Q:

11/7/2011

I have a compounding pharmacy in my town that is willing to make a copper paste for loading a Finn chamber. Dx is copper sensitivity via IUD. My questions are:

 

1. What concentration of copper sulfate paste to use?
2. How reliable are these results?

 

Thank-you.

A:

Thank you for your recent inquiry.

I am not sure why you would like to use a Finn chamber for this since there are numerous reported cases of patients tested by standard patch testing. For your perusal, I have copied abstracts below from some of these studies. These abstracts do give you the concentrations employed, and I assume you could use the same concentrations in a Finn chamber, but you can also simply order a standard patch test online via Dormer Laboratories. I have copied the link for this lab below as well.

The interpretation of these tests remains controversial since copper allergy is extremely rare, and there has been discussion as to whether or not true copper allergy to intrauterine devices exist. This discussion is contained in the articles, the abstracts of which are copied for you below. You should have easy access to at least some of these.

In summary, the existence of allergy to intrauterine devices is controversial. Investigators have looked at this through standard patch tests which are available for purchase. The percent used in these studies is contained in the abstracts. You would have the option of using a standard patch test or applying the same percent via a Finn chamber. However, I was not able to find any published studies using the Finn chamber in this regard.

Thank you again for your inquiry and we hope this response is helpful to you.

Ann Allergy. 1978 Sep;41(3):194.
Intrauterine copper contraceptive devices and allergy to copper and nickel.
Dry J, Leynadier F, Bennani A, Piquet P, Salat J.
Abstract
PIP:
Allergic reactions to copper IUDs and contact dermatitis to copper sulfate are uncommon. We tested for allergy to copper by patch tests in 69 women who were using copper IUDs and 50 young women who did not use any IUD. In these 119 women we have also tested to nickel. Patch tests were performed with a 5% solution of copper sulfate and with a 10% glycerol solution of nickel sulfate. The tests were read immediately after removal of the patches after 48 hours of application. 1 (1.49%) positive test to copper and 4 (5.8%), positive tests to nickel resulted in the 69 women with copper IUDs. 4 (8%) of the 50 women without IUDs had a positive reaction to nickel. (Results are presented in a table.) The 1 positive test to copper was observed in a woman with known previous allergy to copper. She developed generalized dermatitis 8 days after placing the IUd (TCU-200). Replacement by Lippes loop (no copper involved) resulted in rapid and definitive improvement. In contrast, a positive patch test to nickel appeared in 8 of the 199 women (6.7%). This reflects the index of sensitivity to nickel in an unselected group of women and differs from that (13.1%) reported by Baer and Ramsey in a group of patients suffering from skin diseases. Although in themselves copper IUDs do not appear to produce allergic sensitization, one should inquire if there has been a previous allergy to copper before inserting a copper IUD to avoid a recurrence of the previous sensitivity

Acta Derm Venereol. 1980;60(1):69-71.
Cutaneous eruptions and intrauterine contraceptive copper device.
Frentz G, Teilum D.
Abstract
In the course of 6 months, 1888 intra-uterine contraceptive devices (IUCD) were inserted in a public clinic for contraception. In 10 of the women the IUCD subsequently had to be removed because of skin complaints. Four of these women as well as 3 out-patients of the Department of Dermatology. The Finsen Institute, who had been fitted with an IUCD were tested for metal allergy with closed patch tests and intracutaneous tests. None of the women was allergic to copper. One woman was allergic to nickel, which could be traced in minimal amounts in the copper wire of the IUCD, though causal connection between nickel in the IUCD and the skin symptoms is believed to be unlikely.
PIP:
Contact dermatitis to metals, though rare, does occur. This study estimated the practical significance of IUD material in skin disease by conducting tests for metal allergy over a 6-month period in copper IUD-using women with skin reaction complaints; i.e., can internal provocation result in cutaneous allergic reactions? In these 6 months, 1888 IUDs were inserted in a public clinic, all of which were copper-containing devices. Of these 1888 clients, 13 women complained of skin disease. Of these 13, 7 were investigated clinically for skin manifestations and were exposed to a standard patch tests for nickel, cobalt, potassium, and copper sulfate, which was performed as a closed patch test. None of the women showed positive delayed allergic reactions to copper sulfate at 2.5 and 5% in petrolatum. (1 woman showed positive allergic reactions to lanolin and rubber and a toxic reaction to copper sulfate at 5%.) In 6 of the 7 women, the copper IUD was removed because of skin symptoms, and the removal showed certain positive effects on the skin disease, varying from clearing in several days to gradual but incomplete regression. In 4 women, dermatological diagnoses not implicating the copper IUD were established. 1 woman with hand eczema developing after insertion of IUD was allergic to nickel sulfate, of which minimal amounts were present in the IUD's copper wire. However, causal connection between nickel in the copper IUD and skin symptoms is believed unlikely.

Ann Allergy. 1978 Sep;41(3):194.
Intrauterine copper contraceptive devices and allergy to copper and nickel.
Dry J, Leynadier F, Bennani A, Piquet P, Salat J.
Abstract
PIP:
Allergic reactions to copper IUDs and contact dermatitis to copper sulfate are uncommon. We tested for allergy to copper by patch tests in 69 women who were using copper IUDs and 50 young women who did not use any IUD. In these 119 women we have also tested to nickel. Patch tests were performed with a 5% solution of copper sulfate and with a 10% glycerol solution of nickel sulfate. The tests were read immediately after removal of the patches after 48 hours of application. 1 (1.49%) positive test to copper and 4 (5.8%), positive tests to nickel resulted in the 69 women with copper IUDs. 4 (8%) of the 50 women without IUDs had a positive reaction to nickel. (Results are presented in a table.) The 1 positive test to copper was observed in a woman with known previous allergy to copper. She developed generalized dermatitis 8 days after placing the IUd (TCU-200). Replacement by Lippes loop (no copper involved) resulted in rapid and definitive improvement. In contrast, a positive patch test to nickel appeared in 8 of the 199 women (6.7%). This reflects the index of sensitivity to nickel in an unselected group of women and differs from that (13.1%) reported by Baer and Ramsey in a group of patients suffering from skin diseases. Although in themselves copper IUDs do not appear to produce allergic sensitization, one should inquire if there has been a previous allergy to copper before inserting a copper IUD to avoid a recurrence of the previous sensitivity.

Dtsch Med Wochenschr. 1986 Jun 27;111(26):1016-21.
[Do copper intrauterine devices cause contact allergy?].
[Article in German]
Hausen BM, Hohlbaum W.
Abstract
Allergological examinations were conducted on 49 women (out of a gynaecological clientele of 982) with different degrees of complaints after wearing an intrauterine device (IUD). At the same time, they and a control group had an histological examination of endometrial biopsies. Nickel allergy was found in 38 of the 49. Nine of them (eight with a nickel sensitivity) reacted within 24 hours to an application of a 1% copper sulphate solution. A reaction was still present 72 hours later in six women. Only one woman still reacted to further dilution of the test solution, but 48-hour application of the copper spiral to her forearm was negative. It is only in this patient that a (though very weak) copper allergy can be accepted with certainty. There was no evidence of an endometrial allergy histologically. The results justify the view that copper allergy is extremely rare.
PIP:
Examinations were conducted on 49 women (out of a gynecological clientele of 982 women) with a varying degree of complaints after IUD use. At the same time, this group and a group of controls underwent histological examination of endometrial biopsies. A nickel allergy was discovered in 38 of 49 women. 9 of them (8 with a nickel sensitivity) reacted within 24 hours to an application of a 1% copper sulphate solution. This reaction was still present at 72 hours in 6 of the women. Only 1 women continued to react to further dilution of the test solution, but a 48-hour application of the copper spiral to her forearm was negative. It is only in this patient that a copper allergy, albeit very weak, is a certainty. There was no evidence of an endometrial allergy histologically. These results justify the view that a copper allergy is extremely rare. (author's modified).

http://www.dormer.ca/Chemosite/SeriesDetails.aspx?Series=MET-1000

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology