Contact Allergy to Two Aluminum Salts in Consecutively Patch-Tested Dermatitis Patients

Siemund, Ingrid; Dahlin, Jakob; Hindsén, Monica; Zimerson, Erik; Antelmi, Annarita; Hamnerius, Nils; Hauksson, Inese; Isaksson, Marléne; Pontén, Ann; Mowitz, Martin; Svedman, Cecilia; Bruze, Magnus

doi:10.1097/der.0000000000000787

Cited by 6 publications

(21 citation statements)

References 17 publications

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“…Contact allergy to aluminum was once considered to be very rare but is today more common. 50 The ASIT preparations and vaccines with aluminum hydroxide are the major sensitization sources. Pruritic subcutaneous nodules and eczematous dermatitis are the predominant clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

“…16,17,57 A patch test reading should be performed 1 week after the application so as not to miss 15% to 20% of aluminum allergy. 16,17,50,60 When a strong reaction to aluminum is expected, particularly in young children, a nonaluminum chamber should be used with a lower dose of ACH in petrolatum, for example, 2%. 30,60 Again, a test reading after 1 week is mandatory unless ACH is the only tested sensitizer and the test is positive already at the first reading.…”

Section: Discussionmentioning

confidence: 99%

“…Independent of the salt, 18.2% of the aluminum allergy was only detected on the day 7 (D7) reading. 50 In 2 reports with fewer patients tested with ACH, the additional yield of contact allergy exclusively detected on D7 has been 13% 16 and 38%. 17 Patch testing in children requires a reading on D7 not to miss an aluminum contact allergy.…”

Section: Is There An Increase In Aluminum Contact Allergy?mentioning

confidence: 99%

“…Interestingly, aluminum allergy was significantly more common in atopics, not only children but also adults. 50…”

Section: Contact Allergy Rates In Various Populationsmentioning

confidence: 99%

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Aluminum—Allergen of the Year 2022

Bruze¹,

Netterlid²,

Siemund³

2022

Dermatitis

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Is There An Increase In Aluminum Contact Allergy?mentioning

confidence: 99%

“…Interestingly, aluminum allergy was significantly more common in atopics, not only children but also adults. 50…”

Section: Contact Allergy Rates In Various Populationsmentioning

confidence: 99%

See 2 more Smart Citations

Aluminum—Allergen of the Year 2022

Bruze¹,

Netterlid²,

Siemund³

2022

Dermatitis

Self Cite

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“…A recent Swedish study found that 0.9% of 5448 adults and 5.1% of 196 children showed positive reactions to aluminum chloride hexahydrate (ACH) 10% in petrolatum and/or aluminum lactate 12% in petrolatum. 21 Notably, there was a significant association between aluminum allergy and history of atopy for both adults (P=.0056) and children (P=.046), which remains to be further explored. A systematic review and meta-analysis found comparable rates of aluminum allergy in 0.4% of adults and 5.6% of children without vaccine granulomas who were tested.…”

Section: Prevalence Of Sensitization To Aluminummentioning

confidence: 90%

Aluminum: The 2022 American Contact Dermatitis Society Allergen of the Year

Novack

Adler

2022

Cutis

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Aluminum recently was selected as the 2022 Allergen of the Year by the American Contact Dermatitis Society. Aluminum contact allergy, which most often is related to its use as an adjuvant in select vaccines and allergen-specific immunotherapies, tends to present with pruritic subcutaneous nodules at the injection site. Allergy to aluminum-containing antiperspirants manifests as axillary vault dermatitis. In this article, we highlight the growing recognition of aluminum contact allergy, particularly in the pediatric population, focusing on distinct presentations of aluminum allergic contact dermatitis (ACD), unique sources of exposure, and nuances of patch testing to this metal.

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