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EC number: 204-847-9
CAS number: 127-52-6
48-year old hospital bath attendant developed itchy hand dermatitis.
Half a year later, her dermatitis was accompanied by whealing on the
wrists and forearms from spilling of a liquid disinfectant, Klorilli®
(containing 8.5% sodium –p-Toluenesulfonchloramine, CAS 127-65-1, i.e.
Chloramine T). Spillings had caused no skin reactions during the
previous 6 months of exposure. She also developed stuffiness of her nose
and sneezing when working with Klorilli®. She daily diluted concentrated
Klorilli® to a 2% solution before use. She used disposable vinyl gloves
and the reaction to Klorilli® appeared only on the unprotected skin of
the wrists and forearms. Both concentrated and diluted Klorilli® caused
symptoms. The diluted Klorilli® was used to disinfect surfaces in the
hospital bathrooms. Accordingly, the diluted 2% solution of Klorilli®
contained 0.17% of chloramine T.
testing with standard environmental allergens and flours was negative.
Prick tests with Chloramine T conjugated with human serum albumin (HSA)
or in aq. gave positive reactions. A radioallergosorbent test (RAST) to
Chloramine T showed specific IgE antibodies. A provocation test with
2% Klorilli® was negative on intact skin but provoked a reaction on a
skin site that 1 h earlier had been used for prick testing. A
provocation test with undiluted Klorilli® containing 8.5% Chloramine T
provoked a strong whealing reaction on intact skin. On patch testing,
the patient had a +++ reaction to nickel sulphate in the standard
series. The antimicrobial series was negative, and Chloramine T was
negative in a dilution series. It was concluded that the patient had
developed occupational allergic contact urticaria from Chloramine T.
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