Thank you for your recent inquiry.
I must admit that I may not be able to give you any helpful information. This is an unusual case, and I have never personally encountered one like it.
As you know, reactions to dental appliances are usually delayed hypersensitivity reactions. Almost every ingredient you mentioned has been responsible for delayed contact reactions, especially the metals and the methacrylate (see abstract below).
There are, however, rare reports of acrylics and methacrylates producing reactions that at least resemble immediate hypersensitivity responses. This has occurred in occupational asthma settings as well as in dental settings (see two abstracts below).
Relative to the immediate hypersensitivity-like reactions, skin tests have been performed. The abstracts do not mention the exact concentrations used, but I am sure if you will obtain the original articles, the methods section will give you that information.
Ordinarily I would not have recommended immediate hypersensitivity skin testing to detect the culprit in a reaction to a dental application, but in your case, the symptoms certainly suggest an immediate hypersensitivity-like reaction, and skin testing may theoretically be helpful in determining the culprit.
You have done an excellent job in tracing down a source of the material for testing, and my suggestion is to obtain liquid and powder forms of the ingredients, and apply skin tests using the articles mentioned above as the “model” for testing. I believe certainly it is correct that these substances can be skin irritants, but based upon the precedent of skin tests being done previously, without reported nonspecific skin reactivity, I believe you could use the concentrations noted in the articles successfully without worrying about false-positive reactions. You could also of course use yourself and any office volunteer to check for concentrations not producing a false-positive reaction.
We would greatly appreciate a follow-up if you are able to find the culprit since such a follow-up would be very helpful to our readers.
Thank you again for your inquiry, and we hope this response is of help to you.
Clinical & Experimental Allergy
Volume 28, Issue 11, pages 1404–1411, November 1998
Allergic contact dermatitis caused by acrylate compounds is common in dental personnel; they also often complain of work-related respiratory or conjunctival symptoms.
The aim of the present study was to report the cases of acrylates induced respiratory hypersensitivity in dental personnel diagnosed in Finland during the last 6 years.
Occupational asthma, rhinitis, laryngitis and pharyngitis cases were diagnosed according to patient history, PEF monitoring, and a work-simulating provocation test.
Twelve cases of respiratory hypersensitivity caused by acrylates diagnosed in dental personnel (six dentists and six dental nurses) in 1992–97 are reported. During this period one case of conjunctivitis and one of laryngitis have been published separately. Nine cases of occupational asthma, two rhinitis cases, and one laryngitis case were verified according to the challenge tests with dental acrylate compounds (acrylates, methacrylates and epoxy acrylates). Only three patients had positive skin-prick test reactions to common environmental allergens, and none reacted to acrylates in the skin-prick tests. Five patients had an elevated total IgE (>110 kU/L). PEF follow-up showed an occupational effect in all examined eight patients with diagnosed asthma. The mean duration of exposure to acrylates was 22 years, and the duration of respiratory symptoms 8 years.
The results indicate that acrylates constitute an important hazard for dental workers. The mechanism of respiratory hypersensitivity is still unknown, and it is probably not IgE-mediated.
Volume 10, Issue 8, October 1989, Pages 545-548
Nickel, chromium, cobalt dental alloys and allergic reactions: an overview
Hartmut F. Hildebrand , a, Christian Verona and Pierre Martina
aInstitut de Médécine du Travail, Faculté de Médécine, 1Place de Verdun, F-59045 LILLE-Cedex, France
Received 16 June 1988;
accepted 25 July 1988.
Available online 2 May 2003.
Possible correlations between allergic reactions and the significance of a dental prosthesis or restoration made from one or more of the metals nickel, cobalt and chromium are considered. Described clinical cases are reviewed. These allergic reactions may appear either locally as stomatitis or distantly in the form of general or local contact dermatitis.
Thorax. 1985 Nov;40(11):836-9.
Occupational asthma due to methyl methacrylate and cyanoacrylates.
Lozewicz S, Davison AG, Hopkirk A, Burge PS, Boldy DA, Riordan JF, McGivern DV, Platts BW, Davies D, Newman Taylor AJ.
Five patients had asthma provoked by cyanoacrylates and one by methyl methacrylate, possibly because of the development of a specific hypersensitivity response. Acrylates have wide domestic as well as industrial uses, and inhalation of vapour emitted during their use can cause asthma.
Phil Lieberman, M.D.
Key Words: dentures, methylmethacrylate, ethylene glycol dimethacrylate