Reply #107: See supporting Medline studies:

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A generalized reaction to thimerosal from an influenza vaccine.

2005 Jan;94(1):90-4.
Lee-Wong M, Resnick D, Chong K.

Division of Clinical Immunology and Allergy, Department of Internal Medicine, Beth Israel Medical Center, New York, New York 10003, USA.

BACKGROUND: Thimerosal is a preservative commonly used in ophthalmic solutions, otic drops, and vaccines because of its bactericidal property. OBJECTIVE: To report a case of a generalized reaction to thimerosal in a patient who received an influenza vaccine. METHODS: We describe a patient who developed a generalized maculopapular eruption after receiving a thimerosal-containing influenza vaccine. Patch testing was performed to determine if there was an allergy to thimerosal. RESULTS: Patch testing confirmed a T-cell-mediated sensitivity to thimerosal. CONCLUSIONS: Physicians need to be aware that thimerosal is found in many products, including vaccinations. Clinicians should also be aware that allergic reactions occur with exposure to thimerosal even in vaccines. To our knowledge, this is the first case report in the literature of a generalized reaction to thimerosalfrom an influenza vaccine.

Publication Types:
Case Reports

PMID: 15702823

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15702823&query_hl=1&itool=pubmed_docsum

Contact sensitization in 1094 children undergoing patch testing over a 7-year period.

2005 Jan-Feb;22(1):1-5.
Seidenari S, Giusti F, Pepe P, Mantovani L.

Department of Dermatology, University of Modena and Reggio Emilia, Italy. [email protected]

Contact sensitization in children is frequent. However, because exposure to sensitizing agents varies rapidly, it is of utmost importance to perform a periodic evaluation of patch test results. Our purpose was to compare our data on contact sensitization in children during the past 7 years to our previous 1988-1994 findings, in order to identify emerging allergens and update our pediatric series. From 1995 to 2001, 1094 consecutive children were examined. Of these, 997 patients were patch tested with our pediatric series, which includes 30 allergens, whereas 97 underwent patch testing with 46 allergens. A total of 570 children proved allergic (52.1%). The highest sensitization rate was observed in children under 3 years of age. No differences between atopic dermatitis patients and nonatopic ones were observed in the sensitization rate. Neomycin, nickel, wool alcohols, thimerosal, and ammoniated mercury gave most of the positive responses. With respect to 1988-1995 data, allergy to substances such as neomycin, nickel, wool alcohols, thimerosal, ammoniated mercury, propolis, potassium dichromate, and thiuram mix proved more frequent. In conclusion, as sensitization rates to different allergens show great variations over time, periodic evaluations of patch test results in children is necessary in order to update the test trays.

PMID: 15660887

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15660887&query_hl=1&itool=pubmed_docsum

Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group.

2004 Sep;51(3):111-7.
Heine G, Schnuch A, Uter W, Worm M.

Klinik fur Dermatologie, Venerologie und Allergologie, Campus Charite-Mitte, Universitatsmedizin, Berlin, Germany.

Allergic contact dermatitis (ACD) affects approximately 7% of the general population. To evaluate the frequency of ACD in children, we analysed patch test results collected by the Information Network of Departments of Dermatology between 1995 and 2002. Data of 285 children (6-12 year) and 2175 adolescent patients (13-18 year) were analysed to determine the frequency of sensitization to the 30 most common contact allergens, adjusting for age and sex. As control group, we defined adult patients (60-66 year, n = 7904). The top allergens in children were thimerosal, gentamicin sulphate, nickel-II-sulphate, ammoniated mercury, cobalt-II-chloride, fragrance mix, bufexamac, Compositae mix, propylene glycol and turpentine. The overall proportion of sensitized patients according to the patch test results was 52.6% in the children group compared to 49.7% in the adolescent group. These findings were similar in the adult group at 52.2%. The detailed analysis regarding sex, occupation, atopy, site of eczema and age showed distinct patterns in each group indicating age-specific exposures. Atopy-related diseases were more common in children compared to adults. On the basis of the data of this study, the relationship between atopy and the risk of development of ACD, at least in children, needs further investigation.

PMID: 15479199

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15479199&query_hl=1&itool=pubmed_docsum

Contact dermatitis to metals.

2004;17(4):321-7.
Garner LA.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA. [email protected]

Metals are in close contact with skin and mucous membranes on a repeated, if not constant, basis. Nickel and mercury, well-recognized causes of contact dermatitis; gold and palladium, recently gaining acceptance as patch test allergens on standard screening trays; and cobalt are reviewed in this article. Sensitization to nickel, the most frequently identified allergen on patch testing, is associated with ear piercing. Contact with this potential allergen is ubiquitous. Mercury may be encountered as organic mercury in thimerosal, used as an antiseptic and a preservative in topical medications and vaccines, and metallic mercury found in dental amalgam and thermometers. Both forms may cause contact dermatitis. Gold, recognized as a frequent sensitizer, has been implicated in some cases of eyelid, patchy diffuse and oral lichenoid dermatitis. Cobalt allergy, found frequently in patients who are nickel allergic, also has been associated with ear piercing. Palladium sensitivity is often associated with nickel allergy. However, the incidence of clinical relevance is yet to be established.

Publication Types:
Review

PMID: 15327477

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15327477&query_hl=1&itool=pubmed_docsum

Oral lichenoid lesions (OLL) and mercury in amalgam fillings.

2003 Feb;48(2):74-9.
Wong L, Freeman S.

Skin and Cancer Foundation, Darlinghurst NSW, Australia.

84 patients with oral lichenoid lesions (OLL) were seen in the contact dermatitis clinic. All these patients had reticulate, lacy, plaque-like or erosive lichenoid changes adjacent to amalgam fillings. Patch testing to metallic mercury, 0.1% thimerosal, 1% ammoniated mercury, 0.1% mercuric chloride, and in some cases 0.05% phenylmercuric nitrate and amalgam discs was undertaken. 33 (39%) patients had positive patch test findings. 30/33 patch test positive patients had replacement of their amalgam fillings, with 28 (87%) patients experiencing improvement of symptoms and signs within 3 months. This confirms that mercury allergy is a factor in the pathogenesis of OLL in some cases. In cases where patch test negative patients improve with amalgam replacement, mercury may be acting as an irritant in the pathogenesis of OLL.

PMID: 12694209

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12694209&query_hl=1&itool=pubmed_DocSum