Gold treatment provides great relief to many sufferers of rheumatoid arthritis, but can cause allergic dermatological reactions in some people. Researchers are now attempting to find a means by which allergies to gold may be identified prior to beginning treatment with gold salts.
In this study from Malmö, Sweden, one patient, a 52-year-old woman suffering from rheumatoid arthritis, was tested for allergy before being started on gold treatment. She had a history of wearing gold jewelry without difficulty, or only a slight itchiness after days of continued use. A patch containing two different gold solutions was applied for 48 hours, and produced a positive skin reaction only after three weeks of follow-up. To confirm the finding, the patient was given a single dose of gold treatment and subsequently reacted with irritated and itchy skin. No further gold treatments were administered.
Various skin reactions may occur as a result of an allergy when gold salt treatments are given. An area of skin which has reacted previously to gold upon contact might flare up or a systemic rash may develop. Both of these reactions are extremely uncomfortable and best avoided if possible. The medical community is searching for better methods of identifying patients with allergies to gold, as well as trying to understand the process by which systemic gold treatment causes a reaction in the skin.
Based on the fact that the reaction to the allergy test only occurred three weeks after the patch was administered, this case suggests that test readings should be repeated over several weeks. It appears that the patch test primed the tissue under the patch so that once the gold was applied systemically, it caused a flare-up in the patch site. The gold allergen, which travels through the blood during systemic gold treatment for rheumatoid arthritis, must be a catalyst for reactivating the allergen-specific T-cells responsible for flare-ups.
In conclusion, this case suggests that skin tests can be used to identify a contact allergy to gold. However, a patch test can take up to three weeks to produce a positive result and the test reading must therefore be repeated over this time period. The study confirms that systemic administration of gold salts can produce a flare-up in an area of skin which had previously reacted to surface contact with gold. It is hoped that such testing will reduce any additional suffering for rheumatoid arthritis patients and that further research may help prevent such reactions by identifying the means through which gold treatment causes skin reactions.