Angioedema and urticaria as acute and late phase reactions to zinc fume exposure, with associated metal fume fever-like symptoms.

IgE-mediated acute and late phase reactions associated with occupational metal fume exposure are rare compared with the more common metal fume fever. The latter is a common acute industrial disease caused by inhalation of oxides of metals, especially zinc. It is a flu-like illness and is thought to be self-limited. This article describes the first case, to my knowledge, of an immediate and a late phase reaction (urticaria and angioedema) to zinc fumes, associated with a metal fume fever-like reaction. Hives and angioedema developed immediately and in a delayed fashion in a 34-year-old man after he had welded zinc at his job. There also was an associated metal fume fever-like reaction. The relationship was proved by a challenge test done at home. The patient has been asymptomatic since using complete protective measures while welding zinc. Possible immunologic mechanisms are discussed.