Pulmonary Hypersensitivity in the Alginate Industry

Henderson, A; Ranger, A.; Lloyd, John Uri; McSharry, Charles; Mills, R. J.; Moran, Fidelma

doi:10.1177/003693308402900204

Cited by 13 publications

(5 citation statements)

References 11 publications

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“…A fatal case of anaphylaxis caused by alginate paste used for dental impressions, and a single report of anaphylaxis caused by sodium alginate contained in Gaviscon for the management of dyspepsia, have also been reported . Furthermore, occupational pulmonary hypersensitivity to alginates was noted in 7% of workers exposed to dried milled seaweed and alginate compounds . We report the first case of anaphylaxis caused by a calcium sodium alginate dressing.…”

Section: Discussionmentioning

confidence: 85%

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Anaphylaxis caused by alginate dressing

et al. 2018

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Alginates are non-woven absorbent dressings derived from seaweed, and are widely used in the management of exuding wounds or to achieve haemostasis after surgery. We report a case of anaphylaxis secondary to the use of a calcium sodium alginate dressing. CASE REPORTA 46-year-old man underwent an elective endoscopic polypectomy and septal reconstruction for gross nasal polyposis and a deviated septum under general anaesthesia. The procedure was uneventful, and after the procedure his nasal cavity was packed with a calcium sodium alginate dressing (Kaltostat) to achieve haemostasis.Approximately 2 hours postoperatively, he complained of lightheadedness in the recovery room. He was noted to have a generalized urticarial rash. Treatment with intravenous hydrocortisone, chlorphenamine and 0.9% saline was commenced. The nasal pack was removed, and shortly thereafter the patient became unresponsive, with bradycardia and hypotension. His blood pressure and pulse recovered after the application of intravenous atropine.A cardiac cause for the sudden clinical deterioration was ruled out because of a normal echocardiogram and normal serial troponin data. The patient's urticarial rash improved with regular antihistamines, and he was discharged home the following day.Interestingly, he had undergone nasal polypectomy 1 year previously, and the same calcium sodium alginate dressing had been used for nasal packing. Latex-specific IgE was not detected.The patient was referred to dermatology for further investigation.Prick testing undertaken with 0.9% saline-soaked calcium sodium alginate dressing gave a positive result ( Figure 1A,B); 0.9% saline and histamine were used as a negative and a positive control, respectively ( Figure 1B). The patient was diagnosed with alginate allergy, and advised to avoid alginate-containing products. Sensitization may have occurred during his previous surgery. DISCUSSIONCalcium sodium alginate is derived from brown seaweeds of the phylum Phaeophyceae. Calcium sodium alginate dressings are absorbent FIGURE 1 (A) Positive prick test reaction to alginate dressing (7-mm wheal and 9-mm flare). (B) Positive prick test reaction to alginate dressing soaked in saline ('K', on the right) with histamine as a positive control ('H', on the left) and saline as a negative control ('S', in the centre) 396 MCCARTHY ET AL.fibrous fleece dressings composed of sodium and calcium salts of alginic acid. Allergy to seaweed-derived products has been reported previously in the literature. In 1 case, anaphylaxis was reported following insertion of a laminaria stick, a derivative of brown seaweed, to dilate the cervix during a therapeutic abortion. 1 A fatal case of anaphylaxis caused by alginate paste used for dental impressions, and a single report of anaphylaxis caused by sodium alginate contained in Gaviscon for the management of dyspepsia, have also been reported. 2,3 Furthermore, occupational pulmonary hypersensitivity to alginates was noted in 7% of workers exposed to dried milled seaweed and alginate compounds. 4 We r...

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Section: Discussionmentioning

confidence: 85%

“…2,3 Furthermore, occupational pulmonary hypersensitivity to alginates was noted in 7% of workers exposed to dried milled seaweed and alginate compounds. 4 We report the first case of anaphylaxis caused by a calcium sodium alginate dressing.…”

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confidence: 96%

Anaphylaxis caused by alginate dressing

et al. 2018

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“…In one publication on the effects of sodium alginate on the respiratory exposure to raw seaweed dust, it has been reported that it causes pulmonary hypersensitivity, although it is not clear that pure sodium alginate would have the same effects (Henderson et al, 1984). However, considering that the product is a dermal sensitiser, the Panel concludes that sodium alginate should be considered also a respiratory sensitiser.…”

Section: Assessmentmentioning

confidence: 99%

Safety and efficacy of a feed additive consisting of sodium alginate for all animal species (ALGAIA)

Bampidis¹,

Azimonti²,

Bastos³

et al. 2022

EFS2

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Following a request from the European Commission, the Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was asked to deliver a scientific opinion on the safety and efficacy of sodium alginate for all animal species. The additive is intended to be used as a technological additive (functional groups: thickeners and gelling agents). Sodium alginate is intended to be used in feedingstuffs for all animal species at a proposed minimum concentration of 2,000 mg/kg feed and a maximum concentration of to 30,000 mg/kg feed. The data provided for the composition of the additive does not allow a proper assessment of the product consistency, purity and physico‐chemical properties. Sodium alginate is not irritant to skin but should be considered irritant to eyes, a skin and respiratory sensitiser and hazardous by inhalation. Sodium alginate is a high‐molecular‐weight polymer naturally occurring in brown algae. The use of sodium alginate in animal nutrition is considered safe for the consumers and the environment. No conclusion could be drawn on the safety of sodium alginate for the target species or on its efficacy as a thickener or gelling agent in feed.

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“…No specific information on the safety of sodium and potassium alginate for the user was provided. From the available information, the only effect reported for alginate is a pulmonary hypersensitivity in an occupational context (Henderson et al, 1984). Given the high dusting potential and the high proportion of particles of respirable size, exposure via inhalation is regarded as hazardous.…”

Section: Safety For the Usermentioning

confidence: 99%

Safety and efficacy of sodium and potassium alginate for pets, other non food‐producing animals and fish

Additives¹,

Rychen²,

Aquilina³

et al. 2017

EFS2

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Sodium and potassium alginate are intended to be used as technological additives (functional groups: emulsifiers, stabilisers, thickeners, gelling agents and binders). Sodium alginate is intended to be used in feedingstuffs for pets, other non food-producing animals and fish, with no maximum recommended use level. Potassium alginate is intended to be used in feedingstuffs for cats and dogs at levels up to 40,000 mg/kg feed (on dry matter). Since the functional properties of the additives are determined by the alginate content, sodium and potassium alginate were considered equivalent. The maximum dose considered safe for cats, dogs, other non food-producing animals, salmonids and other fish is 40,000 mg alginates (sodium and potassium salts)/kg complete feed. The use of alginates in feedingstuffs for fish is of no concern for the consumer. Alginates are reported not to be irritant to the skin but mildly irritant to the eyes. They are considered as potential sensitisers to the skin and the respiratory tract. Alginates are high-molecular-weight polymers naturally occurring in brown algae. Their use in feedingstuffs for fish does not pose a risk for the aquatic environment. Alginates are effective as stabilisers, thickeners, gelling agent and binders. No conclusion could be drawn on the efficacy of alginates as emulsifiers.

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Pulmonary Hypersensitivity in the Alginate Industry

Cited by 13 publications

References 11 publications

Anaphylaxis caused by alginate dressing

Anaphylaxis caused by alginate dressing

Safety and efficacy of a feed additive consisting of sodium alginate for all animal species (ALGAIA)

Safety and efficacy of sodium and potassium alginate for pets, other non food‐producing animals and fish

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