What question did this study set out to answer?

To identify the allergen causing severe anaphylaxis in a patient post-hair dye application.

April 25, 2026Contact Dermatitis0 citationsOpen Access

Severe Hair Dye Anaphylaxis Caused by Toluene‐2,5‐ Diamine Identified by Positive in Vitro Tests

EJEglé JanušonytėUniversity Hospital of Geneva THThomas HarrUniversity Hospital of Geneva PPPierre PilettaUniversity Hospital of Geneva

Key Points

To identify the allergen causing severe anaphylaxis in a patient post-hair dye application.
Case study of a 60-year-old woman with a history of liver transplantation and allergies; collections included serum tryptase, in vitro tests (BAT, LTT) for allergic reactions.
Conducted prick testing and skin tests, including positive and negative controls, for potential allergens.
Patient received intramuscular adrenaline and corticosteroids following reaction; treatment assessed for improvement.
Elevated serum tryptase indicated mast cell degranulation (19.5 μg/L) after hair dye exposure.
Positive basophil activation test demonstrated strong reactivity to toluene-2,5-diamine, with borderline reactivity to p-phenylenediamine.
Lymphocyte transformation test showed IL-13 positivity for p-phenylenediamine, suggesting a Th2-type specific response.

Abstract

We report a case of a severe allergic reaction following hair dye application in a 60-year-old woman with a history of liver transplantation in 2003, maintained on tacrolimus 3.5 mg. The patient was known for multiple allergies, including peanut, oral allergy syndrome, and anaphylaxis to vancomycin and influenza vaccination. Ten minutes after the application of a black-coloured hair dye (Syoss Permanent, Henkel AG a negative response therefore points to decreased mast-cell density and/or impaired degranulation capacity, which may contribute to the difference between skin and in vitro testing. Tacrolimus is a known suppressor of mast cell activation and histamine release acting probably via the MRGPRX2 receptor 8, 9. Therefore, we were not astonished to see the difference between a positive histamine reaction on the skin induced by exogenous histamine and a lack of response to codeine as well as the suspected culprits due to a lack of mast cell activation by tacrolimus. Additionally, petrolatum-based preparations, while standard for patch testing, may not be optimal vehicles for prick testing with these compounds. BAT, by directly assessing basophil reactivity ex vivo, bypasses these cutaneous confounders and may therefore offer greater sensitivity in this clinical context. To the best of our knowledge, this is the first documented case of IgE (or IgG)-mediated hair dye anaphylaxis with positive results in both BAT and LTT. Potential cross-reacting hair dyes should be included in the testing to increase patient safety. Written informed consent was obtained from the patient for the publication of this manuscript, including any accompanying clinical information and images. Pierre Piletta: writing – review and editing. Eglė Janušonytė: conceptualization, investigation, writing – original draft. Sophie Vandenberghe-Dürr: writing – review and editing, conceptualization, investigation. Thomas Harr: writing – review and editing. Open access publishing facilitated by Universite de Geneve, as part of the Wiley - Universite de Geneve agreement via the Consortium Of Swiss Academic Libraries. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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