title: Anaphylaxis and severe systemic reactions caused by skin contact with persulfates in hair-bleaching products.
abstract: BACKGROUND
  Persulfates have been reported to cause both delayed-type and immediate skin reactions. They may also cause immediate reactions of the mucous membranes of the bronchial system through inhalation, leading to asthma and rhinitis. Anaphylactic reactions caused by contact with persulfates are rare. The mechanism of immediate reactions caused by persulfates is unclear.
  
  
  OBJECTIVE
  To report 2 cases with systemic reactions after skin contact with persulfates, and to propose a test protocol for diagnosing immediate reactions caused by persulfates.
  
  
  METHODS
  Prick tests with serial dilutions of ammonium and potassium persulfate were performed. Patch tests were also performed with the two agents. Persulfate-specific IgE was detected with two different IgE immunoblotting techniques.
  
  
  RESULTS
  Prick tests were positive with ammonium and potassium persufate, but no specific IgE was detected in the serum. Patch tests showed early positive reactions to both persulfates in 1 patient.
  
  
  CONCLUSIONS
  Prick tests and patch tests can be valuable in the testing of patients with a suspicion of an immediate-type reaction caused by persulfates. The mechanism of these reactions remains unclear.
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Hoekstra
authors.forename: Sicco
authors.initials: S
authors.lastname: van der Heide
authors.forename: Pieter Jan
authors.initials: PJ
authors.lastname: Coenraads
authors.forename: Marie Louise Anna
authors.initials: ML
authors.lastname: Schuttelaar
mesh_terms: D000328:Adult; D000645:Ammonium Sulfate / Q000009:adverse effects / Q000276:immunology; D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology; D001249:Asthma / Q000139:chemically induced* / Q000276:immunology; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000209:etiology / Q000276:immunology*; D005260:Female; D058206:Hair Bleaching Agents / Q000009:adverse effects*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008875:Middle Aged; D017680:Potassium Compounds / Q000009:adverse effects / Q000276:immunology; D012882:Skin Tests; D013431:Sulfates / Q000009:adverse effects / Q000276:immunology
chemical_list: D058206:Hair Bleaching Agents; D017680:Potassium Compounds; D013431:Sulfates; C031276:ammonium peroxydisulfate; D007073:Immunoglobulin E; C009007:potassium persulfate; D000645:Ammonium Sulfate