ABSTRACT
The patient had been treated with on-demand short-acting beta-agonists. His FEV
sodium hexachloroplatinate 1 mg/mL was negative. He had an elevated total IgE of 397 kU/L, but SPT with common aeroallergens was negative. Fractional exhaled nitric oxide (FeNO) was elevated at 140 ppb. A specific inhalation challenge (SIC) with platinum salt was deferred due to his degree of airways obstruction. A diagnosis of probable platinum salt allergy was made, and asthma therapy with inhaled steroids and longacting beta-agonists was initiated. When the patient presented for a follow-up examination two years later, he had improved considerably with only minor symptoms and requiring only occasional use of a rescue inhaled short-acting beta-agonist. While his spirometry was normal, he exhibited bronchial hyperresponsiveness (BHR) (methacholine PD
and FeNO had fallen to 20 ppb (normal). A controlled SIC with sodium hexachloroplatinate that was considered necessary for the confirmation of occupational asthma (OA) demonstrated a positive immediate reaction with a maximal fall of FEV
of 235 ng. A diagnosis of platinum salt-induced allergy and OA was made. His current job without any exposure to platinum salts was considered safe. He receives $500 per month of workers’ compensation and was advised to continue to use his short-acting beta-agonists on demand.
