Cobalt-induced anaphylaxis, contact urticaria, and delayed allergy in a ceramics decorator Contact Dermatitis 2009: 60: 173–174 Beata Krecisz 1 , Marta Kiec-Swierczynska 1 , Patrycja Krawczyk 2 , Dorota Chomiczewska 1 and Cezary Palczynski 2 1 Outpatient Department of Occupational Diseases, and 2 Department of Occupational Diseases and Toxicology, Nofer Institute of Occupational Medicine, Lodz, Poland Key words: allergic contact dermatitis; anaphylaxis; cobalt; contact urticaria. Metals are the most common causal agents of allergic contact dermatitis. Immediate allergic reaction to metals or the co-existence of immediate and delayed reactions are very rare (1). Case Report A 39-year-old non-atopic woman, employed as a ceramics decorator from 2000, developed eczematous skin lesions on the back of her hands and forearms 3 months after starting the work. The condition was recurrent but disappeared during prolonged periods off work. After 5 years of working, she devel- oped generalized urticaria; angioedema of the face, lips, and tongue and general fatigue after using the blue paint containing cobalt chloride (Glass and Ceramics Institute, Warsaw, Poland). She was moved to a different job at the same factory, and all the symptoms receded. In 2007, (i) she was patch tested with the European baseline series of contact allergens (Chemotech- nique Diagnostics, Malmo¨, Sweden) according to International Contact Dermatitis Research Group criteria; (ii) she was prick tested with common aeroallergens (commercial kit; Allergo- pharma, Reinbek, Germany); (iii) she was prick tested with cobalt chloride (1 and 0.1 mg CoCl 2 /ml), potassium dichromate (1 and 0.1 mg K 2 CrO 4 /ml) and nickel sulfate (10 and 1 mg NiSO 4 /ml) dissolved in water and performed as described by Kanerva et al. (2), the same tests with metals were also performed in 10 healthy volunteers; (iv) serum samples from the patient were analysed for metal- specific immnoglobulin E (IgE) using the HY-TEC specific and total IgE enzyme immunoassay (Hycor Bio- medical Inc., Irvine, CA, USA); and (v) a challenge test with the patient painting pottery using the blue paint containing cobalt chloride from the workplace was carried out. Patch tests showed reactions to cobalt chloride and nickel sulfate (both þþþ at 2 and 4 days). Prick tests were negative with common aero- allergens, potassium dichromate and nickel sulfate, whereas positive with cobalt chloride (both 1 and 0.1 mg/ml dilutions). All prick tests with metals were negative in the healthy volun- teers. The level of cobalt-specific IgE was 2.97 IU/ml (class 2), while chro- mium- or nickel-specific IgE was not found in patient’s serum. The challenge test was also positive. After 30 min of painting, the patient developed the first symptoms of urti- caria: the wheals appeared on her hands and forearms, followed by oedema of her face, lips, and tongue and hands 20 min later (Figs. 1 and 2). Despite stopping exposure, an anaphylactic reaction developed over the next 30 min: blood pressure fall (from 120/ 80 mmHg to 80/60 mm Hg); tachycar- dia 110/min (75/min before challenge) and pale skin with sweating, abdominal cramps, nausea, vomiting, diarrhoea and dizziness. After administration of intravenous corticosteroids, the symp- toms receded. Discussion Cases of contact urticaria caused by cobalt (3) or cobalt-induced asthmatic CONTACT POINTS 173