Occupational Immediate-Type Allergic Asthma due to Potassium Tetrachloroplatinate in Production of Cytotoxic Drugs

摘要

Allergic immediate-type reactions by halogenated compounds of platinum (Pt) (platinum salts) have been described in workers in precious metal refineries and catalyst productions. In both industries there are exposures to many different Pt compounds. It is believed that the most important allergens are those compounds with the highest number of halide ligands. It is unknown whether sensitizations to compounds with a lower number of halide ligands represent co-sensitizations or are due to cross-reactivity. We report a worker engaged in the production of cytotoxic drugs with occupational asthma and exposure to only one Pt salt with four halide ligands. The 22-year-old worker developed work-related sneezing, runny nose, and variable dyspnea about a year after he had started to work in the cytotoxic drugs production with exposure to potassium tetrachloroplatinate(II) (K2PtCl4). He was immediately removed from his workplace and admitted for a medical opinion about 6 months afterwards. Spirometry was normal, but asthma was corroborated by a positive response to methacholine. The results of skin prick testing could not be interpreted due to urticaria factitia. Challenge with K2PtCl4 by a dosimeter method yielded a clear immediate-type reaction with an increase of exhaled nitric oxide from 32 to 156 ppb after 24 h indicating an increased airway inflammation. Pt salts with four halide ligands like K2PtCl4 may cause an allergic immediate-type reaction and occupational asthma. Workers in the production of Pt-containing cytotoxic drugs with exposure to these substances should be included in medical surveillance programs for the prevention of occupational asthma caused by Pt salts.