Asthma caused by platinum/palladium salts


Occupations
  • Chemist
  • Dentist
  • Electronic components industry
  • Electronics industry
  • Jeweller
  • Metallurgist
  • Nurse
  • Photographer
  • Refinery worker
 
Agents
 
Hexachloroplatinates, Palladium salts, Platinum salts, Tetrachloroplatinates
 
Incidence
 
Incidence: originally very high (>50% of exposed subjects) when first reported. With appropriate precautions in the work place this figure is now 10%. Most sufferers are atopic. The sensitization period takes from 15 days to several years. IgE-dependent mechanism, however platinum salts will cause release of histamine in vitro (cutaneous basophils and mast cells behave differently). The immunological assay of specific IgE molecules remains the most usual area of research: but conflicting results have been obtained. Skin tests with palladium have proved positive in dentistry; palladium being contained in dental alloys. Cross-reactivity between nickel and palladium frequently occurs.
 
Conditions

The first reported cases involved subjects who worked in photographic studios. Precious metals industry: platinum refining.

Metals of the platinum group, the so called “precious metals” include ruthenium, palladium, osmium and irridium

 
Symptoms
 
 
Asthma is sometimes preceded by eczema, urticaria and angioneurotic oedema. Rhinitis may be the only symptom for a long time or it may be immediately associated with asthma. It occurs at work and may continue during the night with or without a spasmodic cough. Respiratory parameters and bronchial hyperreactivity only partially regain their normal values after work has stopped.Changes in the workstation of the subject to a less exposed area does not result in an improvement in airway parameters.
 
Diagnostic methods
 
Skin prick test: using large dilutions of ammonium hexachloroplatinate from 10-9 to 10-3. Bronchial provocation test (in hospital) is very reliable but difficult to conduct successfully. The response is almost always an immediate reaction. Measurement of specific IgE : phadezym (Germany). Skin tests with Pd(NH3)4Cl2 are positive where there is an IgE-dependent mechanism. In the case of eczemas, patch tests are positive for the causative metal.

References

  1. J. Allergy Clin. Immunol. 2001, 107:707 - Merget R. at al.
  2. J. Allergy Clin. Immunol. 1999,103:1211 - Yoshida S. et al.
  3. Eur. Resp. J. 1999,13:213 - Deanen M. et al.
  4. Int. Arch. Occup. Environ. Health 1999,72:33 - Merget R. et al.
  5. Int. Arch. Allergy Appl. Immunol. 1995,107:406
  6. Am. J. Respir. Crit. Care Med. 1994,150:1146
  7. Fiche Allerg. Resp. Prof. INRS n°12
  8. Presse Méd. 1967,75,55:2817
  9. Eur. Respir. J. 1990,3:202
  10. Chest 1990,97:1401
  11. J. Allergy Clin. Immunol.1985,76:794
  12. J. Allergy Clin. Immunol.1980,66:179
  13. Clin. Allergy 1988,18:569
  14. Clin. Allergy 1979,9:109

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.