Severe hypersensitivity reaction to gold. Positive lymphocyte transformation test

Walzer, R. A.

doi:10.1001/archderm.106.2.231

Cited by 10 publications

(2 citation statements)

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“…Other tests and investigations listed in Table 1, except for active sensitization and predictive testing in animals, have supported the interpretation of an allergic nature of the positive test reactions to gold (1,10,24,37,(40)(41)(42)(43)(44)(45)(46).…”

Section: Establishment Of Contact Allergymentioning

confidence: 89%

Gold – a controversial sensitizer

Bruze

Andersen

1999

Contact Dermatitis

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Until recently, gold allergy was considered to be extremely rare. Gold has been used and worshipped for thousands of years without any obvious complaints of skin problems, either in those participating in mining and other ways of prospecting, or in those wearing jewellery. When studies on contact allergy to gold sodium thiosulfate were published at the beginning of the 1990s, the allergic nature of the reported positive patch test reactions to gold was questioned. The major argument for such questioning was the lack of demonstrable clinical relevance in most positive reactors. A major reason for the questioning may have been confusion in differentiating between contact allergy and allergic contact dermatitis. To arrive at a diagnosis of allergic contact dermatitis, 3 steps have, in principle, to be fulfilled: (i) establishment of contact allergy; (ii) demonstration of present exposure; (iii) assessment of clinical relevance, i.e., causing or aggravating a contact dermatitis. In this paper, these steps are discussed with regard to gold. With our present knowledge of contact allergy -allergic contact dermatitis, we do not recommend including gold sodium thiosulfate in the standard series. It should be applied for scientific purposes and when allergic contact dermatitis from gold is suspected.

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Section: Establishment Of Contact Allergymentioning

confidence: 89%

Gold – a controversial sensitizer

Bruze

Andersen

1999

Contact Dermatitis

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“…Lymphocyte proliferation in vitro shows correlation to allergic epicutaneous test reactions to gold (34–36). The lymphocyte transformation test (LTT) has been used in the diagnosis of allergy since the 1960s (37) and is based on the fact that truly allergic individuals develop specific memory T cells that can be activated by allergen exposure.…”

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confidence: 99%

Interferon‐γ secreted from peripheral blood mononuclear cells as a possible diagnostic marker for allergic contact dermatitis to gold

et al. 2006

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10% of patch-tested patients have a positive reaction to gold. Most lack clinical symptoms, but allergic contact dermatitis (ACD) to gold is increasing. In this study, 77 dermatological outpatients were divided into 3 groups depending on epicutaneous patch test outcomes: a group positive to gold (EPI+), a group negative to gold (EPI-), and a group with irritant reactions to gold (EPI-IR). Lymphocytes were stimulated in vitro with gold sodium thiosulfate. Proliferation was assessed using the lymphocyte transformation test (LTT), and cytokine secretion was assessed using a multibead array (Luminex; Linco Research Inc., St. Charles, MO, USA), in order to evaluate whether an in vitro method with high diagnostic accuracy could be devised. The EPI+ group showed a significantly increased secretion of interferon (IFN)-gamma, interleukin (IL)-2, and IL-13 and also showed a significantly higher stimulation indexes for LTT, compared to the other 2 subject groups. Sensitivity and specificity were calculated for all methods individually and combined, but IFN-gamma assessment alone was the most accurate method for identifying ACD to gold, with sensitivity and specificity of 81.8% and 82.1%, respectively. This method also identified 87.5% of the EPI-IR subjects as non-allergic. Therefore, assessment of secretion of IFN-gamma should be a valuable complement to patch test for diagnosing gold allergy.

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