Does aluminium hydroxide provoke allergies?

Question

A German documentary released on the German channel Arte a few years ago makes the claim that aluminium hydroxide, when ingested alongside some foods, can induce allergies to those specific foods, citing allergy researchers of the University of Vienna:

Zunächst machten die Forscherinnen die Mäuse gegen Äpfel oder Nüsse allergisch, indem sie diese Lebensmittel zusammen mit Aluminiumhydroxyd verfütterten. [...] Wenn Sie so wollen, man könnte eigentlich die gesamte Küche hernehmen und mit Hilfsstoffen versehen, und aus meiner heutigen Perspektive könnten wir hier eigentlich gegen alles - in unterschiedlicher Intensität - aber wir könnten Nahrungsmittelallergien induzieren.

My translation:

First, the researchers made the mice allergic to apples or nuts, by feeding them these substances together with aluminium hydroxide. [...] Put it this way, you could take the entire kitchen and add adjuvants, and from my current perspective we could - in varying intensity - but we could induce food allergies against everything.

They also claim that the aluminium hydroxide doses contained in some reflux prevention drugs are sufficient to induce such allergies.

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On the other hand, aluminium hydroxide is used as an adjuvant in specific immune therapy, where a drug based on some allergen is injected or ingested to reduce the effects of an allergy.

The Paul Ehrlich Institute released a statement about the safety of aluminium:

Die häufig geäußerte Sorge, dass die Anwendung von Aluminium das Allergierisiko generell erhöhen könnte, wird u.a. damit begründet, dass es in Mausmodellen dazu verwendet wird, spezifische Allergien hervorzurufen. Allerdings zeigen Untersuchungen, dass nur dann in den Mäusen eine allergische Immunantwort ausgelöst werden konnte, wenn mit sehr geringen Konzentrationen des Antigens immunisiert wurde. Bei höheren Konzentrationen des Antigens kommt es trotz Aluminiumhydroxid als Adjuvans zu normalen, nicht allergischen Immunreaktionen. [...] Die derzeitige Datenlage lässt somit bei der Anwendung von Aluminiumhydroxid keine Erhöhung des Risikos erkennen, Allergien zu entwickeln.

My translation:

The commonly expressed fear that the use of aluminium could increase the risk of allergies in general is partially based on it being used in mice models to induce specific allergies. However, research shows that an allergic immune response could only be triggered in the mice if very low doses of the antigen were used to immunize. For higher concentrations of the antigen there are only normal, non-allergic immune responses, despite the use of aluminium hydroxide as an adjuvant. [...] The current state of the data does not support an increased risk of developing allergies when aluminium hydroxide is used.

But of course, there will always be some things that are only available in trace doses. For example, you eat some nuts, there may be trace amounts of other kinds of nuts in there because of nut dust in the factories. If you ingest aluminium hydroxide at the same time, could this fulfill the requirements for inducing an allergy?

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So I'm wondering which side to trust.

• Can aluminium hydroxide induce allergies?
• If so, how realistic is this happening in daily life, from commonly quoted sources of aluminium, such as using antiperspirants, licking the covers of yogurt cups, or using various drugs (anti-reflux, vaccines, SIT)?

Answer 1

Using these updated parameters we found that the body burden of aluminum from vaccines and diet throughout an infant's first year of life is significantly less than the corresponding safe body burden of aluminum modeled using the regulatory MRL. We conclude that episodic exposures to vaccines that contain aluminum adjuvant continue to be extremely low risk to infants and that the benefits of using vaccines containing aluminum adjuvant outweigh any theoretical concerns.

Updated aluminum pharmacokinetics following infant exposures through diet and vaccination.

The CDC gives 1.0 mg/kg/day as the Minimal Risk Levels for aluminum.

Aluminum in vaccines in particular has been found to pose extremely low risk to infants.

The FDA study found that the maximum amount of aluminum an infant could be exposed to over the first year of life would be 4.225 milligrams (mg), based on the recommended schedule of vaccines. Federal Regulations for biological products (including vaccines) limit the amount of aluminum in the recommended individual dose of biological products, including vaccines, to not more than 0.85-1.25 mg. For example, the amount of aluminum in the hepatitis B vaccine given at birth is 0.25 mg.

Aluminum is found naturally in large quantities in the environment, often consumed through drinking water or ingesting certain foods, such as infant formula. Using the updated parameters, the authors found that the body burden of aluminum from vaccines and diet throughout an infant’s first year of life is significantly less than the corresponding safe body burden of aluminum, based on the minimal risk levels established by the Agency for Toxic Substances and Disease Registry.

Here is the aluminum ToxGuide published by the CDC:

Aluminum is poorly absorbed following either oral or inhalation exposure and is essentially not absorbed dermally. Approximately 1.5–2% of inhaled and 0.01–5% of ingested aluminum is absorbed. The absorption efficiency is dependent on chemical form, particle size (inhalation), and concurrent dietary exposure to chelators such as citric acid or lactic acid (oral).

Conclusion: I've found no evidence for or against aluminum causing allergies. An allergy to aluminum however does exist.

Handling aluminum products (cans/yogurt cup lids) is safe, vaccines are only a small contributor of aluminum and other medications are assumed safe

in healthy people at recommended doses based on historical use.

Exceeding the safety levels of aluminum can cause neurological problems.

Answer 2

More a comment, than an answer:

The claims made in "Die Akte Aluminium" were thoroughly debunked by German skeptics, e.g. in this post of the GWUP.

Regarding your explicit questions: I am not sure which evidence you are expecting if you don't trust a renowned scientific institution like the Paul-Ehrlich-Institut. Especially when all of the studies are linked in the article you mentioned.

The study mentioned where they feeded mice aluminium and sucralfate seems to be this one.

They indeed find evidence, that aluminium in its pure form can encourage (not cause!) allergies. But, as the PEI describes, further research showed that this is only applicable for low antigen concentration and the results cannot be transferred directly from mice to humans.