“…3,4 Drug and skin-contact allergies are more common in patients with pSS than in those with other rheumatic diseases. [5][6][7] Notably, it has been suggested that delayed-type (type IV) hypersensitivity to environmental metals, which induces contact dermatitis and systemic inflammatory symptoms, underlies a subset of autoimmune diseases, such as pSS. 8,9 To better understand the contribution of metal allergy to pSS, a case-control study was conducted to assess the prevalence and severity of zinc, gold, nickel, and palladium hypersensitivity in a cohort of Japanese patients with pSS.…”