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Letter to the Editor

Could aluminum be a new hidden allergen in type 1 hypersensitivity reactions when used as a drug additive? Medications usually contain numerous additives and preservatives. Some of these agents have been reported as causative factors in adverse drug reactions, including asthma attacks, urticaria and/or angioedema, and even severe systemic anaphylaxis. Moreover, allergens such as additives and preservatives may be hidden as they are not easily identified during etiological investigations. Aluminum is one of the most widely used adjuvants in medications and vaccines. It is also used as a coloring agent in the pharmaceutical and cosmetic industries. In the case presented here, we report on a patient who experienced anaphylaxis in response to a tetanus vaccination and urticaria attacks after administration of a colchicum preparation, which suggested that aluminum (used as an adjuvant in both drugs) could be a hidden allergen responsible for both reactions. A 26-year-old female patient had been followed up at two allergy clinics because of the multidrug allergy syndrome and food allergies. The patient described allergic reactions (urticaria and angioedema) after use of a large number of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, most of which had been proven by provocation tests and specific IgE measurements. She was also allergic to inhalant allergens (grass pollens and latex), and many foods (including nuts, peanuts, soy beans, wheat flour, banana, kiwi, tomatoes, potatoes, and peaches, some of which are known to be cross-sensitive with latex). Furthermore, she was reactive to numerous antihista-mine preparations and methylprednisolone, as had been proven by provocation tests. In addition, at the age of 6, she was diagnosed with Familial Mediterranean fever (FMF) due to recurrent abdominal pain and fever, which was confirmed by the presence of a genetic mutation. She is currently on a daily colchicum regimen. Colchicum preparation had been tolerated well by the patient for several years, but in recent years she has reported urticaria attacks. This reaction started after a change in the pharmaceutical form of her medication. The patient was seen after an anaphylactic attack after a tetanus vaccine. She was admitted to the emergency department (ED) because of a contaminated sharp injury and a standard dose of tetanus vaccine was administered (Tetavax 0.5 ml, Sanofi Pasteur, by the intramuscular (IM) route). Approximately 10 min after the injection she developed widespread urticaria, shortness of breath, hoarse-ness, palpitations, and hypotension (according to the ED medical records). She was treated successfully with …