IgE-mediated reactions
Allergic asthma caused by chloramines-T is well-known and the reactions are IgE-mediated (1). There have also been case reports of immediate-type sensitisation to this agent associated with symptoms of rhinitis and urticaria. As the substance is a commercial rather than a domestic cleaning and bleaching agent, this sensitisation is occupational.
Occupational allergic contact urticaria and contact dermatitis have been reported (1-3).
Occupational asthma is the most frequently reported hazard. Bronchial asthma in workers who had handled Chloramine-T powder have been described (4-6). A patient exposed to chloramine-T experienced severe asthmatic symptoms when spraying chloramine-T solutions. The patient used chloramine-T as a sterilising agent in medical facilities (7). In statistics of the Finnish Register of Occupational Diseases (FROD; 1975-1998) and the patient material of the Finnish Institute of Occupational Health (FIOH; 1990-1998), 3 cases of asthma and one of rhinitis caused by chloramine-T were recorded in dental personnel (8). Occupational asthma and rhinitis have been described (9-10). Seven brewery workers developed asthmatic symptoms after using chloramine powder as a sterilising agent (11-12). Specific IgE antibodies were demonstrated in a patient who developed asthmatic symptoms after exposure to chloramine-T (13).
Late or immediate and late asthma, occasionally accompanied by fever and leukocytosis, can occur. A report indicates that a patient, after 4 years of exposure to chloramine-T, developed rhinitis and asthma. A male dairy worker developed rhinitis and asthma after 4 years of exposure to the chloramine-T. Skin tests with chloramine T were positive. RAST detected specific IgE, and bronchial provocation induced immediate and late bronchoconstriction (14).
Respiratory symptoms developed in 5 patients who were exposed to chloramine-T. Skin tests, performed in 4 patients, showed an immediate type of wheal and flare reaction followed by a late-type infiltrative reaction. In 3 patients, inhalation tests with chloramine-T were done. One patient showed asthmatic bronchial obstruction immediately after inhalation, followed by a late-type asthmatic reaction after some hours. Two patients exhibited only late-type reactions, 4 to 8 hour after the challenge. The late bronchial response lasted for several hours or even days and was accompanied by leukocytosis in all 3 patients and a slight fever in 1 patient (15).
Other reactions
Chlorine reacts with bodily proteins to form chloramines, mostly associated with swimming pools; the most volatile and prevalent in the air above swimming pools is nitrogen trichloride, which may result in occupational asthma in lifeguards and swimmers (16). This compound needs to be differentiated from Chloramine-T, an organic derivative of chlorine.
