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Baskar Murthy A, Palaniappan V, Karthikeyan K. Aluminium in dermatology - Inside story of an innocuous metal. Indian J Dermatol Venereol Leprol 2024; 0:1-9. [PMID: 38595024 DOI: 10.25259/ijdvl_188_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/23/2023] [Indexed: 04/11/2024]
Abstract
Aluminium, the third most abundant element in the earth's crust, was long considered virtually innocuous to humans but has gained importance in the recent past. Aluminium is ubiquitous in the environment, with various sources of exposure like cosmetics, the food industry, occupational industries, the medical field, transport and electronics. Aluminium finds its utility in various aspects of dermatology as an effective haemostatic agent, anti-perspirant and astringent. Aluminium has a pivotal role to play in wound healing, calciphylaxis, photodynamic therapy and vaccine immunotherapy with diagnostic importance in Finn chamber patch testing and confocal microscopy. The metal also finds significance in cosmetic procedures like microdermabrasion and as an Nd:YAG laser component. It is important to explore the allergic properties of aluminium, as in contact dermatitis and vaccine granulomas. The controversial role of aluminium in breast cancer and breast cysts also needs to be evaluated by further studies.
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Affiliation(s)
- Aravind Baskar Murthy
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
| | - Vijayasankar Palaniappan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
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Teo NAH, Koh MJA, Wee LWY. An unusual case of itchy subcutaneous nodules secondary to aluminium allergy from vaccination. Singapore Med J 2024; 65:57-58. [PMID: 35139630 PMCID: PMC10863737 DOI: 10.11622/smedj.2022015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022]
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Lidholm AG, Inerot A, Gillstedt M, Bergfors E, Trollfors B. Long-term prognosis of vaccine-induced contact allergy to aluminium: Third patch-test with additional test preparations. Contact Dermatitis 2023; 89:359-367. [PMID: 37548037 DOI: 10.1111/cod.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND A high incidence of local itching subcutaneous nodules and aluminium allergy was observed in clinical trials of a new aluminium adsorbed pertussis vaccine in Gothenburg, Sweden, in the 1990s. A total of 495 children with itching nodules were patch tested with aluminium chloride hexahydrate 2% and an empty Finn Chamber®, 377 (76%) with positive reactions. When 241 of them were re-tested some years later 186 (3 out of 4) had unexpectedly lost their patch test reactivity. AIM To investigate the long-term prognosis of vaccine-induced contact allergy to aluminium by a third patch test about 20 years after Patch test I. METHODS Twenty individuals with positive and 11 with negative results in Patch test II were tested a third time with the same sensitisers as in in the first two tests. Three additional aluminium preparations were also tested. RESULTS A total 15 out of 20 persons with positive results in the second test had lost their patch test reactivity. Two of 11 with negative tests had turned positive again. The addition of the preparations gave no conclusive results. CONCLUSION Contact allergy to aluminium caused by vaccination with aluminium-adsorbed vaccines in childhood seems to fade away with time as measured by loss of patch test reactivity.
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Affiliation(s)
- Anette Gente Lidholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annica Inerot
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Bergfors
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Paediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Palmeiro AG, Silva L, Pimentel B, Amaro C. Pruritic subcutaneous nodules of the upper arm in a 2-year-old child. Pediatr Dermatol 2023; 40:952-954. [PMID: 37767646 DOI: 10.1111/pde.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/21/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Ana Gusmão Palmeiro
- Department of Dermatology and Venereology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Leandro Silva
- Department of Dermatology and Venereology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Bernardo Pimentel
- Department of Dermatology and Venereology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Cristina Amaro
- Department of Dermatology and Venereology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Hoffmann SS, Elberling J, Skamstrup Hansen K, Thyssen JP, Mortz CG, Overgaard Bach R, Johansen JD. Adverse reactions after oral provocation with aluminium in children with vaccination granulomas and aluminium contact allergy. J Eur Acad Dermatol Venereol 2022; 37:1028-1035. [PMID: 36478462 DOI: 10.1111/jdv.18811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND According to their parents, some children with aluminium contact allergy and vaccination granulomas may react to aluminium-containing foods by developing dermatitis, granuloma itch and subjective symptoms. OBJECTIVES The objective of this study is to determine whether oral intake of aluminium-containing pancakes can cause adverse events and/or systemic contact dermatitis (SCD) in children with vaccination granulomas and aluminium contact allergy. PATIENTS/METHODS A total of 15 children aged 3-9 years (mean age, 5 years) with vaccination granulomas and positive patch-test results to aluminium chloride hexahydrate 2%/10% pet. completed a 3-week blinded randomized controlled crossover oral aluminium/placebo provocation study with pancakes. Granuloma itch and other subjective symptoms were evaluated daily on a visual analogue scale (VAS). Dermatitis was evaluated by the primary investigator, and sleep patterns were tracked with an electronic device. Aluminium bioavailability was assessed by measuring aluminium excretion in the urine. The children served as their own controls with the placebo provocations. RESULTS All 15 children completed the study. The mean VAS scores were slightly higher during aluminium provocations compared with placebo for granuloma itch (mean VAS, 1.5 vs. 1.4, p = 0.6) but identical for other subjective symptoms (0.6 vs. 0.6, p = 1). There were no differences in sleep patterns and no significant correlation between urinary aluminium excretion and symptom severity. Three children developed a symmetrical rash on the face or buttocks on day 4 of the aluminium provocations, but not during placebo provocations. CONCLUSIONS No difference was found between oral aluminium intake and the occurrence of subjective symptoms and granuloma itch, but on a case-basis oral aluminium may be associated with the development of systemic contact dermatitis.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Kirsten Skamstrup Hansen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Rasmus Overgaard Bach
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Abstract
ABSTRACT 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.
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Mistry BD, DeKoven JG. Widespread cutaneous eruption after aluminum-containing vaccination: A case report and review of current literature. Pediatr Dermatol 2021; 38:872-874. [PMID: 33931889 DOI: 10.1111/pde.14613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aluminum salts are adjuvants found in many vaccines. Although rare, patients have reported cutaneous reactions to aluminum salts including persistent pruritic subcutaneous nodules at the injection site. We report the case of an 11-year-old male who at the age of 5 years developed a generalized pruritic cutaneous eruption after receiving the aluminum-containing Quadracel® vaccination. Patch testing at that time was positive to aluminum salts and again on repeat patch testing 6 years later. Our case highlights a delayed systemic cutaneous reaction to a vaccine containing aluminum salts. We review cutaneous allergic reactions to vaccines containing aluminum salts and vaccination advice for patients with aluminum contact allergy.
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Affiliation(s)
- Bhavik D Mistry
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
| | - Joel G DeKoven
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
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Hoffmann SS, Wennervaldt M, Alinaghi F, Simonsen AB, Johansen JD. Aluminium contact allergy without vaccination granulomas: A systematic review and meta-analysis. Contact Dermatitis 2021; 85:129-135. [PMID: 33797096 DOI: 10.1111/cod.13852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
Aluminium contact allergy is mainly seen as granulomas following immunization with aluminium-adsorbed vaccines and contact allergy following epicutaneous exposure may be overlooked. To investigate the prevalence of aluminium allergy confirmed by patch testing, with no association with vaccination granulomas, and explore whether epicutaneous exposure to aluminium can contribute to allergic contact dermatitis. Two authors independently searched PubMed and MEDLINE (OVID) for case studies on contact allergy to aluminium proven by patch testing. Age-stratified meta-analyses to calculate the pooled prevalence were performed. Twenty-five studies describing a total of 73 cases were included in the review. Seven studies were suitable for meta-analyses. The prevalence of aluminium contact allergy was 5.61% (95% confidence interval [CI] 0.12%-11.08%) for children and 0.36% (95% CI 0.04%-0.67%) for adults. The studies described a variety of epicutaneous exposures, where metallic aluminium, topical medicaments, and deodorants were the main sources. Aluminium sensitization without a known exposure source was described in 10 of the 25 articles. The prevalence of aluminium contact allergy in the general public may be higher than expected and not solely related to vaccination granulomas. However, the clinical relevance is rare if not related to granulomas.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Michael Wennervaldt
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Farzad Alinaghi
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Goossens A, Morren MA. Contact Allergy in Children. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hedberg YS, Wei Z, Matura M. Quantification of aluminium release from Finn chambers under different in vitro test conditions of relevance for patch testing. Contact Dermatitis 2020; 83:380-386. [DOI: 10.1111/cod.13629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Yolanda S. Hedberg
- Division of Surface and Corrosion Science, Department of Chemistry School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology Stockholm Sweden
| | - Zheng Wei
- Division of Surface and Corrosion Science, Department of Chemistry School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology Stockholm Sweden
| | - Mihály Matura
- Unit of Occupational and Environmental Dermatology Centre for Occupational and Environmental Medicine, Stockholm County Council Stockholm Sweden
- Unit of Dermatology Skaraborgs Hospital Skövde Skövde Sweden
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Hoffmann SS, Thyssen JP, Elberling J, Hansen KS, Johansen JD. Children with vaccination granulomas and aluminum contact allergy: Evaluation of predispositions, avoidance behavior, and quality of life. Contact Dermatitis 2020; 83:99-107. [DOI: 10.1111/cod.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Stine S. Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jacob P. Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Kirsten S. Hansen
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
- The Pediatric Department, Herlev and Gentofte HospitalUniversity of Copenhagen Herlev Denmark
| | - Jeanne D. Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
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Contact Allergy-Emerging Allergens and Public Health Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072404. [PMID: 32244763 PMCID: PMC7177224 DOI: 10.3390/ijerph17072404] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have a considerable public health impact. For the present review, all pertinent articles were systematically searched via Medline and Web of Science™; additionally, all available issues of the journals "Contact Dermatitis" and "Dermatitis" were manually searched, covering the years 2018-2019, thereby extending and re-focusing a previous similar review. New allergens, or previously described allergens found in a new exposure context or of other current importance, are described in sections according to substance classes, e.g., metals, preservatives, fragrances. As a common finding in many investigations, a lack of information on product composition has been noted, for instance, regarding a newly described allergen in canvas shoes (dimethylthiocarbamylbenzothiazole sulfide) and, most notably, absence of co-operation from manufacturers of glucose-monitoring devices and insulin pumps, respectively. These latter devices have been shown to cause severe ACD in a considerable number of diabetic patients caused by the liberation of isobornyl acrylate and N,N'-dimethylacrylamide, respectively, as demonstrated by an international collaboration between dermatologists and chemists. Improved and complete ingredient labelling for all types of products, and not just cosmetics, must be put on the legislative agenda.
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Thyssen JP, Ahlström MG, Bruze M, Rustemeyer T, Lidén C. Metals. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_35-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bergfors E, Inerot A, Falk L, Nyström U, Trollfors B. Patch testing children with aluminium chloride hexahydrate in petrolatum: A review and a recommendation. Contact Dermatitis 2019; 81:81-88. [DOI: 10.1111/cod.13303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Elisabet Bergfors
- Department of Public Health and Community Medicine, Unit of Family MedicineInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg Göteborg Sweden
| | - Annica Inerot
- Department of Dermatology and VenereologyInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy Göteborg Sweden
| | - Lars Falk
- Department of Dermatology and VenereologyCounty Council of Östergötland Linköping Sweden
- Department of Clinical and Experimental MedicineLinköping University Linköping Sweden
| | - Ulla Nyström
- Allergy CentreLinköping University Hospital Linköping Sweden
| | - Birger Trollfors
- Department of PediatricsSahlgrenska University Hospital Göteborg Sweden
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Goiset A, Darrigade AS, Labrèze C, Boralevi F, Milpied B. Aluminium sensitization in a French paediatric patch test population. Contact Dermatitis 2018; 79:382-383. [DOI: 10.1111/cod.13087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Goiset
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | | | - Christine Labrèze
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | - Franck Boralevi
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
| | - Brigitte Milpied
- Dermatology Department; Hôpital St André, CHU de Bordeaux; Bordeaux France
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