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Abstract

Background: Persulfate salts are potent oxidizing agents in hair bleach products that accelerate the bleaching process. Ammonium and potassium persulfates may cause delayedtype and immediate skin reactions. Also allergic asthma and rhinitis have been described. Objectives: Ammonium and potassium persulfates may cause delayed-type and immediate skin reactions. Also allergic asthma and rhinitis have been described. Methods: Case 1A 36-year-old female hairdresser suffered from contact urticaria after exposure to bleaching agents for ten years. She also experienced asthma and rhinitis when she worked in the hair salon for the same period. Several minutes after accidental contact with bleaching powder she developed an urticarial reaction on the neck, facial angioedema, and dyspnoea. We performed prick-to-prick tests with serial dilutions of freshly prepared persulfates starting with 0.1%. Prick-to-prick tests with ammonium persulfate 1.0% aqua and potassium persulfate 1.0% aqua showed wheals of 8 mm (positive control 6 mm). Ten minutes after the prick-to-prick tests, she suffered from asthmatic complaints which cleared after inhalation of b2-sympathicomimetics. Patch testing with ammonium persulfate 2.5% petrolatum and potassium persulfate 2.5% aqua resulted in wheals at the test site after 20 minutes. Prick tests with ammonium and potassium persulfate 1.0% aqua were negative in four controls.Case 2A 48-year-old woman showed pruritus of the scalp and facial angioedema which started several minutes after application of a hair bleaching product. Forty-five minutes after application she fainted with increased heart rate and low blood pressure. She was treated with clemastine, dexamathasone, and saline and transferred to a hospital. Prick tests with ammonium persulfate 2.0% aqua and potassium persulfate 2.0% aqua showed wheals of 4 mm (positive control 7 mm). Intradermal testing with ammonium persulfate 0.1% aqua and potassium persulfate 0.1% aqua showed wheals of almost 20 mm. Several hours after the intradermal tests, she became increasingly dizzy which cleared after treatment with fexofenadine. Patch tests with ammonium persulfate 2.5% petrolatum and potassium persulfate 2.5% aqua were negative after 20 minutes. Intradermal tests with ammonium and potassium persulfate 0.1% aqua were negative in three controls. Results: We presented two cases of immediate type hypersensitivity to persulfates with an anaphylactic reaction in one patient. These reactions have never been adequately documented. Conclusion: It seems that the reactions are immunologic and based on release of IgE. In patients suspected of allergic reactions to persulfates, prick and patch tests should be performed. Because severe respiratory symptoms and anaphylaxis may occur, we recommend to start with prick-toprick testing.