Allergic chromium

Prolonged contact with certain chromium compounds may produce allergic reactions and dermatitis in some individuals (114). The initial response is usually caused by exposure to Cr(VI) compounds, but once the allergy is estabUshed, it is extended to the trivalent compounds (111,115). There is also limited evidence of possible chromium associated occupational asthma, but there is insufficient data to estimate a dose for assumed chromium-induced asthma. Reference 116 provides a summary and discussion of chromium hypersensitivity. 

The property most frequently cited in connection with the use of Ti dental or medical appHances is titanium s unique biocompatibiHty. This helps practitioners avoid occasional allergic reactions that occur with nickel or chromium alloys, and removes concerns about the toxic or carcinogenic potential of appHances that contain nickel, chromium, or beryUium. Wrought alloys of titanium are used for orthodontic wires because of their unique elastic... 

Chromium (total) 0.1 0.1 Some people who use water containing chromium well in excess of the MCL over many years could experience allergic dermatitis Discharge from steel and pulp mills erosion of natural deposits... 

Unlike nickel, chromium metal does not produce allergic contact dermatitis. Some patients exhibit positive patch tests to divalent chromium compounds, but these compounds are considerably less potent as sensitizers than hexavalent chromium compounds. A case of chromium (chromic) sulfate-induced asthma in a plating worker, confirmed by specific challenge testing and the presence of IgE antibodies, has been reported. ... 

A 54-year-old woman with gestational diabetes was later found to be allergic to chromium, pollen, dust, penicillin, acarbose, and metformin (130). She was treated with diet and glibenclamide, but later required insulin. With Humulin N insulin she developed a wheal of 15 mm immediately after the injection, which resolved in a few hours. However, a painful itchy induration appeared 2-3 hours after the injection and lasted a few days. She had an immediate reaction to isophane insulin, with induration, but insulin lispro was well-tolerated. 

Since the early 1940s, it has been known that there is a genetic predisposition to allergic contact dermatitis, a skin condition that is one of the most common maladies caused by workplace exposure to xenobiotics and to cosmetics (see Section 9.3). A study published in 1993 revealed that some individuals have a genetic predisposition to produce human leukocyte (white blood cell) antigen, resulting in allergy to nickel, chromium, and cobalt.4... 

Dermal Effects. Acute systemic and dermal allergic reactions have been observed in chromium-sensitive individuals exposed to chromium via inhalation as described in Sections 2.2.3.2 and 2.2.3.3. 

Dermal Effects. Occupational exposure to airborne chromium compounds has been associated with effects on the nasal septum, such as ulceration and perforation. These studies are discussed in Section 2.2.1.2 on Respiratory Effects. Dermal exposure to chromium compounds can cause contact allergic dermatitis in sensitive individuals, which is discussed in Section 2.2.3.3. Skin burns, blisters, and skin ulcers, also known as chrome holes or chrome sores, are more likely associated with direct dermal contact with solutions of chromium compounds, but exposure of the skin to airborne fumes and mists of chromium compounds may contribute to these effects. 

In a study of 1,752 patients considered to have occupational dermatoses, contact dermatitis was the main diagnosis in 1,496 patients (92% women, 83% men). The allergic type, as opposed to the irritant type, was more prevalent in men (73%) than in women (51%). Positive patch tests to chromium (not otherwise specified) occurred in 8% of the women and 29% of the men. Among 280 chromium-sensitized men, 50% were employed in building and concrete work, 17% in metal work, and 12% in tanneries. In the 42 chromium-sensitized women, 20% were in cement work, 19% in metal work, 28% in cleaning, and 15% in laboratory work (Fregert 1975). 

A study was performed on 54 volunteers who were sensitive to chromium-induced allergic contact dermatitis to determine a dose-response relationship and to determine a minimum-elicitation threshold... 

Dermal Effects. Chromium compounds can produce effects on the skin and mucous membranes. These include irritation, burns, ulcers, an allergic type of dermatitis. Irritation of the nasal mucosa and other mucosal tissues of the respiratory system, and nasal septum ulcers, and perforation were considered under Respiratory Effects discussed above. Dermatitis is considered under Immunological Effects discussed below. 

A number of additional health effects have been observed in adults exposed to chromium (primarily chromium(VI)) at work. The primary targets appear to be the respiratory tract, gastrointestinal tract, hematological system, liver, and kidneys an increased cancer risk has also been observed. Dermal contact in chromium sensitized individuals can lead to an allergic type dermatitis. In the absence of data to the contrary, it is likely that these organs/systems will also be sensitive targets in children. There is insufficient information to determine whether the susceptibility of children would differ from that of adults. 

The effect of decreasing the concentration of water-soluble chromium in cement from about 10 to below 2 ppm on the incidences of chromium-induced dermatitis was examined among construction workers in Finland (Roto et al. 1996). After 1987, when the decrease occurred, allergic dermatitis caused by chromium in the industry was reduced by 33% from previous levels, whereas irritant contact dermatitis remained unchanged. 

Basketter DA, Briatico-Vangosa G, Kaestner W, et al. 1993. Nickel, cobalt and chromium in consumer products a role in allergic contact dermatitis Contact Dermatitis 28 15-25. 

Fregert S, Rorsman H. 1966. Allergic reactions to trivalent chromium compounds. Arch Dermatol 93 711-713. 

Nethercott J, Paustenbach D, Adams R, et al. 1994. A study of chromium induced allergic contact dermatitis with 54 volunteers Implications for environmental risk assessment. Occup Environ Med 51 371-380. 

Paustenbach DJ, Sheehan PJ, Pauli JM, et al. 1992. Review of the allergic contact dermititis hazard posed by chromium-contaminated soil Identifying a "safe" concentration. J Toxicol Environ Health 37 177-207. 

Samitz MH, Gross S, Katz S. 1962. Inactivation of chromium ion in allergic eczematous dermatitis. J Invest Dermatol 38 5-12. 

Stern AH, Bagdon RE, Hazen RE, et al. 1993. Risk assessment of the allergic dermatitis potential of environmental exposure to hexavalent chromium. J Toxicol Enivron Health 40 613-641. 

Attempts continue to predict metal sensitivity in the individual patient so that the choice of material can be made accordingly. In vitro tests for metal allergies have been developed on the basis of lymphokine (MIF) release from sensitized T lymphocytes exposed to metal-protein complexes (11). About 6% of patients without a previous metal implant had positive reactions to nickel, chromium, or cobalt. However, it is still not clear whether such a positive reaction is a reliable predictor of clinical problems. In practice few patients have either local or systemic reactions when symptoms occur and other causes are ruled out, the implant should be removed. Some workers recommend removal of an implant whenever there is both a positive MIF test and a positive skin test, even in the current absence of a serious reaction. Allergic dermatitis will clear up as soon as the metal has begun to be cleared from the tissue. The type of metal and the amount released into the tissue will affect the time taken for the disappearance of toxic dermatological phenomena. 

Allergic contact dermatitis has apparently been most commonly due to occupational exposure of building workers to a form of cement containing a water-soluble form of chromium (SEDA-20,208) (15). Such reactions to medical exposure have not been described but could in principle occur. 

Ingesting large amounts of chromium(VI) can cause stomach upsets and ulcers, convulsions, kidney and liver damage, and even death. Skin contact with certain chromium(VI) compounds can cause skin ulcers. Some people are extremely sensitive to chromi-um(VI) or chromium(ni). Allergic reactions consisting of severe redness and swelling of the skin have been noted. 

Chronic exposure to excess hexavalent chromium results in irritation of the skin and mucous membranes. Exposure to low doses of any form of chromium can induce allergic reactions causing skin rashes and swelling of the skin in sensitive individuals. Ulcerations (or chrome holes) can occur among workers who are exposed to high concentrations of chromic acid, sodium or potassium dichromate or chromate or ammonium dichromate. The ulcers... 

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