and 24 h after provocation. Clinical flare‐up, with reactivation of healing patch tests and/or toxicoderma‐like reactions, was observed in patients receiving their specific allergen. A transient fever was noted in patients allergic to gold when exposed to gold, not in others. There was a significant increase in plasma tumour necrosis factor‐α, soluble tumour necrosis factor receptor 1, inter leukin‐1 receptor antagonist, and neutrophil gelatinase associated lipocalin in patients allergic to gold when exposed to gold allergen. Furthermore, in patients allergic to nickel exposed to nickel allergen there was a highly significant increase in plasma soluble tumour necrosis factor receptor 1. Interferon‐gamma, interleukin‐4, and C‐reactive protein did not increase in any of the patient groups. Clinical reactions during flare‐up in contact allergy are accompanied by release in the blood of several cytokines. This release is not a consequence of a toxic effect or bound to a particular allergen. Instead, the cytokine release should be considered a general phenomenon characteristic of the flare‐up in contact allergy.

Occupational allergic contact dermatitis from ethyl cyanoacrylate

Glues based on cyanoacrylates are widely used as contact adhesives for metal, glass, rubber, plastics and textiles, as well for biological materials, including binding tissues and sealing wounds in surgery. In this paper, an apprentice cobbler with an occupational allergic contact dermatitis from an ethyl cyanoacrylate glue, in which the major monomer was shown to be the sensitizer, is reported. Initial patch testing with the cyanoacrylate glue dissolved in acetone with the Finn Chamber (aluminium) technique yielded false‐negative reactions. Positive test reactions were obtained with the same preparations using Van der Bend chambers. With petrolatum as vehicle for the glue, there was no difference between Finn Chamber technique and Van der Bend chamber technique. The role of aluminium in the false‐negative reactions is discussed.

Allergic contact dermatitis from acrylates in ultraviolet curing inks.

Six patients developed dermatitis while working with ultraviolet curing inks in four different printing plants. Contact allergy was found to the multifunctional acrylate monomers pentaerythritol triacrylate (PETA) and trimethylol propane triacrylate (TMPTA) and to the epoxy acrylate and polyesteracrylate prepolymers.

Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold

Previous studies have demonstrated an association between gold allergy and the presence of dental gold restorations. The aim of the present study was to investigate the relationship between the concentration of gold in blood (B-Au) and the number of tooth surfaces with gold alloys in subjects with and without contact allergy to gold. In 80 patients referred for patch testing because of eczematous disease, blood samples were taken and analyzed for B-Au using inductively coupled plasma mass spectrometry. The detection limit for the Au determination was 0.04 µg/L. In addition, a dentist made a clinical and radiological examination of the patients and registered the number of dental gold surfaces. Patients with dental gold restorations had a statistically significantly higher B-Au in Mann-Whitney U test (P = 0.025), (range <0.04-1.07 µg/L) than patients without (range <0.04-0.15 µg/L). Furthermore, a positive correlation was found between B-Au and the number of dental gold surfaces (P < 0.01). There was no statistically significant difference in B-Au between persons with and without contact allergy to gold. The study thus indicates that gold is released from dental restorations and taken up into the circulation.

The sensitizing potential of di-(meth) acrylates based on bisphenol A or epoxy resin in the guinea pig

Most composite materials in dentistry used today, contain resins based on dimethacrylates. BIS–GMA [2,2‐bis‐(4‐(2‐hydroxy‐3‐methacryloxypropoxy)phenyl)propane], the addition reaction product of bisphenol A and glycidyl methacrylate or an epoxy resin and meihacrylic acid, is used most extensively. More recently, dimethacrylates based on bisphenol A, with various chain lengths have appeared on the market as a substitute for or in addition to BIS‐GMA, Such compounds are BIS–MA [2,2‐bis‐(4‐(2‐methacryloxy)phenyl)propane], BIS–EMA [2,2‐bis‐(4‐(2‐methacryloxyethoxy)phenyl)propane] and BIS‐PMA [2,2‐bis‐(4‐(3‐methacryloxypropoxy)phenyl)propane]. Increasing interest in the radiaton cure of coatings and printing inks, have focused attention on these substances and on epoxy diacrylates as radiation‐curable resins. The sensitizing capacity of the different acrylates based on bisphenol A or epoxy resin have been investigated with the guinea pig maximization test. The pattern of simultaneous reactivity of the compounds was also studied. Epoxy diacrylale [2,2‐bis‐(4‐(2‐hydroxy‐3‐acryloxy‐propoxy)phenyl)propane], BIS‐EMA and BIS‐MA are shown to be strong sensitizers, while the linear fraction of BIS‐GMA and its isomers and BIS‐PMA have none or a low sensitizing capacity. The impurities in the BIS‐GMA and BIS‐MA batches seem to have high allergenic potential. These results stress the importance of a pure substance when discussing allergenicity and cross reactions.

Clinical reactions to systemic provocation with gold sodium thiomalate in patients with contact allergy to gold

In a double blind experimental study, 20 patients with a contact allergy to gold sodium thiosulphate were challenged intramuscularly with the chemically similar gold sodium thiomalate and with placebo. The most spectacular clinical reaction in the 10 patients given the active agent, was an epidermal and dermal flare up of healed patch‐test reactions to the gold salts, as well as a high, but transient, rise in body temperature. Previous intradermal tests were similarly reactivated. In addition, toxicoderma‐like rashes were observed in several cases, but a flare up of a previous contact dermatitis site was seen in one patient only. The specificity of the positive provocations was demonstrated.

Occupational allergic contact dermatitis in a company manufacturing boards coated with isocyanate lacquer.

Over a short period of time, there was an outbreak of work‐related skin lesions among workers at a company producing flooring laminate boards, after the introduction of a water‐repellent lacquer based on diphenylmethane‐4,4′‐diisocyanate (MDI). In 5 workers, patch testing was performed with a standard series, an isocyanate series and work‐environmental products when indicated. 3 of the workers were tested with the lacquer, and contact allergy was found with concurrent reactions to 4,4′‐diaminodiphenylmethane (MDA). 1 of the 3 workers also showed a simultaneous reaction to MDI, whereas 1 showed a positive reaction to dicyclohexylmethane‐4,4′‐diisocyanate (HMDI). Of the 2 individuals not tested with the lacquer, 1 reacted to both MDI and MDA, whereas the other reacted to a soap used at work. In 3 of 4 cases, the isocyanate reactions appeared after D3. Occupational contact with isocyanates should not exclusively be focused upon respiratory hazards, as this report shows that skin contamination probably increases the risk of developing contact allergy to isocyanates and isocyanate‐related substances. When aiming at diagnosing contact allergy to isocyanates, it is desirable to perform a late reading, as positive reactions appear late. MDA appears to be a good marker for isocyanate hypersensitivity.