In 2400 consecutive patients at 8 clinics in 5 countries, nickel hypersensitivity was found in 176 cases (7.3%), 19 male (2.1%) and 157 female (10.5%). The incidence ranged from 15 to 38 cases in 300 patients of every department (5.0% Sofia to 12.7% Erfurt). 60.6% of the nickel positives were schoolgirls or younger than 25 years. The exposure time was 3 years, in 49% 1 year or shorter. Most cases (75%) are not occupationally acquired, but due to costume jewelry (31.8%), wrist watches (23.3%), metal clothing buckles (3.4%) including jeans buttons. Job dependent nickel dermatitis is often (36/51 cases) linked with wet work. Atopic dermatitis was found in 8.3% of female nickel allergy. Nickel positivity without a dermatitis history was seen in 9/176 cases (5%). Nickel allergy will become a sex-indifferent phenomenon in Europe, because of the changing customs of adornment.

Dermatitis in 8 female nursery workers handling Alstroemeria ligtu cultivars has been proven/proved in 6 cases to be of allergic origin. Epicutaneous tests with cut flower extracts as well as with the isolated and purified sensitizer were positive. Successful animal experiments corroborated the sensitising capacity of Alstroemeria cultivars. The responsible but unstable contact allergen, alpha-methylene-gamma-butyrolactone (tulipalin A), was found in short ether extracts of flower petals in concentrations up to 18%. Due to its instability, subsequent extractions were performed with methanol, yielding the sensitising constituent after purification in the glucosidic form (tuliposide A). This could be stored at room temperature for longer periods without loss of activity. Tuliposide A was determined in specimens of Alstroemeria ligtu cultivars of 14 different origins of various colours; its content varied between 1 and 2%. Direct testing of the plant material in human patients carries the risk of false positive reactions and active sensitisation, as the threshold for both forms of the allergen is very high. Only a concentration of 0.01% can be considered safe.

In a previous paper, we reported on nickel sensitivity in 2400 consecutive patients in 5 countries. 3 years later, we reassessed 104 of the 157 nickel-positive patients of this former study and found 13 now to be negative to nickel sulphate. Nearly all the others can no longer tolerate nickel contact. 68 patients were free from nickel dermatitis, 16 showed a very mild eczema or dyshidrosis, and 13 were suffering from chronic hand dermatitis. 42 of 104 patients had changed their occupation, 36 successfully, with clearance of skin lesions. Rehabilitation by avoidance of nickel-containing costume jewelry, wrist-watches and clothing buckles, and by change of occupation, is possible and necessary.

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