Small molecular weight chemicals may cause contact urticaria. Chemicals,
acting as haptens, for example ethylene oxide,
isocyanates, chloramine-T, epoxy resins and nickel sulphate have caused
IgE-mediated allergies. This can be confirmed by
using skin prick testing.
Mrvos R, Dean BS, Krenzelok EP
Home exposures to chlorine/chloramine gas: review of 216 cases.
South Med J 1993 Jun;86(6):654-7
Chlorine and chloramine gas are frequently produced in the home when
cleaning products are mixed. These gases are strong irritants with the
potential for tissue damage. Numerous literature citations report
exposures to chlorine/amine gas, but there are few reports regarding home
exposures. The purpose of this study was to determine symptoms, treatment,
and outcome in individuals exposed to these gases in the home. All
to chlorine/amine gas produced as a result of mixing cleaning products in
the home and reported to a Regional Poison Information Center (RPIC) over
12-month period were reviewed. All calls were documented and follow-up was
done at appropriate intervals. All patients with respiratory embarrassment
either at the initial contact or on follow-up were referred to a medical
facility. Of the 216 patients (ages 12 to 81 years), 200 had resolution of
symptoms within 6 hours, whereas only 16 had symptoms for more than 6
after exposure; 145 patients were treated at home and 71 received further
medical care. Ten symptoms were identified, with the majority of patients
experiencing more than one. Emergency room treatment included oxygen (62
patients), bronchodilators (9 patients), and steroid therapy (3 patients).
Of the 70 patients who had chest x-ray films, only one had a positive
finding; 41 had arterial blood gas measurements done, and all were within
normal limits. Only one patient in the study group required admission for
continued respiratory distress, but he had a preexisting chronic
problem as well as an upper respiratory tract infection at the time of
exposure. Although the gas produced by mixing cleaning products in the
can cause severe respiratory irritation, most of the patients exposed to
chlorine and chloramine gas can safely be treated at home with comfort
measures. Appropriate follow-up must be done to determine resolution of
Oxidants are generated by various chemical processes (e.g. certain drugs,
metals), enzymatic reactions, or they can directly
be inhaled (e.g. smoking, ozone, hyperoxia) (for review see (6, 8)).
Myeloperoxidase, present in polymorphonuclear cells (PMN) and released
during respiratory burst, converts H2O2 into
HOCl, another highly toxic oxidant which can further react to form more
long-lived chloramines (9).
(9: Weiss SJ, Lambert MB, Test ST Long-lived oxidants generated by human
neutrophils: characterization and bioactivity. Science 1983; 222:
The capacity of ambroxol to scavenge HOCl and ŠOH can explain the
above mentioned inhibitory effect of this drug on chloramine-T- and
cigarette smoke-induced decrease of serum elastase
inhibitory capacity (127,128). Both these factors inactivate
alpha-1-antitrypsin via generation of HOCl and ŠOH.
(127 Rozniecki J, Nowak D Effect of ambroxol on the chloramine-T-induced
decrease of serum elastase inhibitory capacity in vitro. Lung &
Respiration 1987; 4: 14-15.
128 Rozniecki J, Nowak D Protective effect of ambroxol on serum elastase
inhibitory capacity against chloramine-T and cigarette smoke extract.
Bull Europ Physiopath Resp 1987; 12: 366s)