A day in the life of a patch tester – Formaldehyde allergy – Surprise

Formaldehyde allergy:  I saw a patient with ‘recalcitrant eczema’ who we diagnosed with a formaldehyde allergy by patch testing.  They were doing very well, minor flares here and there…and, then one day they came to see me with a horrific reaction on their face, chest and arms – new involved areas.

We reviewed the exposure sources – person hygiene products, aspartame, dishwashing soap, cleaning agents, building supplies – remodeling – the full investigative history gave no clues – until I asked the pivotal question, where were you 3-5 days before – did anything different happen?

“My car broke down”.

Me: ‘Did you work on it? Did you go to the automotive shop?’

All answers were no.

Me: ‘The how did you get to work?’

“I rode the bus.”

Then, there was that moment of pause –

Surprise!

“While I was waiting for the bus at the bus stop, a car backfired right there and exhaust smoke got all over us”.

In Florida, at that time, catalytic converters were not required on every vehicle…

The source of this totally compliant patient’s reaction – formaldehyde in the exhaust fumes!

 

Is this commonly reported?  No. could it have been potentially missed?  Yes.

Conclusion – always consider the timing of the “flare up” responses…

 

More on formaldehyde:  ”   It reaches the air via automobile exhaust fumes from vehicles without catalytic converters, or from any other plant which burns fossil fuels, including energy plants. Forest fires and waste incinerators also give off formaldehyde.

Symptoms of Formaldehyde Allergy” – read more here:

http://www.news-medical.net/health/Formaldehyde-Allergy.aspx