T cell involvement in persulfate triggered occupational contact dermatitis and asthma.

Background: Ammonium and potassium persulfates may induce a variety of cutaneous and respiratory diseases. The precise underlying mechanisms, however, are unclear.

Objective: To describe a hairdresser, who developed contact dermatitis, rhinoconjuntivitis, and bronchial asthma of delayed onset after occupational exposure to hair bleaches containing persulfate salts and to provide evidence for a common T-cell mediated mechanism responsible for the clinical manifestations.

Methods: We performed skin testing, routine histologic and immunohistochemical examination of the skin reaction after prick testing, lymphocyte proliferation analysis, nasal challenge test, and pulmonary function testing.

Results: The causative role of bleaching powder and ammonium persulfate was demonstrated by case history, skin tests, and a nasal challenge test. Patch tests produced a delayed cutaneous reaction to ammonium persulfate confirming contact sensitization. Prick tests with bleaching powder and ammonium persulfate were negative at 15 minutes but revealed a late skin reaction with a papule at the prick sites after 24 hours. Histologic examination of this late reaction demonstrated a perivascular infiltration comprising predominantly T lymphocytes. Further, a significant proliferation of T cells to bleaching powder was reproducibly found by a lymphocyte proliferation analysis. Nasal challenge test with bleaching powder showed a significant reduction of air flow after 24 hours.

Conclusion: Our findings suggest that immunologic mechanism with direct involvement of T cells may not only play an important role in the pathogenesis of the cutaneous but also in the respiratory and rhinoconjunctival reactions.