Allergic Reactions to PPD Hair Dye
Medical Journal Articles

The following articles investigated the underreporting of allergic reactions from hair dye, the rates of sensitivity, the symptoms, severity and in rare instances, death.

55 cases of allergic reactions to hair dye: a descriptive, consumer complaint-based study.
S°sted, H.; Agner, T.; Andersen, K. E.; MennÚ, T.. Contact Dermatitis, Nov2002, Vol. 47 Issue 5, p299, 5p; DOI: 10.1034/j.1600-0536.2002.470508.x; (AN 8875800)

In spite of the fact that PPD is highly sensitizing, and has been proven to cause severe allergic reactions including fatalities, commercial hair dyes are permitted to contain up to 6% PPD.  Because the allergic reactions often go unreported or misdiagnosed, it is suspected that injuries from hair dye are more widespread than anyone is aware of.

Dose–time relationships for elicitation of contact allergy to para -phenylenediamine.
Hextall, J. M.; Alagaratnam, N. J.; Glendinning, A. K.; Holloway, D. B.; Blaikie, L.; Basketter, D. A.; McFadden, J. P.. Contact Dermatitis, Aug2002, Vol. 47 Issue 2, p96, 4p; DOI: 10.1034/j.1600-0536.2002.470207.x; (AN 7735067)

Although there have been many studies concerning skin reactions to PPD, there had not been research on the relationship between length of contact with PPD and severity of reaction, nor the relationship of PPD levels and severity of reaction.  This study shows that the longer you leave PPD dye on the skin, the more likely there is to be an allergic reaction.  A higher content of PPD is positively correlated with a higher incidence of allergic reaction.  People who have had more exposure to PPD have a higher incidence of allergic reation. People who have already been sensitized to PPD may have rapid onset severe allergic reactions.

At 5 minutes exposure, 16% of sensitive people had a reaction.
At 15 minutes exposure, 38% of sensitive people had a reaction.
At 30 minutes exposure, 50% of sensitive people had a reaction.
at 120 minutes, 69% of sensitive people had a reaction.

 A similar direct relationship was found between exposure to higher levels of PPD and higher incidence of allergic reation.
22% of sensitive people had a reaction to 0.01% PPD
69% of sensitive people had a reaction to 1% PPD.

Cumulive exposure has a positive correlation to allergic reaction:
After 8 days, a second exposure to PPD yielded double the probablity of allergic reaction.

Hair Dye Reaction
Calman CD.., Contact Dermatitis Newsletter 1967; 1:16 

Severe cases of immediate type hypersensitivity to PPD are described in which the patients developed severe edema, irritation of the eyes and face and  difficulty in breathing

Allergic contact dermatitis from para-phenylenediamine in Bigen« powder hair dye.
Ho, S. G. Y.; White, I. R.; Rycroft, R. J. G.; McFadden, J. P.. Contact Dermatitis, Aug2004, Vol. 51 Issue 2, p93, 2p; DOI: 10.1111/j.0105-1873.2004.0396f.x; (AN 14418458)

Bigen Hair dye has a 12.5% PPD content, and may cause severe allergic reactions.  6% is the maximum allowed by FDA law.  According to the article above, Dose–time relationships for elicitation of contact allergy to para - phenylenediamine., .01% is sufficient to cause an allergic reaction.

Acute Renal Failure Following para-Phenylenediamine (PPD) Poisoning: A Case Report and Review. By: Anuradha, S.; Arora, Sandeep; Mehrotra, S.; Arora, A.; Kar, P.. Renal Failure, May2004, Vol. 26 Issue 3, p329, 4p; DOI: 10.1081/JDI-200026722; (AN 13872095)

PPD is shown to cause severe angioneurotic edema, rhabdomyolysis and intravascular hemolysis with hemoglobinuria culminating in acute renal failure (death).  Such cases are more common in East Africa, South Asia and the Middle East than in western countries.

Immediate-type hypersensitivity and allergic contact dermatitis due to para-phenylenediamine in hair dye.
Wong, G. A. E.; King, C. M.. Contact Dermatitis, Mar2003, Vol. 48 Issue 3, p166, 1p; DOI: 10.1034/j.1600-0536.2003.00038.x; (AN 9796308)

This article reports an immediate allergic reaction including severe rash and swelling around the eye requiring steroid treatment, and fatal potential of hair dye application.

Contact anaphylaxis due to para-phenylenediamine.
 Fukunana, Tohru; Kawagoe, Rika; Hozumi, Hideki; Kanzaki, Tamotzu. Contact Dermatitis, Sep96, Vol. 35 Issue 3, p185, 2p; DOI: 10.1111/1600-0536.ep12036223; (AN 12036223)

A 57 year old woman, who had used PPD hair dyes for 8 years without incident, collapsed within minutes of applying hair dye, and had severe skin reactions.

Contact dermatitis in hairdresser' clients.

Guerra, Liliana; Bardazzi, Federico; Tosti, Antonella. Contact Dermatitis, Feb92, Vol.
26 Issue 2, p108, 4p; DOI: 10.1111/1600-0536.ep11977899; (AN 11977899)

Contact dermatitis in hairdressers: the Italian experience.
Guerra, L.; Tosti, A.; Bardazzi, F.; Pigatto, P.; Lisi, P.; Santucci,
B.; Valsecchi, R.; Schena, D.; Angelini, G.; Sertoli, A.; Ayala, F.; Kokeli, F.. Contact Dermatitis, Feb92, Vol. 26 Issue 2, p101, 7p; DOI:10.1111/1600-0536.ep11977892; (AN 11977892)

Innate PPD sensitivity rates range between 4% and 7.3% (that means if you have NEVER been exposed to anything containing PPD you've got roughly a 5% chance of having a reaction the first time. However, the more frequently a person comes into contact with PPD, the more likely that person is to become sensitized. People who use hair dye regularly have an 18.7% rate of sensitization and hairdressers may have a 60% rate of sensitization.

There are further articles on PPD reactions at