In 1994, a study of nickel release and allergic contact dermatitis from nickel-plated metals and stainless steels was published in this journal. It was shown that low-sulfur stainless steel grades like AISI 304, 316L or 430 (S < or = 0.007%) release less than 0.03 microgram/cm2/week of nickel in acid artificial sweat and elicit no reactions in patients already sensitized to nickel. In contrast, nickel-plated samples release around 100 micrograms/cm2/week of Ni and high-sulfur stainless steel (AISI 303-S approximately 0.3%) releases about 1.5 micrograms/cm2/week in this acid artificial sweat. Applied on patients sensitized to nickel, these metals elicit positive reactions in 96% and 14%, respectively, of the patients. The main conclusion was that low-sulfur stainless steels like AISI 304, 316L or 430, even when containing Ni, should not elicit nickel contact dermatitis, while metals having a mean corrosion resistance like a high-sulfur stainless steel (AISI 303) or nickel-plated steel should be avoided. The determining characteristic was in fact the corrosion resistance in chloride media, which, for stainless steels, is connected, among other factors, to the sulfur content. Thus, a question remained concerning the grades with an intermediate sulfur content, around 0.03%, which were not studied. They are the object of the study presented in this paper. 3 tests were performed: leaching experiments, dimethylglyoxime and HNO3 spot tests, and clinical patch tests; however, only stainless steels were tested: a low-sulfur AISI 304 and AISI 303 as references and 3 grades with a sulfur content around 0.03%: AISI 304L, AISI 304L added with Ca, AISI 304L+Cu. Leaching experiments showed that the 4 non-resulfurised grades released less than 0.5 microgram/cm2/week in acid sweat while the reulfurized AISI 303 released around or more than 0.5 microgram/cm2/week. This is explained by the poorer corrosion resistance of the resulfurized grade. Yet all these grades had the same reaction to the DMG test (negative result), which shows again its lack of sensitivity. In contrast, the HNO3 spot test distinguished AISI 303 from the non-resulfurized grades. Clinical patch tests again showed that some patients (4%) were intolerant to AISI 303, while none were intolerant to the other grades. Thus, this study confirms that non-resulfurized stainless steels (S < or = 0.03%) like Ni-containing 304 and 304L should not elicit Ni contact dermatitis, while the resulfurized grades (S > 0.1%) should be avoided.

Nickel release from nickel-plated metals often induces allergic contact dermatitis, but, for nickel-containing stainless steels, the effect is not well-known. In this paper, AISI 304, 316L, 303 and 430 type stainless steels, nickel and nickel-plated materials were investigated. 4 tests were performed: patch tests, leaching experiments, dimethylglyoxime (DMG) spot tests and electrochemical tests. Patch tests showed that 96% of the patients were intolerant to Ni-plated samples, and 14% to a high-sulfur stainless steel (303), while nickel-containing stainless steels with a low sulfur content elicited no reactions. Leaching experiments confirmed the patch tests: in acidic artificial sweat, Ni-plated samples released about 100 micrograms/cm2/week of nickel, while low-sulfur stainless steels released less than 0.03 microgram/cm2/week of nickel, and AISI 303 about 1.5 micrograms/cm2/week. Attention is drawn to the irrelevance of the DMG spot test, which reveals Ni present in the metal bulk but not its dissolution rate. Electrochemical experiments showed that 304 and 316 grades remain passive in the environments tested, while Ni-plated steels and AISI 303 can suffer significant cation dissolution. Thus, Ni-containing 304 and 316 steels should not induce contact dermatitis, while 303 should be avoided. A reliable nitric acid spot test is proposed to distinguish this grade from other stainless steels.

Nickel ingestion can cause exacerbation of dermatitis in patients who are already nickel-sensitive; Chromium (Cr VI) is the 2nd allergen, after nickel. However, stainless steel is widely used in home cookware. In this study, we determined nickel and chromium levels by atomic absorption spectrometry in 11 habitual menus cooked in different grades of stainless steel utensils. We noted a great difference in nickel and chromium intake depending on the menu, and a significant difference between the glass and stainless steel saucepans, but this was very low compared with the levels of nickel and chromium contained in the menus; mean intakes of these elements were under the tolerable daily intake (TDI) recommended by the World Health Organization. Hence, there is no advantage for nickel-sensitive patients in switching to materials other than stainless steel, provided that this is of good quality.

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