title: [Occupational allergic "march". Rapid evolution of contact dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser].
abstract: BACKGROUND
  Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma.
  
  
  OBJECTIVE
  In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate.
  
  
  METHODS
  After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge.
  
  
  RESULTS
  The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms.
  
  
  CONCLUSIONS
  Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.
authors.affiliation: Scuola di Specializzazione in Medicina del Lavoro, Università di Milano.
authors.forename: Anna
authors.initials: A
authors.lastname: Poltronieri
authors.forename: L
authors.initials: L
authors.lastname: Patrini
authors.forename: P
authors.initials: P
authors.lastname: Pigatto
authors.forename: L
authors.initials: L
authors.lastname: Riboldi
authors.forename: Chiara
authors.initials: C
authors.lastname: Marsili
authors.forename: M
authors.initials: M
authors.lastname: Previdi
authors.forename: M
authors.initials: M
authors.lastname: Margonari
authors.forename: P
authors.initials: P
authors.lastname: Marraccini
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational; D000645:Ammonium Sulfate / Q000009:adverse effects*; D000799:Angioedema / Q000139:chemically induced / Q000188:drug therapy; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D001461:Barbering; D001944:Breath Tests; D001985:Bronchial Provocation Tests; D009783:Dermatitis, Occupational / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003951:Diagnostic Errors; D018450:Disease Progression; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D058206:Hair Bleaching Agents / Q000009:adverse effects*; D006801:Humans; D009569:Nitric Oxide / Q000032:analysis; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D010328:Patch Tests; D012221:Rhinitis, Allergic, Perennial / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014581:Urticaria / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D000395:Air Pollutants, Occupational; D018926:Anti-Allergic Agents; D058206:Hair Bleaching Agents; C031276:ammonium peroxydisulfate; D009569:Nitric Oxide; D000645:Ammonium Sulfate