Immediate Type Dermatitis, Contact Urticaria, and Rhinitis from Carbonless Copy Paper: Report of Four Cases

Abstract

Carbonless copy paper (CCP) has been reported to be able to cause type I immediate reactions, especially in the airways. Within a 2-year period, four female patients were seen with chronic dermatitis on their palms, resembling dermatitis known as infectious or chronic dermatitis of unknown origin. One of them also had rhinitis. All four were office-workers and handled CCP for several hours per day. In contact urticaria tests with the upper CCP sheet and the back side towards the patients’ skin, tiny wheals and erythema appeared in all four cases. RASTs were performed with the sera of three patients, using four different CCP brands. The RAST value was slightly greater (1.5 kU/l) in one patient’s serum than in any of three control sera (maximum 0.6 kU/l). All four patients were able to continue their work by reducing contact with the paper. The present findings suggest that immediate-type skin reactions appearing as contact urticaria and chronic hand dermatitis may be more common than has been assumed.