Disulfiram Hypersensitivity and Rubber Contact Dermatitis

DISULFIRAM is a valuable adjunct in the outpatient therapy of ethanol abuse. Persons taking maintenance doses of disulfiram avoid alcohol, as ingestion causes unpleasant symptoms such as flushing, dyspnea, headache, and vomiting. The danger of a severe reaction with tachycardia and hypotension has received much publicity and is minimized by lower disulfiram doses, abandonment of intentional challenge with ethanol, and careful screening of candidates for cardiopulmonary disability. It is little recognized that screening should also seek a history of rubber contact sensitivity. No such precaution is noted in the disulfiram prescribing information. This case illustrates the dangers of administering disulfiram to a patient with this history. Report of a Case A 32-year-old white male bartender requested disulfiram therapy as an aid to resist the temptation to drink at his job. He was otherwise well, with no history of major illnesses, and had abstained from alcohol for one week. A screening