Gold (Gold Sodium Thiosulfate) Allergy

Metallic gold is known for its electrochemical nobility, and resulting lack of reactivity. Thus, it is usually accepted to be a non-allergenic metal.

For this reason, contact dermatitis due to gold has been rare, and difficult to prove. It was Kligman who first found that gold chloride could cause sensitization.

Fowler later initiated the use of 0.5% w/w gold sodium thiosulfate (GSTS) in petrolatum as a test preparation to determine the presence of contact allergy to gold. At present, varying concentrations of GSTS in petrolatum are in use.

Symptoms of Gold Sodium Thiosulfate Allergy

Patients who are allergic to gold often present with contact dermatitis, contact stomatitis, or oral lichen planus.

Skin manifestations such as a papular pruritic rash are most commonly found on the ears, eyelids or the area around the eyes, the fingers, and the neck.

Reactions in remote areas far from contact are also possible. Gold allergy is more commonly found in women.

It has been found that one in ten patients with eczema had positive reactions when their standard patch tests included gold patch testing (as GSTS). Thus, gold is a potent sensitizer, second only to nickel sulfate.

Dental patients with gold fillings, or individuals who wear gold allergy, show an incidence of allergy that is higher than normal, which means the gold in the fillings could be a major cause of gold allergy.

At the same time, patients with contact allergy to gold have a higher chance of sensitivity to other monovalent gold salts, such as gold sodium thiomalate, as well as to nickel and cobalt.

Diagnosis and Treatment

The presence of a contact allergy to gold is confirmed by a positive patch test to GSTS, consisting of a persistent papular reaction.

The test reaction may often persist for months after the patch application. Patch size must be measured at 3 days, 1 week, and even at 3 weeks, because many reactions take a longer time than expected to appear when the patch test is used.

With intracutaneous testing, however, all reactions occur within the first week, and dermal nodules are often formed.

Percutaneous absorption of ionized gold is essential for the formation of a positive reaction.

An in vitro test for gold allergy looks for the appearance of blast transformation induced by gold salts.

Treatment of gold allergy comprises the use of local emollients and corticosteroids to suppress local allergic manifestations, as well as the treatment of any secondary bacterial infection.

Exposure to gold salts must be minimized in order to prevent future allergic reactions.

References

Further Reading

Last Updated: Feb 26, 2019

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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Comments

  1. Lynn Mullins Lynn Mullins United States says:

    Well this article actually offered more information than my dermatologist was able to give me. I had the TRUE allergy patch test done 5 months ago. I had positive reactions to nickel and cobalt, and at the time gold, however my dermatologist said this was a false positive. Unfortunately, the skin reaction rash for gold has not gone away, and it's now 5 months later. I don't wear any jewelry, so I'm not exposed, which I thought would make it go away. I guess it's just a case of wait and see if the skin eruptions at the test site eventually go away.

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