Acute systemic reactions to carbonless copy paper associated with histamine release

JAMA. 1988 Jul 8;260(2):242-3.


We report two cases of recurrent episodes of hoarseness, cough, flushing, pruritus, and rash occurring within 30 minutes of topical exposure to carbonless copy paper. Provocative challenges revealed that alkylphenol novolac resin was the ingredient responsible. Video endoscopy of the larynx was performed and plasma histamine levels were obtained prior to and 30 minutes after cutaneous challenge of a patient with alkylphenol novolac resin. We documented marked laryngeal edema and a sixfold increase in plasma histamine levels after challenge. We conclude that topical exposure to carbonless copy paper may cause mast cell/basophil-mediated acute systemic and potentially life-threatening reactions in susceptible patients.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Copying Processes / instrumentation*
  • Cough / chemically induced
  • Female
  • Histamine Release / drug effects*
  • Hoarseness / chemically induced
  • Humans
  • Laryngeal Edema / chemically induced
  • Middle Aged
  • Occupational Diseases / chemically induced*
  • Phenols / adverse effects*
  • Resins, Synthetic / adverse effects*
  • Skin Tests
  • Vocal Cords / pathology


  • Phenols
  • Resins, Synthetic