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Modre B, Kränke B
| Authors |
Anaphylactic reaction to formaldehyde | Title |
Allergy 2001, 56/3, 263-264
| Source |
| Formaldehyde, Allergy, Anaphylaxis
| Index terms |
| It is known that (para-)formaldehyde and paraformaldehyde, which are commonly used as denture base material, can cause severe anaphylactic reactions in patients with dental treatment (13). A total of 14 cases has been reported, but the presented diagnostic criteria are contradictory (16). Specific IgE antibodies against formaldehyde or formaldehyde-human serum albumin (F-HSA) conjugates were detected in eight patients. Four of the patients had a positive patch test, whereas in only two patients was a positive scratch test reported. Prick tests in all of the patients were negative (Table 1) (7). We describe a patient with anaphylactic symptoms after the second application of the root canal paste Toxavit, which contains paraformaldehyde.
A 31-year-old man with no personal or family history of allergies was referred to our outpatient clinic with a massive swelling of his face after a second endodontic treatment. He had had his first contact with Toxavit about 6 weeks before. This formaldehyde-containing tooth-filling material, which is used for devitalization of the tooth pulp, had to remain in the tooth for 6 weeks. Approximately 5 h after the second treatment with Toxavit, our patient developed an anaphylactic reaction (urticaria) with associated cardiovascular symptoms, but without unconsciousness. He received immediate medical help an recovered within 1 day. Our patient was nonsmoker and did not take any medications at all, not even local anesthetics.
Allergy testing showed a highly positive RAST (Pharmacia and Upjohn, Sweden) to formaldehyde (CAP-FEIA class 3, total:3.6 kU/l), whereas total IgE was within the normal range (29.7 kU/l). Prick testing with formaldehyde in aqueous solution up to 1% revealed no reaction after 30 min or after 24 h, but an erythematous papule appeared on day 2. Patch testing with Finn Chambers on Scanpore also revealed an erythematous reaction to aqueous formaldehyde (1.0%) but was otherwise uneventful. Although the exact mechanism of sensitization to formaldehyde in our patient is unknown, our results seem to support the notion of contact sensitization leading to a type-I as well as a delayed-type hypersensitivity.
References
1. Ebner H & Kraft D. Formaldehyde-induced anaphylaxis after dental treatment? Contact Dermatitis 1991;24:307308.
2. Geusau A, Pirkhammer D & Aberer W. Anaphylaxie durch paraformaldehydhaltige Dentalmaterialien. Allergologie1994;17:439441.
3. Wantke F, Hemmer W, Haglmüller T, Götz M & Jarisch R. Anaphylaxis after dental treatment with a formaldehyde-containing tooth-filling material. Allergy 1995;50:274276.
4. Burri C & Wüthrich B. Quincke-Ödem mit Urtikaria nach Zahnwurzelbehandlung mit einem Paraformaldehyd-haltigen Dentalantiseptikum bei Spättyp-Sensibilisierung auf Paraformaldehyd. Allergologie1985;8:264266.
5. Fehr B, Huwyler T & Wüthrich B. Formaldehyd und Paraformaldehyd-Allergie. Allergische Reaktionen auf Formaldehyd und Paraformaldehyd nach Zahnwurzelbehandlungen. Schweiz Monatsschr Zahnmed 1992;102:9497.
6. El-Sayed F, Seite-Bellezza D, Sans B, Bayle-Lebey P, Marguery MC & Bazex J. Contact urticaria from formaldehyde in a root-canal dental paste. Contact Dermatitis 1995;33:353.
7. Kränke B & Aberer W. Severe anaphylactoid reactions to formaldehyde and paraformaldehyde indentistry. Allergologie 1997;5:246251.
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