GOLD - AN ALLERGEN OF GROWING SIGNIFICANCE

Gold moved into the limelight of medical literature thanks to the anti -inflammatory activity and effectiveness; of gold compounds in the tre atment of rheumatoid arthritis, but more recently also because of the growing incidence of hypersensitivity induced by it which is expressed in cutaneous and mucosal reactions. This review discusses dermatotoxi city associated with gold. In some countries gold has moved into secon d place as allergen, following nickel. Such recognition is mainly due to improved diagnostic methods and to its inclusion in routine dermal patch testing. Some unconventional manifestations of hypersensitivity are associated with use patterns which involve intimate contact with t he metal as a component of jewellery. In-depth analysis of the growing number of cases of allergy has revealed various immunological idiosyn crasies as being characteristic of this metal. These include late reac tions to challenge, extraordinary persistence of clinical effects, for mation of intracutaneous nodules and immunogenic granuloma unresponsiv e to conventional steroid therapy, the occurrence of eczema at sites d istant from the site of contact, and flare-ups of eczema upon systemic provocation with allergen which are characteristic of drug induced al lergy. These manifestations demand investigations at the molecular lev el of the unusual mechanisms of action involved. (C) 1997 Elsevier Sci ence Ltd.