Cutaneous exposure to aluminum may occur via contact with metal items, medications, and personal care products. Despite the widespread use of aluminum, allergic contact dermatitis is relatively rare. Sensitization is often incidentally identified during patch testing with aluminum-based chambers. This article presents several cases along with a literature review summarizing prevalence and clinical manifestations of cutaneous reactions to aluminum, recommendations for patch testing, sources of aluminum, and reproducibility of aluminum allergy over time.
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References
1.
SiemundI.Contact Allergy to Aluminum. Malmö, Sweden: Lund University, Faculty of Medicine Doctoral Dissertation Series; 2017.
2.
KrewskiD, YokelRA, NieboerE, et al.Human health risk assessment for aluminum, aluminum oxide, and aluminum hydroxide. J Toxicol Environ Health B Crit Rev, 2007; 10:1–269.
3.
WillhiteCC, KaryakinaNA, YokelRA, et al.Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts. Crit Rev Toxicol, 2014; 44:1–80.
4.
SiemundI, MowitzM, ZimersonE, et al.Variation in aluminum patch test reactivity over time. Contact Dermatitis, 2017; 77(5):288–296.
5.
ClemmensenO, KnudsenHE. Contact sensitivity to aluminum in a patient hyposensitized with aluminum precipitated grass pollen. Contact Dermatitis, 1980; 6:305–308.
6.
LidholmA, BergforsE, InerotA, et al.Unexpected loss of contact allergy to aluminum induced by vaccine. Contact Dermatitis, 2013; 68:286–292.
7.
HemmerW, WantkeF, FockeM, et al.Evaluation of cutaneous hypersensitivity to aluminum by routine patch testing with A1C1 (3). Contact Dermatitis, 1996; 34(3):217–218.
8.
BergforsE, TrollforsB, InerotA. Unexpectedly high incidence of persistent itching nodules and delayed hypersensitivity to aluminum in children after the use of adsorbed vaccines from a single manufacturer. Vaccine, 2003; 22(1):64–69.
9.
NetterlidE, HindsenM, SiemundI, et al.Does allergen-specific immunotherapy induce contact allergy to aluminum?. Acta Derm Venereol, 2013; 93(1):50–56.
10.
SiemundI, HindsenM, NetterlidE, et al.Contact allergy in atopic individuals in relation to allergen-specific immunotherapy. Eur J Dermatol, 2016; 26(3):271–280.
11.
NielsenJP, BangK. On the persistence of acquired hypersensitivity, illustrated by re-examination and repetition of standardized patch tests on eczematous patients. Acta Derm Venereol, 1954; 34:110–117.
12.
GoisetA, DarrigadeAS, LabrèzeC, et al.Aluminum sensitization in a French paediatric patch test population. Contact Dermatitis, 2018; 79:382–383.
13.
BergforsE, TrollforsB. Sixty-four children with persistent itching nodules and contact allergy to aluminum after vaccination with aluminum-adsorbed vaccines—prognosis and outcome after booster vaccination. Eur J Pediatr, 2013; 172(2):171–177.
14.
NetterlidE, HindsenM, BjorkJ, et al.There is an association between contact allergy to aluminum and persistent subcutaneous nodules in children undergoing hyposensitization therapy. Contact Dermatitis, 2009; 60(1):41–49.
15.
BergforsE, HermanssonG, Nystrom KronanderU, et al.How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminum induced by currently used pediatric vaccines? A prospective cohort study. Eur J Pediatr, 2014; 173(10):1297–1307.
16.
KaaberK, OtkjerA, WhenNK. Vaccination granulomas and aluminum allergy: course and prognostic factors. Contact Dermatitis, 1992; 26:304–306.
Garcia-PatosV, PujolR, AlomarA, et al.Persistent subcutaneous nodules in patients hyposensitized with aluminum-containing allergen extracts. Arch Dermatol, 1995; 131:1421–1424.
19.
HallAF.Occupational contact dermatitis among aircraft workers. JAMA, 1944; 125(3):179–185.
20.
HindsenM.Contact allergy to aluminum in patients hyposensitized with aluminum-containing hyposensitizing extracts. Contact Dermatitis, 2005; 53(5):301–302.
21.
VeienNK, HattelT, LaurbergG. Systemically aggravated contact dermatitis caused by aluminum in toothpaste. Contact Dermatitis, 1993; 28(3):199–200.
22.
FischerT, RystedtI. A case of contact sensitivity to aluminum. Contact Dermatitis, 1982; 8(5):343.
23.
MedingB, AugustssonA, HanssonC. Patch test reactions to aluminum. Contact Dermatitis, 1984; 10:107.
24.
DwyerCM, KerrRE. Contact allergy to aluminum in 2 brothers. Contact Dermatitis, 1993; 29(1):36–38.
25.
McFaddenN, LybergT, Hensten-PettersenA. Aluminum-induced granulomas in a tattoo. J Am Acad Dermatol, 1989; 20(5):903–908.
26.
HelgesenAL, AustadJ. Contact urticaria from aluminum and nickel in the same patient. Contact Dermatitis, 1997; 37(6):303–304.
27.
PetersT, HaniN, KirchbergK, et al.Occupational contact sensitivity to aluminum in a machine construction plant worker. Contact Dermatitis, 1998; 39(6):322–323.
28.
SchwarzeHP, Giordano-LabadieF, LocheF, et al.Delayed-hypersensitivity granulomatous reaction induced by blepharopigmentation with aluminum-silicate. J Am Acad Dermatol, 2000; 42(5):888–891.
29.
Purello-D'AmbrosioF, GangemiS, MinciulloPL, et al.Aluminum allergy in a patient with occupational contact dermatitis. Allergol Immunopathol (Madr), 2000; 28(2):74–75.
30.
FrederiksenMS, TofteH. Immunisation with aluminum-containing vaccine of a child with itching nodule following previous vaccination. Vaccine, 2004; 23(1):1–2.
31.
BruzeM, LundhK, GruvbergerB, et al.Aluminum chloride hexahydrate 2% is insufficient to trace contact allergy to aluminum. Contact Dermatitis, 2008; 59:183–184.
32.
GargS, LoghdeyS, GawkrodgerDJ. Allergic contact dermatitis from aluminum in deodorants. Contact Dermatitis, 2010; 62(1):57–58.
33.
BeveridgeMG, PolcariIC, BurnsJL, et al.Local vaccine site reactions and contact allergy to aluminum. Pediatr Dermatol, 2012; 29(1):68–72.
34.
LaurenCT, BelsitoDV, MorelKD, et al.Case report of subcutaneous nodules and sterile abscesses due to delayed type hypersensitivity to aluminum-containing vaccines. Pediatrics, 2016; 138(4):e20141690.
35.
KingN, MoffittD. Allergic contact dermatitis secondary to the use of aluminum Finn Chambers. Contact Dermatitis, 2018; 78(5):365–366.
36.
GordonSC, BartensteinDW, TajmirSH, et al.Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child. Pediatr Dermatol, 2018; 35:234–236.
37.
DeleuranMG, AhlströmMG, ZachariaeC, et al.Patch test reactivity to aluminum chambers. Contact Dermatitis, 2019; 81:1–2.
38.
GolosA, LutynskaA. Aluminum-adjuvanted vaccines—a review of the current state of knowledge. Przegl Epidemiol, 2015; 69:731–734.
GlennyAT, ButlerAH, StevensAF. Rate of disappearance of diphtheria toxoid injected into rabbits and guinea pigs: toxoid precipitated with alum. J Pathol Bacteriol, 1931; 34:267–275.
41.
MannhalterJW, NeychevHO, ZlabingerGJ, et al.Modulation of the immune response by the non-toxic and non-pyrogenic adjuvant aluminum hydroxide: effect on antigen uptake and antigen presentation. Clin Exp Immunol, 1985; 61:143–151.
42.
UlanovaM, TarkowsiA, Hahn-ZoricM, et al.The common vaccine adjuvant aluminum hydroxide upregulates accessory properties of human monocytes via an interleukin-4–dependent mechanism. Infect Immun, 2001; 69:1151–1159.
43.
RamanathanVD, Badenoch-JonesP, TurkJL. Complement activation by aluminum and zirconium compounds. Immunology, 1979; 37:881–888.
Vaccine excipient summary: excipients included inU.S. vaccines, by vaccine. In: Epidemiology and Prevention of Vaccine-Preventable Diseases (Appendix B). 13th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2020.
46.
HeidaryN, CohenD. Hypersensitivity reactions to vaccine components. Dermatitis, 2005; 16:115–120.
47.
MitkusRJ, KingDB, HessMA, et al.Updated aluminum pharmacokinetics following infant exposures through diet and vaccination. Vaccine, 2011; 29:9538–9543.
48.
Global Advisory Committee on Vaccine Safety (GACVS): aluminium adjuvants. Wkly Epidemiol Rec, 2012; 87(30):277–288.
DarbrePD.Aluminum and the human breast. Morphologie, 2016; 100(329):65–74.
51.
GorgogietasVA, TsialtasI, SotiriouN, et al.Potential interference of aluminum chlorohydrate with estrogen receptor signaling in breast cancer cells. J Mol Biochem, 2018; 7(1):1–13.
52.
MandriotaSJ.A case-control study adds a new piece to the aluminum/breast cancer puzzle. EBioMedicine, 2017; 22:22–23.
53.
PineauA, GuillardO, FavreauF, et al.In vitro study of percutaneous absorption of aluminum from antiperspirants through human skin in the Franz diffusion cell. J Inorg Biochem, 2012; 110:21–26.
54.
FlarendR, BinT, ElmoreD, et al.A preliminary study of the dermal absorption of aluminum from antiperspirants using aluminum-26. Food Chem Toxicol, 2001; 39(2):163–168.
55.
Keele University. Aluminum found in sunscreen: could it cause skin cancer?. ScienceDaily, 2007.
56.
ForteG, PetrucciF, BoccaB. Metal allergens of growing significance: epidemiology, immunotoxicology, strategies for testing and prevention. Inflamm Allergy Drug Targets, 2008; 7(3):145–162.
57.
McIntoshJF, SutherlandCG. The use of colloidal aluminum hydroxide in the treatment of peptic ulcer. Can Med Assoc J, 1940; 42(2):140–145.
58.
FriedmanMH.Aluminum hydroxide gel for erosions in patients with bowel fistulas. JAMA, 1946; 131(6):520–522.
59.
BennettTI, GillAM. Colloidal aluminum hydroxide in the treatment of peptic ulcer. Lancet, 1939; 233(6027):500–501.
60.
MorrisT, RhodesJ. Antacids and peptic ulcer—a reappraisal. Gut, 1979; 20(6):538–545.
61.
TimkoAL, MillerCH, JohnsonFB, et al.In vitro quantitative chemical analysis of tattoo pigments. Arch Dermatol, 2001; 137(2):143–147.
62.
BergforsE, InerotA, FalkL, et al.Patch testing children with aluminum chloride hexahydrate in petroleum: a review and a recommendation. Contact Dermatitis, 2019; 81(2):81–88.
63.
LidholmA, InerotA, GillstedtM, et al.Comparison of reactivity to a metallic disc and 2% aluminum salt in 366 children, and reproducibility over time for 241 young adults with childhood vaccine-related aluminum contact allergy. Contact Dermatitis, 2018; 79(1):26–30.
64.
American Contact Dermatitis Society. Contact allergen management program. 2020. Available at: http://www.acdscamp.org/. Accessed April16, 2020.