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Severe allergic systemic reaction to personal protective equipment during the COVID-19 pandemic
  1. Pasquale Filippo Italiano1,
  2. Matthew Krummenacher2 and
  3. Michaela Lucas3
  1. 1Medical Education, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2Immunology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  3. 3Immunology, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Pasquale Filippo Italiano; he24079{at}


Our case describes a hospital worker who suffered a severe reaction to personal protective equipment (PPE) during the COVID-19 pandemic. After researching the excipient list of her PPE and completing a literature review, we postulated that isocyanates used in the production of the polyurethane band of the N95 mask was the cause for her reaction. In the absence of standardised testing, we tested this hypothesis by replicating her reaction to PPE by using a commercially available isocyanate patch, identifying diphenylmethane-4, 4-diisocyanate as the culprit agent.

We recommended caution in the use of polyurethane containing N95 masks- for people reporting allergic reaction- and testing for sensitivity for polyurethane. The patient was able to tolerate non-polyurethane containing standard surgical masks, providing an option for PPE in some clinical circumstances. Since avoiding N95 masks, she has not had any further reactions.

  • Immunology
  • Occupational and environmental medicine
  • Dermatology

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PFI, ML and MK. The following authors gave final approval of the manuscript: PFI, ML and MK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.