Can persulfates cause hypersensitivity pneumonitis? A report of specific inhalation challenge test in 42 hairdressers

Abstract

Background: An increasing number of low-molecular weight substances are identified that may cause hypersensitivity pneumonitis (HP). Hairdressers exposed to persulfates may present with work-related flu-like symptoms and shortness of breath rather than the typical asthmatic wheezy chest, and we speculate that persulfates might cause HP.

Aims: To study to what extent hairdressers investigated with specific inhalation challenge test (SIC) fulfill published criteria for HP.

Methods: Forty-two female hairdressers (median age 31 years) underwent SIC in an inhalation chamber, exposed on consecutive days to 150 g lactose powder (placebo) and increasing dose/time of potassium persulfate, administered by dust tipping from one tray to another. A positive response of asthma was defined as two subsequent measures of FEV1 ≤15% of baseline. HP was defined according to criteria by Morell F, 2008, based on measurements of DLCO, FVC, temperature, white blood cell count, oxygen tension on physical exercise and symptoms of general malaise.

Results: Thirty-two persons filled the criteria for asthma and/or HP on provocation with persulfates. Nine had asthma only, 7 had HP only and 16 filled the criteria for both. Among these patients, 90% presented with shortness of breath, 86% with rhinitis, and 43% with wheeze. In patients who fulfilled HP criteria, fall in FVC and DLCO, and increased neutrophils were the most common characteristics.

Conclusion: A large number of hairdressers filled criteria for HP diagnosed with SIC, and persulfate related airways disease in hairdressers need further study.