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Isolated late asthmatic reaction due to nickel sulphate without antibodies to nickel

A worker with occupational exposure to nickel developed asthma a few months after starting work. Skin prick tests to nickel sulphate were negative. Inhalation challenge with nickel sulphate, at a concentration of 10 mg/ml for 30 min induced a late asthmatic reaction, starting 3 hr after the end of exposure leading to severe nocturnal attack. Tests for antibodies with nickel reactivity were negative.