The results of this study indicate that patch testing with aluminium chloride hexahydrate 2.0%, with an empty Finn Chamber® and the intradermal test with the salt and doses used are insufficient methods to detect contact allergy to aluminium. Aluminium chloride hexahydrate at 10.0% gave the highest number of positive reactions to aluminium.

Persistent, itching nodules have been reported to appear at the injection site after allergen-specific immuno-therapy with aluminium-precipitated antigen extract, occasionally in conjunction with contact allergy to aluminium. This study aimed to quantify the development of contact allergy to aluminium during allergen-specific immunotherapy. A randomized, controlled, single-blind multicentre study of children and adults entering allergen-specific immunotherapy was performed using questionnaires and patch-testing. A total of 205 individuals completed the study. In the 3 study groups all subjects tested negative to aluminium before allergen-specific immunotherapy and 4 tested positive after therapy. In the control group 4 participants tested positive to aluminium. Six out of 8 who tested positive also had atopic dermatitis. Positive test results were found in 5/78 children and 3/127 adults. Allergen-specific immunotherapy was not shown to be a risk factor for contact allergy to aluminium. Among those who did develop aluminium allergy, children and those with atopic dermatitis were more highly represented.

Summary Background In contact dermatitis, it is crucial to understand and remember the outcome of patch testing. Unfortunately, many patients do not remember the results of their patch tests. Objectives Our aim was to evaluate the effects of an intervention programme in which extensive information on specific contact allergy was provided, in individuals with positive patch test reactions. Methods The study was designed as a randomized, investigator‐blinded clinical trial. Participants with positive test reactions were randomized into two groups that received either standard information according to clinical routine or standard information and a reminder letter. Knowledge of contact allergies was evaluated using questionnaires 12 months after inclusion. Results There were 184 adults included in the trial and the response rate at 1‐year follow‐up was 78% (143 of 184). Sixty‐five per cent (45 of 69) in the intervention group and 54% (40 of 74) in the control group reported the correct name of the allergen (P = 0·23). Participants with several – as opposed to few – positive patch test reactions had difficulty in remembering the correct names of the allergens (P = 0·001). Moreover, the type of allergy had an influence on their ability to remember the name of the allergen correctly and their ability to make changes in lifestyle. Conclusions The intervention performed did not significantly affect the participants’ ability to remember their contact allergy. To achieve better knowledge and changes in lifestyle, efforts to inform should concentrate on individuals with several positive patch test reactions, those with particular allergens, individuals over 60 years of age, and – concerning changes in lifestyle – males.

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Background: Recently, aluminum chloride hexahydrate (ACH) 10.0% petrolatum (pet) was recommended for patch testing to detect aluminum contact allergy. Aluminum lactate (AL) may be as reliable a test substance as ACH.Objective: We aimed to investigate the frequencies of aluminum allergy when ACH and AL were used in patch testing consecutive patients.Methods: Petrolatum preparations of ACH 10.0% and AL 12.0% were added to the baseline series in 2010-2017. Aluminum chloride hexahydrate 10.0% pet was added to the children baseline series from July 1, 2012, to December 31, 2017.Results: A total of 5448 patients were patch tested with the extended baseline series and 196 children with the extended children baseline series. Forty-eight of the 5448 adults (0.9%) and 10 of the 196 children (5.1%) were diagnosed with aluminum contact allergy. A significant difference was found between the aluminum allergy frequencies in children and adults patch tested with ACH in 2013-2017 (P < 0.001). The difference between the frequencies of contact allergies for the 2 aluminum salts is not statistically significant.Conclusions: Patch testing with ACH and AL demonstrated similar contact allergy frequencies. To detect aluminum allergy, patch testing with ACH 10.0% pet is recommended. Aluminum chloride hexahydrate 10.0% pet should be considered for inclusion in baseline series for patch testing adults and children.

The patch test reactivity to aluminium varies over time. Aluminium-allergic individuals may have false-negative reactions. Therefore, retesting with aluminium should be considered when there is a strong suspicion of aluminium contact allergy.

Exposure to elemental aluminum and its salts is unavoidable. Aluminum as a metal is present in transport, construction, packaging, and electronic equipment. Aluminum salts are present in consumer products, food items and drinking water, vaccines, drugs, and antiperspirants. Aluminum in vaccines and preparations for allergen-specific immunotherapy are the major sensitization sources. The predominent clinical manifestations of aluminum allergy are pruritic subcutaneous nodules and eczematous dermatitis. Patch testing shall be performed with aluminum chloride hexahydrate (ACH) in petrolatum. The preparation with ACH 10% detects substantially more aluminum allergy than ACH 2%. A patch test with elemental aluminum, for example, an empty Finn Chamber, is only positive when there is a strong aluminum allergy. A patch test reading should be performed 1 week after the application so as not to miss 15% to 20% of aluminum allergy. Aluminum should be included in any baseline patch test series for children and investigated for a possible inclusion in baseline series for adults. Aluminum test chambers can interfere with the testing resulting in both false-negative and false-positive patch test reactions to nonaluminum contact sensitizers.A luminum has within the periodic system the symbol Al and atom number 13. Its weight is 26.98. Aluminum is the third most abundant element in the Earth's crust; approximately 8% of the crust consists of aluminum. It is rare to find aluminum in its elemental form because it is too reactive. Pure aluminum virtually always forms compounds by bonding to other elements, oxygen being a favorite. In our environment, aluminum is present as oxides. EXPOSUREAluminum is widely used and contact with its elemental form or its salts is unavoidable. The metal form of aluminum has many advantages because it is soft, nonmagnetic, light, corrosion resistant, and recyclable. Aluminum as a metal is, therefore, used in applications such as in transport, packaging, construction, electronic equipment, household goods, and as alloys in medicine and dentistry. Aluminum as a trivalent metal cation, Al 3+ , can be found in many different aluminum salts with various properties. These salts are, therefore, used in industry, cosmetics, sunscreens, dental restorations, food, and medicine. [1][2][3] Aluminum is also found in drinking water. 3 Examples of the use of aluminum salts include aluminum sulfate, which is used in water purification and paper production. Aluminum acetate and aluminum acetotartrate are used as astringents in solutions. Aluminum chloride hexahydrate (ACH) and aluminum chlorohydrate are used in antiperspirants. In antacids, aluminum hydroxide can be used. Aluminum hydroxide and aluminum phosphate are added to many vaccines to enhance the immune response in the treated individuals. Aluminum may also be found in tattoo pigments. 4

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