CD14 To gym or not to gym, that is the question?

Abstract

We report the case of a 30-year-old woman with a 5-year history of recurrent, unexplained allergic reactions presenting mainly as periorbital and eyelid swelling with intermittent facial swelling. There was no identifiable trigger in the community and no background of atopy. She required multiple attendances to the emergency department and was repeatedly treated with courses of systemic corticosteroids and antibiotics, with prompt relapse of her symptoms on cessation of steroid therapy. General practitioner records noted allergy to false eyelashes, and despite avoiding these triggers she continued to get mild-to-moderate symptoms. After a recent episode of severe facial swelling following rope climbing, where she used liquid chalk for grip, she was advised a dermatology referral for allergy testing. Patch testing was performed using the standard and cosmetic series and patient’s own products. The results were as follows: day 2, colophony 2+ and abitol 2+; day 4, colophony 3+ and abitol 3+. Colophony (rosin) is a pine derivative resin and abitol is a derivative of colophony. These are commonly used in adhesives and friction-enhancing products such as liquid chalk for gripping. This would explain the severe reaction when the patient used liquid chalk for rope climbing. On further enquiry, she frequently visited the gym and revealed that liquid chalk was used on various equipment by other users. This explains her ongoing mild-to-moderate symptoms over the years because of transfer of allergens from traces of liquid chalk on her hands to her face. In conclusion, this case highlights the importance of recognizing delayed reactions to minute quantities of allergens present in the environment. This can help prevent the delay in diagnosis and inappropriate referrals to respiratory or food allergy clinics. There is a need for increased awareness and education among both healthcare professional and patients.