title: Delayed and immediate allergy caused by methylhexahydrophthalic anhydride.
abstract: Epoxy resin compounds (ERC) include a large number of chemicals, such as epoxy resins (ER), reactive diluents and hardeners. Many hardeners, e.g., aliphatic polyamines, are well-known sensitizers. Another type of ER hardeners are the phthalic anhydrides, such as methylhexahydrophthalic anhydride (MHHPA) and methyltetrahydrophthalic anhydride (MTHPA), which have been reported as causing immunologically-mediated respiratory diseases and contact urticaria, but not allergic contact dermatitis. Here, we present a horizontal boring-machine worker who developed allergic contact dermatitis, as well as allergic rhinitis and an immediate contact skin reaction from MHHPA. Patch testing with a dilution series of MHHPA in pet. elicited the following results: 2%, 1% and 0.5%, +2; 0.25% and 0.125%, + (3- to 6-day readings). An immunohistochemical and electron microscopic study also indicated that the patch test reactions were conventional-delayed allergic reactions. Interleukin 8 was observed in the epidermal cells, whereas interleukin 4 immunoreactivity was detected in the dermal cells. Immunoreactivity to-interleukin 5, granulocyte/macrophage-colophony stimulating factor (GM-CSF) or eosinophil cationic protein was not seen. In conclusion, the patient developed both Type I and Type IV allergy to MHHPA. The clinical data, patch test results, immunohistochemical and electron microscopic observations indicated that the MHHPA allergy detected by the patch test reaction was a conventional delayed-type hypersensitivity reaction. The patient also had an allergic patch test reaction to para-phenylenediamine and diaminodiphenylmethane, possibly representing occupational sensitization.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Kanerva
authors.forename: H
authors.initials: H
authors.lastname: Hyry
authors.forename: R
authors.initials: R
authors.lastname: Jolanki
authors.forename: M
authors.initials: M
authors.lastname: Hytönen
authors.forename: T
authors.initials: T
authors.lastname: Estlander
mesh_terms: D000485:Allergens / Q000009:adverse effects*; D000814:Aniline Compounds / Q000009:adverse effects; D001798:Blood Proteins / Q000032:analysis; D017449:Dermatitis, Allergic Contact / Q000209:etiology* / Q000473:pathology; D009783:Dermatitis, Occupational / Q000209:etiology* / Q000473:pathology; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000473:pathology; D004817:Epidermis / Q000473:pathology; D004853:Epoxy Resins / Q000009:adverse effects; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000032:analysis; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000473:pathology; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000473:pathology; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000032:analysis; D015847:Interleukin-4 / Q000032:analysis; D015848:Interleukin-5 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D010328:Patch Tests; D010655:Phenylenediamines / Q000009:adverse effects; D010796:Phthalic Anhydrides / Q000009:adverse effects*; D012130:Respiratory Hypersensitivity / Q000139:chemically induced; D012220:Rhinitis / Q000139:chemically induced; D012260:Ribonucleases; D012867:Skin / Q000473:pathology; D014581:Urticaria / Q000139:chemically induced; D001559:Benzhydryl Compounds
chemical_list: D000485:Allergens; D000814:Aniline Compounds; D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D004853:Epoxy Resins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D018836:Inflammation Mediators; D015847:Interleukin-4; D015848:Interleukin-5; D016209:Interleukin-8; D010655:Phenylenediamines; D010796:Phthalic Anhydrides; D012260:Ribonucleases; C051070:4-methylcyclohexyl-1,6-dicarboxylic acid anhydride; C009505:4,4'-diaminodiphenylmethane; D001559:Benzhydryl Compounds; C029728:4-phenylenediamine