Sodium Disulfite/Bisulfite Allergy Manifesting from Dish Soap: Not Limited to Hairdressing or Food Industries Sara A. Kullberg, BA1,2; Sara A. Hylwa, MD1,3 1. Park Nicollet Contact Dermatitis Clinic; 2. University of Minnesota Medical School; and 3. University of Minnesota Department of Dermatology, Minneapolis, MN Background Patch Testing Discussion • Sulfites (sodium sulfite, sodium bisulfite, Final patch test reading (standard screening series, - Sodium metabisulfite has been recognized for its ability sodium metabisulfite, and potassium several supplemental series, few home products): to cause skin sensitization; other sulfite compounds are metabisulfite) are found extensively among • very strong (+++) reaction to sodium less well understood cosmetic, photography, pharmaceutical, and disulfite/bisulfite (1% in pet) (Fig. 2) - Preliminary studies demonstrate sulfite cross- food industries Reviewing home products, sulfites declared in: reactivity1 • This case demonstrates a novel source of • PalmOlive SoftTouch Almond Milk and Blueberry - Prevalence of sulfite allergy has increased over the sodium disulfite/bisulfite allergy in PalmOlive dish soap (sodium bisulfite) past 20 years2 liquid dish soap • Clairol Professional LiquiColor Gray Busters hair dye (sodium sulfite) New sources of sulfite allergy over the past 5 years3-5 : Case Presentation • rectal enemas Given exclusive • catheter systems • 62-year-old woman with 5- distribution of dermatitis • intravitreal injections year history of bilateral to the hands and hand dermatitis, inconsistency with Conclusion specifically on her palms wearing gloves washing and fingers with dishes (dying her hair she • Sodium bisulfite, a lesser known relative allergen of involvement of the nails exclusively wore gloves), sodium metabisulfite, can be sensitizing and found in her dish soap appeared seemingly inconspicuous sources such as liquid dish • Previous treatments: to be significantly soap • topical steroid ointments contributing to her Figure 2 • coal tar dermatitis References • flurandrenolide tape • Bactine cleansing spray 1. Oliphant T, Mitra A, Wilkinson M. Contact allergy to sodium sulfite and its • Neosporin Treatment and Follow Up relationship to sodium metabisulfite. Contact Dermatitis. 2012;66(3):128-30. • moisturizing creams Figure 1 2. Ralph N, Verma S, Merry S, et al. What Is the Relevance of Contact Allergy - Advised to switch to sulfite-free dish soap to Sodium Metabisulfite and Which Concentration of the Allergen Should • Worked as a caregiver We Use? Dermatitis. 2015;26(4):162-5. - Prescribed twice daily use of triamcinolone 0.1% 3. Borges AS, Val e j o Coelho MM, Fernandes C, et al. Systemic allergic • Affinity for PalmOlive Ultra ointment dermatitis caused by sodium metabisulfite in rectal enemas. Contact SoftTouch Almond Milk Dermatitis. 2018;78(6):429-430. and Blueberry Scent liquid - Follow up (1 week later): symptom improvement 4. Grosch E, Mahler V. Allergic contact dermatitis caused by a catheter system dish soap (Fig. 1) for washing - Repeat Open Application Testing of own Palm Olive containing sodium metabisulfite. Contact Dermatitis. 2017;76(3):186-187. dishes (with inconsistent dish soap: recurrence of hand dermatitis 5. Veramme J, de Zaeytijd J, Lambert J, et al. Contact dermatitis in patients undergoing serial intravitreal injections. Contact Dermatitis. 2016;74(1):18-21. glove use)