title: Eosinophilic airway disease in a patient with a negative skin prick test, but a positive patch test with platinum salts--implications for medical surveillance.
abstract: We present the case of a 52-year-old woman with a topic dermatitis since adolescence who developed work-related hand eczema, cough and runny nose 12 years after she had started working as a laboratory technician at a precious metals refinery. While skin prick test with sodium hexachloroplatinate (SPTPt ) was negative, patch testing with ammonium tetrachloroplatinate was positive after 24, 48, 72, and 96 hr. Inhalation challenge with sodium hexachloroplatinate yielded cough, mild shortness of breath, and a maximal decrease of FEV1 of 8% from baseline 24 hr after the challenge. Significant increases of bronchial hyperresponsiveness, exhaled nitric monoxide and sputum eosinophils were documented after the challenge. We conclude that eosinophilic airway disease due to platinum salts may occur in SPTPt negative subjects. Both, patch testing and inhalation challenge with platinum salts should be considered in SPT negative subjects with occupational exposure to precious metal salts and work-related allergic symptoms.
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Merget
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Manigé
authors.initials: M
authors.lastname: Fartasch
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sander
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Van Kampen
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Raulf
authors.affiliation: Institute of the Ruhr University (IPA), Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brüning
mesh_terms: D004485:Eczema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006225:Hand; D006801:Humans; D008669:Metallurgy; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D010328:Patch Tests; D010984:Platinum / Q000633:toxicity; D011657:Pulmonary Eosinophilia / Q000175:diagnosis* / Q000209:etiology; D012492:Salts / Q000633:toxicity; D012882:Skin Tests
chemical_list: D012492:Salts; D010984:Platinum
keywords: Asthma; late reaction; platinum salts; sputum analysis; surveillance