Chromium allergy and dermatitis: prevalence and main findings

Abstract

SummaryThe history of chromium as an allergen goes back more than a century, and includes an interventional success with national legislation that led to significant changes in the epidemiology of chromium allergy in construction workers. The 2015 EU Leather Regulation once again put a focus on chromium allergy, emphasizing that the investigation of chromium allergy is still far from complete. Our review article on chromium focuses on the allergen's chemical properties, its potential exposure sources, and the allergen's interaction with the skin, and also provides an overview of the regulations, and analyses the epidemiological pattern between nations and across continents. We provide an update on the allergen from a dermatological point of view, and conclude that much still remains to be discovered about the allergen, and that continued surveillance of exposure sources and prevalence rates is necessary.Key words: allergic chromium dermatitis; allergy; chromium; chromium allergy; dermatitis; leather; metals; potassium dichromate; screening; spot test.Chromium is a transition metal with the atomic number 24. Industrialization and modern living have resulted in increased exposure to chromium ions for more than a century. Chromium salts can induce skin irritation and allergic contact dermatitis. These manifestations have been the basis for multiple studies, reports, and regulations (Table 1). We review chromium allergy from a dermatological perspective, providing an update combined with a historical perspective. Materials/MethodsFor the epidemiological part of this review article, a PubMed/MEDLINE literature search was performed on 10 December 2014, with the following search terms:'((((chromium or chromate or chrome or potassium dichromate) and (patch test or For a study to be included in the prevalence calculation, the prevalence rate had to be obtained from patch test clinics where the primary indication was dermatitis and not, for example, prosthesis insertion. Studies needed to report prevalence rates that would allow for calculations. Finally, we decided to only include studies published from 2004 and onwards, with the primary intention of performing an up-to-date review analysis on prevalence rates and trends during the last 10 years.The information for the remaining sections of this review article originated from a similar PubMed/ MEDLINE literature search performed with relevant search terms for the respective topics, focusing mainly on newer publications, but not neglecting older studies. The historical perspective of chromium allergy was mainly based on the doctoral theses by the Scandinavian dermatologists Bonnevie (7) . Statistical significance was predefined as a p-value of < 0.05. ResultsThe literature search resulted in a total of 1066 potential studies for the epidemiological part. Abstracts were then screened, and 132 articles were found to be relevant for further analysis. For the epidemiological comparison between Europe, North America, and Asia, a total of 31 studies were relevant. The Passivati...

Contact allergy in children with atopic dermatitis: a systematic review

“…Reactions to cobalt chloride and potassium dichromate were also frequent among the children with AD. Previous studies have reported the same pattern of sensitization in patients with AD . In a study by Malajian and Belsito, positive patch test reactions to nickel sulfate, cobalt chloride and potassium dichromate were significantly more frequent among patients with AD than in controls.…”

“…In a study by Malajian and Belsito, positive patch test reactions to nickel sulfate, cobalt chloride and potassium dichromate were significantly more frequent among patients with AD than in controls. The three metal allergens are known to occur concomitantly, and the irritating properties of potassium dichromate could in theory cause a false‐positive reaction in AD skin . However, especially reactions to potassium dichromate were relevant in a substantial proportion of the reviewed cases .…”

Chromate and amine contact allergies in workers manufacturing precast concrete elements

“…The prevalence of chromate contact allergy is decreasing in Europe, probably as a result of the legislative measures regarding hexavalent chromium in cement , but cases of chromate allergy among concrete workers are still being observed . Whereas cement has been a historically important source of sensitization in Europe, it is currently thought that exposure to chromium‐tanned leather is of greater importance .…”

Allergic contact dermatitis pattern in Kuwait: nickel leads the pack. In-depth analysis of nickel allergy based on the results from a large prospective patch test series report

“…It may present acutely as an initial sensitization after exposure to the allergen or may be seen in a previously sensitized individual on re-exposure. The epidemiology of contact dermatitis has been analyzed in various studies done in the past from almost all over the world [1–4], but no such data from Kuwait exists. Nickel is the most common identified allergen worldwide, and is extensively used in everyday life.…”