ASTHMA IN PATIENTS...

WITH SILICONE BREAST IMPLANTS: REPORT OF A CASE SERIES AND IDENTIFICATION OF HEXACHLOROPLATINATE CONTAMINANT AS A POSSIBLE ETIOLOGIC AGENT.

Michael R Harbut Brenda C Churchill* IJOH; 1999; 3:73-82.

From: Center for Occupational and Environmental Medicine; Wayne State University, School of Medicine, Detroit, Michigan, and *Department of Internal Medicine, Providence Hospital, Southfield, Michigan

Address for correspondence:

Michael R. Harbut MD , MPH; Wayne State University School of Medicine, Detroit, Michigan,

and Center for Occupational and Environmental Medicine,

22255 Greenfield;

Southfield, Mi. 48075

ABSTRACT

The following study is of 8 breast implant patients evaluated because of respiratory systems, pruritus and rhinorrhea. The presence of hexachoroplatinate in the implants was notes and support for the hypothesis that this contaminant was related to the symptoms experienced by the patients is presented. Cases of implant related asthma were defined by episodic dyspnea, cough, or breathlessness with onset or worsening after implant placement and objective evidence of reversible airways obstruction, either during the presence or after the removal of the devices. All eight patients were found to have asthma, with airway hyper-reactivity demonstrated by methacholine challenge testing performed in seven patients and by partially reversible obstruction after nebulized administration of a beta-agonist in one patient. Eight patients had urticaria and seven had rhinorrhea. Eight of eight breast implant patients evaluated had findings consistent with asthma. Hexachloroplatinate, a potent sensitizer and component of breast implants, is identified as the likely primary etiologic agent in view of findings consistent with platinosis in these patients, and the demonstration of the leaching of hexachloroplatinate from even intact silicone breast implants.

INTRODUCTION Human illness as a result of toxicity of silicone gel breast implants is an evolving and controversial area of medical investigation. The nature of any toxicity has not yet been fully characterized, but at least in part it appears to be consistent with a hypersensitivity process. The medical community is moving away from early reports of an autoimmune process, but has not yet offered a clear explanation for complaints registered by patients who have had the devices placed. There is also significant uncertainty with respect to any responsible agents of toxicity. Silicone breast implants consist of a shell encasing a gel. Both the shell and gel are complex formulations that include carbon and silicone and traces of many other elements. Saline implants are comprised of a saline fluid contained in a silicone shell casing. From an Occupational Medicine perspective, notable among the agents present in both gel and shell are the metals chromium, nickel, aluminum and platinum. The presence of platinum in the implants occurs as a result of its use as a catalyst in its hexasolvent form (H2PtCl6) in the production of gel and shell.

(1). All three metals are known to be associated with occupational asthma. Hexachloroplatinate, however, is the most potent of sensitizers reported. There is an extensive medical literature related to the occupational disease entity platinosis and airways reactivity, caused by exposure to complex platinum salts. Respiratory problems in platinum refinery workers were reported as long ago as 1911 and are extensively reviewed in the World Health Organization Monograph of the Internal Program of Chemical Safety.

(2). Platinosis or platinum allergy historically refers to the triad of asthma, dermatitis and rhinitis in workers exposed to platinum. Pruritis has also been reported. Platinosis is highly prevalent in workers exposed to platinum with a cumulative prevalent rate 50% or more.