Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Alveolitis due to hair-spray

Ultrastructural observations in two patients and the results of experimental investigations

Summary

Observation of two patients with hair-spray induced lung disease have prompted us to study the ultrastructure of the lung lesion. We have compared the results with experimental lesions in animals injected with hair-spray extracts and with human monocyte cell cultures exposed to hair-spray.

The lungs show a chronic alveolitis with a striking granulomatous reaction including macrophages and multinucleated giant cells of the foreign body type. The intraalveolar and interstitial macrophages and the giant cells all contain PAS-positive material. Ultrastructurally distinct lamellar inclusions are found in the secondary lysosomes of the macrophages and giant cells. Identical structures can be produced in animals injected with hair-spray extracts and with polyvinyl-pyrrolidone and -acetate (PVP/PVA), which are regular ingredients of hair-sprays. Large, presumeably polymeric particles (PVP/PVA) are ingested by giant cells. This “gigantophagocytosis” is associated with the fusion of mononuclear phagocytes and leads to the genesis of giant cells. In cell cultures of human blood monocytes hair-spray extracts and PVP/PVA induce maturation and aggregation of these cells, with PAS-positive cytoplasmatic inclusions. The development of multinuclear giant cells in these monocyte cell cultures is also seen.

These observations suggest that hair-spray induced lung disease is caused by the prolonged and extensive body response of the local mononuclear phagocyte system (MPS). Overstimulation of the MPS leads to a quantitative and qualitative change which is followed by a partial blockade of this system. The alveolitis is a consequence of the foreign body response to inhaled hair-spray substances.

This is a preview of subscription content, log in to check access.

References

  1. Adams, D.O.: The granulomatous inflammatory response. A review. Am. J. Pathol. 84, 164–191 (1976)

  2. Andersson, B.: Induction of immunity and immunologic paralysis in mice against polyvinyl pyrrolidone. J. Immunol. 102, 1309–1316 (1969)

  3. Andersson, B., Blomgren, H.: Evidence for thymus-independent humoral antibody production in mice against polyvinyl pyrrolidone and E. coli lipopolysaccharide. Cell. Immunol. 2, 411–419 (1971)

  4. Bergmann, M.: Thesaurosis: Illness or illusion? Chest 64, 153–154 (1973)

  5. Bergmann, M., Flance, I.J., Blumenthal, H.T.: Thesaurosis following inhalation of hair-spray. A clinical and experimental study. N. Engl. J. Med. 258, 471–476 (1958)

  6. Bergmann, M., Flance, I.J., Cruz, P.T., Klam, N., Aroson, P.R., Joshi, R.A., Blumenthal, H.T.: Thesaurosis due to inhalation of hair-spray. Report of twelve new cases, including three autopsies. N. Engl. J. Med. 266, 750–755 (1962)

  7. Brass, K.: Morphologische Befunde bei Mensch und Kaninchen nach wiederholter Periston-(Kollidon-) Zufuhr. Frankf. Z. Path. 63, 95–102 (1952)

  8. Burkhardt, A., Gebbers, J.-O.: Giant cell stromal reaction in squamous cell carcinomata. Electronmicroscopic and ultrahistochemical observations on the genesis and functional activity of multinucleated giant cells in Bleomycin-induced tumor regression. Virchows Arch. A Path. Anat. and Histol. 375, 263–280 (1977)

  9. Burkhardt, A., Gebbers, J.-O., Höltje, W.-J.: Die Bleomycin-Lunge. Dtsch. med. Wschr. 102, 281–289 (1977)

  10. Caldwell, D.M., Mc Queeney, A., Silipo, S.: Pulmonary granulomatosis due to cosmetic sprays. Calif. Med. 95, 246–249 (1961)

  11. Cohen, B.M.: Peripheral airway responses to acute hair-spray exposure. Respiration 34, 270–277 (1977)

  12. Conn, Z.A.: The structure and function of monocytes and macrophages. Adv. Immunol. 9, 163–214 (1968)

  13. Cohn, Z.A., Benson, B.: The differentiation of mononuclear phagocytes. Morphology, cytochemistry, and biochemistry. J. Exp. Med. 121, 153–164 (1965)

  14. Dalton, A.J.: A chrome-osmium fixative for electron microscopy. Anat. Rec. 121, 281 (1955)

  15. Dannenberg, A.M.: Cellular hypersensitivity and cellular immunity in the pathogenesis of tuberculosis: Specificity, systemic and local nature and associated macrophage enzymes. Bacteriol. Rev. 32, 85–102 (1968)

  16. Davies, P., Allison, A.C.: Secretion of macrophage enzymes in relation to the pathogenesis of chronic inflammation. In: D.S. Nelson (edit.) Immunbiology of the macrophage pp 428–461. New York: Academic Press 1976

  17. Draize, H.J., Nelson, A.A., Newburger, S.H., Kelly, E.A.: Inhalation toxicity studies of six types of aerosol hair-spray. Toilet goods A. Scient. Sect. Proc. 31, 28–32 (1959)

  18. Erhardt, D.R., Ahn, C., Sawyers, T.: Pulmonary disease associated with the inhalation of cosmetic aerosols. Chest 64, 251–254 (1973)

  19. Evans, M.J., Cabral, L.J., Stephens, R.J., Freeman, G.: Renewal of alveolar epithelium in rat following exposure to NO2. Am. J. Pathol. 70, 175–198 (1973)

  20. Evans, M., Dekker, N.P., Cabral-Anderson, L.J., Freeman, G.: Quantitation of damage to the alveolar epithelium by means of type 2 cell proliferation. Am. Rev. Resp. Dis. 118, 787–790 (1978)

  21. Fresen, O., Weese, F.: Das gewebliche Bild nach Infusion verschiedener Kollidonfraktionen. Beitr. path. Anat. 112, 44–51 (1952)

  22. van Furth, R., Cohn, Z.A., Hirsch, J.G., Humphrey, J.H., Spector, W.G., Langevoort, H.L.: The mononuclear phagocyte system.: A new classification of macrophages, monocytes and their precursor cells. Bull. WHO 46, 845–852 (1972)

  23. Gebbers, J.-O., Seifert, G., Riesner, K.: Die fibrosierende Alveolitis. Ein Beitrag zur Ultrastruktur und Pathogenese interstitieller Lungenerkrankungen. Röntgen Bl. 30, 539–550 (1977)

  24. Gebbers, J.-O., Tetzner, C., Burkhardt, A., Rüdiger, H.W., v. Wichert, P.: Klinische und morphologische Befunde zur sog. Haarspray-Lunge. Atemwegs- und Lungenkrankheiten 5 (1979) (in-press)

  25. Gordon, S.: Macrophage neutral proteinases and defense of the lung. Fed. Proc. 36, 2707–2711 (1977)

  26. Gordon, S., Unkeless, J.C., Cohn, Z.A.: The macrophage as secretory cell. In: Immune recognition A.S. Rosenthal (ed.) pp. 589–614. New York: Academic Press 1975

  27. Gowdy, J.M., Wagstaff, M.J.: Pulmonary infiltration due to aerosol thesaurosis. A survey of hair-dressers. Arch. Environ Health 25, 101–108 (1972)

  28. Groß J., Peter, P.: Holographische Bestimmungen der Größenverteilung und Dichte von Aerosolteilchen in einem Modell des menschlichen Atemsystems. Aerosol Rep. 12, 64–72 (1973)

  29. Groß, J., Gulden, W.: Holographische Teilchengrößenanalyse von Sprays verschiedener Zusammensetzung und Bestimmung der Teilchendichte in einem Modell des menschlichen Atemtraktes. Aerosol Rep. 13, 137–148 (1974)

  30. Horwitz, A.L., Crystal, R.G.: Collagenase from rabbit pulmonary alveolar macrophages. Biochem. Biophys. Res. Commun. 69, 296–302 (1976)

  31. Hüsselmann, N.: Speichererscheinungen beim Menschen nach Periston. Klin. Wschr. 30, 801–808 (1952)

  32. Jeckeln, E.: Über gewebliche Äußerungen des Säuglingsorganismus nach wiederholten Peristongaben. Virchows Arch. Path. Anat. 322, 529–534 (1952)

  33. Kapp, J.-F.: Phagozytose — ein zentraler Mechanismus der Entzündungsreaktion. Klin. Wschr. 56, 1039–1047 (1978)

  34. Katzenstein, A.-L.A., Bloor, M., Liebow, A.A.: Diffuse alveolar damage — the role of oxygen, shock, and related factors. A review. Am. J. Pathol. 85, 210–228 (1976)

  35. Kerbel, R.S., Eidinger, D.: Enhanced immune responsiveness to a thymusindependent antigen early after adult thymectomy. Evidence for shortlived inhibitory thymus derived cells. Eur. J. Immunol. 2, 114–122 (1972)

  36. Leder, E.-D., Lennert, K.: Über iatrogene Lymphknotenveränderungen. Verh. Dtsch. Ges. Path. 56, 310–320 (1972)

  37. Leibovich, S.J., Ross, R.: A macrophage-dependent factor that stimulates the proliferation of fibroblasts in vitro. Am. J. Pathol. 84, 501–514 (1976)

  38. Lowsma, H.B., Jones, R., Prendergast, J.: Effects of respired polyvinylpyrrolidone aerosols in rats. Toxic. Appl. Pharmacol. 9, 571–582 (1966)

  39. Nevins, M.A., Stechel, G., Fishman, S.: Pulmonary granulomatosis. JAMA 193, 266–271 (1965)

  40. Otto, H.F.: Untersuchungen zur Ultrastruktur lympho-epithelialer Thymustumoren unter besonderer Berücksichtigung der sog. “Emperipolesis”. Virchows Arch. A Path. Anat. and Histol. 379, 335–349 (1978)

  41. Price, P.: Responses to polyvinyl pyrrolidone and pneumococcal polysacharide in protein-deficient mice. Immunology 34, 87–96 (1978)

  42. Ripe, E., Hanngren, A., Hohngren, A.: Thesaurosis? — Analysis of a case. Scand. J. Resp. Dis. 50, 156–167 (1969)

  43. Seal, R.M.E.: Pathology of extrinsic allergic bronchiolo-alveolitis. Alveolar Interstitium of the Lung. Inter. Symp., Paris 1974. Prog. Resp. Res., vol 8, pp. 66–73. Basel: Karger 1975

  44. Spector, W.G.: The macrophage: Its origin and role in pathology. Pathobiol. Ann. 4, 33–64 (1974)

  45. Stringer, G.C., Hunter, S.W., Bonnabeau, R.C.: Hypersensitivity pneumonitis following prolonged inhalation of hair-spray. Jama 237, 888–889 (1977)

  46. Voigt, R., Bornschein, M.: Lehrbuch der pharmazeutischen Technologie. pp. 479–486. Berlin: VEB Verlag Volk und Gesundheit 1973

  47. Wettengel, R.: Vogelhalterlunge — allergische Alveolitis und Lungenfibrose durch Antigeninhalation. In: Interstitielle Lungenerkrankungen — Lungenfibrosen, J. Hamm (Hersg.) pp. 36–44. Stuttgart: Theime 1975

  48. White, R., Lin, H.-S., Kuhn, C.: Elastase secretion by peritoneal exudative and alveolar macrophages. J. Exp. Med. 146, 802–808 (1977)

  49. Zucker-Franklin, D., Grusky, G., Marcus, A.: Transformation of monocytes into “fat” cells. Lab. Invest. 38, 620–628 (1978)

  50. Zuskin, E., Bouhuys, A.: Acute airway responses to hair-spray preparations. N. Engl. J. Med. 290, 660–663 (1974)

Download references

Author information

Correspondence to Dr. Jan-Olaf Gebbers.

Additional information

Dedicated to Professor Dr. Wilhelm Doerr on the occasion of his 65. birthday

The skilful technical assistance of Cornelia Schürmann and Claudia Drescher is gratefully acknowledged.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gebbers, J., Tetzner, C. & Burkhardt, A. Alveolitis due to hair-spray. Virchows Arch. A Path. Anat. and Histol. 382, 323–338 (1979). https://doi.org/10.1007/BF00430408

Download citation

Key words

  • Alveolitis
  • Mononuclear phagocyte system
  • Macrophages
  • Granulomas
  • Giant cells
  • Foam cells
  • Hair-spray
  • Polyvinyl pyrrolidone