Contact dermatitis to alcohol swabs masquerading as vaccine allergy

Abstract

A 14-year-old girl developed an eruption on her upper arm of pruritic, follicular papules each time she received a vaccination. This was initially thought to be a local reaction to the vaccines. After a similar rash appeared at a venepuncture site, a contact allergy to the alcohol swabs used before the procedures was postulated. A repeated open application test clarified this observation.

Delayed hypersensitivity to isopropyl alcohol

“…Isopropyl alcohol is a rare but reported allergen (1–6). We found six previously reported cases in the literature.…”

Allergic contact dermatitis caused by isopropyl alcohol: a missed allergen?

“…Since then, other cases have been published, usually in a young, healthy population who reacted to swabs used to disinfect the skin before venepuncture. Unfortunately, only a few cases (8,(10)(11)(12)15) have been adequately studied and patch tested with isopropyl alcohol (Table 4), and most of the patients were only tested with the swab 'as is' (4,14,16,17). Positive patch test responses to isopropyl alcohol without clinical relevance have also been reported (9,23).…”

“…These preparations are used to achieve skin antisepsis before invasive procedures (i.e. venous puncture or vaccination) and to disinfect wounds, and, more recently, have been used as an alternative to hand washing for routine medical hygiene (3)(4)(5). There is no reported resistance to isopropanol-based products.…”

Infection control guidelines for optometrists 2016

“…Although broken skin may be detected through stinging when the hands are wiped with an alcohol swab, there is the possibility of contact dermatitis developing from alcohol swab use. 71 Latex gloves are not suitable for all optometrists and patients and latex-free nitrile gloves are available as an alternative. Latex allergy has been reported to occur in 4.3 per cent of health-care workers and in 1.4 per cent of the population.…”

“…Gloves do not replace hand washing; hands should be washed before and after using gloves. Although broken skin may be detected through stinging when the hands are wiped with an alcohol swab, there is the possibility of contact dermatitis developing from alcohol swab use …”