Urticaria due to occupational exposure to glyceryl monothioglycolate permanent wave solution.

A 30-year-old woman was referred to us on October 2, 1996, for evaluation of chronic idiopathic urticaria. She had worked as a hairdresser for 9 years with no skin or health problems other than insulindependent diabetes. The hives appeared 3 years ago, a few days after a permanent wave solution container accidentally ruptured spraying her face, chest, and arms with an 80% aqueous solution of glyceryl monothioglycolate (GMTG). Emergency care for chemical burns, severe conjunctivitis, and corneal abrasions resulted in healing, but 4 days later generalized hives appeared. These persisted daily, except when she was away from work. Economic pressures forced her to continue to work while control of the hives was achieved with daily antihistaminics and courses of systemic corticosteroid therapy. The relentless severity of the hives and associated arthralgias ¢nally led the patient to stop work after 2 years. During that period she made approximately 100 o¤ce visits and phone calls to physicians, and was hospitalized once. She has also noted that certain inhalants outside the beauty shop trigger attacks of hives, including perfumes, household cleaning materials, and xerox paper fumes. Long-term steroid therapy has been necessary. The following diagnostic studies were normal: general physical examination, blood chemistries (except for episodes of elevated glucose 300 ^ 600 mg%), urinalysis, chest X-ray, sed rate, immunoelectrophoresis, immune complexes, rheumatoid factor, IgG, IgA, IgM, IgE levels, ASO, ANA, complement screen, hepatitis screen, serum histamine and serotonin, and antibodies for EBV, herpes 1, 2, CMV, and Coccidioides immitis. Scratch tests to 22 danders, pollens, and dusts were negative, as were patch tests to 13 chemicals used in her work and 24 standardized contact allergens, and intradermal tests to trichophytin and candidal antigens. Two skin biopsies revealed changes consistent with urticaria. No leukocytoclastic vasculitis was present. A de¢nitive demonstration of the speci¢c cause of her chronic urticaria was achieved by scratch tests to GMTG. She had positive urticarial responses (w10 mm) to saline dilutions of GMTG 1:12,500. Saline controls were negative. Control scratch testing of 10 normal individuals showed no response to GMTG at these concentrations. Patch tests to 1% GMTG in petrolatum were repeatedly negative in the patient. DISCUSSION