Epidemiology of nickel allergy: results of a follow‐up analysis of patients with positive patch tests to nickel

Schubert, H.; Kohánka, Valéria; Korossy, S; Nebenführer, L; Prater, E.; Rothe, A; Szarmach, H; Temesvári, Erzsébet; Ziegler, Verena

doi:10.1111/j.1600-0536.1988.tb02811.x

Cited by 25 publications

(12 citation statements)

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“…The authors of several studies have promoted nickel avoidance as the ultimate long-term solution to nickel dermatitis (6,7,11,21,22). However, many children and adolescents find it fashionably difficult to give up wearing blue jeans.…”

Section: Discussionmentioning

confidence: 99%

Periumbilical Allergic Contact Dermatitis: Blue Jeans or Belt Buckles?

Byer

Morrell

2004

Pediatric Dermatology

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Nickel is the most ubiquitous contact allergen among children and adolescents. Metal blue jeans buttons and belts have been noted to cause nickel dermatitis around the umbilicus. For these children, traditional teaching is strict avoidance of all pants with metal snaps/buttons, particularly blue jeans. In this study we tested 90 pairs of blue jeans and 47 belts for nickel using the dimethylglyoxime spot test. Only 10% of blue jeans tested positive, while 53% of belts tested positive. Furthermore, 10 pairs of nickel-negative blue jeans remained negative after 10 washings. Overall we found no resistance to testing in clothing stores. From these results, we recommend that patients with allergic contact dermatitis secondary to nickel need not strictly avoid blue jeans and metal belt buckles. Rather, families should be encouraged to use the dimethylglyoxime spot test to test these items for nickel prior to purchase.

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Section: Discussionmentioning

confidence: 99%

Periumbilical Allergic Contact Dermatitis: Blue Jeans or Belt Buckles?

Byer

Morrell

2004

Pediatric Dermatology

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“…Schubert et al (5) restudied 104 nickel‐positive patients 3 years later; 13 (12.5%) were then negative. Christensen (6) examined the prognosis in nickel allergy and hand eczema in 2 similar patch‐test studies performed 6 years apart.…”

Section: Nickelmentioning

confidence: 99%

Is contact allergy in man lifelong?

Lee

Maibach

2001

Contact Dermatitis

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In contradistinction from certain strains of mice, contact allergy in man is hypothesized to be either lifelong or at least to last for years. We examined follow-up studies on contact allergy, as evaluated by patch testing, attempting to quantify its natural history. The allergens include colophonium, gold sodium thiosulfate, nickel, and cobalt. At present, due to technical limitations, we cannot state in quantitative terms whether contact allergy in man is lifelong and whether its clinical manifestations change. Thus, we list some criteria for future studies which may help resolve the above question.Key words: contact allergy; follow-up study; eczema; patch testing. C Munksgaard, 2001. Accepted for publication 4 September 2001Contact allergy in man is considered to be either lifelong or at least to last for years (1). We examined follow-up studies on contact allergy, as evaluated by patch testing, attempting to quantify its natural history. ColophoniumFärm et al. retested 83 patients after 9-13 years in whom contact allergy to colophonium had been diagnosed (2). 16 participants (19%) were negative to colophonium and in 7 the reaction was doubtful. We are uncertain of the biological significance of the doubtful reactions, because test substances from another supplier were used. In addition, since colophonium is not particularly known to cause irritant patch test reactions (3), the doubtful reactions may in fact have represented contact allergy. The composition of this complex natural product may also have varied over the decade. Gold Sodium ThiosulfateBruze et al. (3, 4) examined the development and course of test reactions to gold sodium thiosulfate. This patch-test response has a rate of approximately 10% when added to the standard series. Over 2 months, 10 patients were retested epicutaneously (e.c.) and intracutaneously (i.c.) with dilution series. All 10 patients (100%) had a positive test reaction of some form during the retest. During the entire study, 26 positive e.c. reactions were diagnosed. Within the 1st week, 17 (65%) were recorded; in 10 days, another 9 reactions (35%) appeared. The patients with the latter reactions also had positive test reactions within the 1st week. After 2 months, 9 reactions remained. Out of 30 i.c. tests, 25 became positive within 1 week.Though the authors did not provide information on the rapidity of the initial patch test to diagnose allergy, they did suggest that active sensitization can occur, leading to a more rapid response on retesting. To diagnose contact allergy to gold sodium thiosulfate, readings at 3 days might be supplemented by readings at 1 and 3 weeks (4). All the patients remained positive for contact allergy to gold sodium thiosulfate from the point of their initial diagnosis to the time of this study.

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“…A Belgian follow‐up study including female patients with nickel allergy showed that 75% still suffered from nickel dermatitis when they did not avoid skin contact with metallic items and that 53% still had hand eczema (307). Schubert et al questioned and re‐patch tested 100 patients with nickel allergy 3 years after their first visit and found that nearly all patients reported intolerance to metallic consumer items such as jewellery, watches and buckles (308). A total of 68 patients were free of dermatitis whereas 13 suffered from chronic hand eczema; 42 had changed their job, mostly to white collar occupations (308).…”

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confidence: 99%

“…Schubert et al questioned and re‐patch tested 100 patients with nickel allergy 3 years after their first visit and found that nearly all patients reported intolerance to metallic consumer items such as jewellery, watches and buckles (308). A total of 68 patients were free of dermatitis whereas 13 suffered from chronic hand eczema; 42 had changed their job, mostly to white collar occupations (308). Kalimo et al questioned 91 patients who had been found to be nickel allergic at least 10 years earlier (182).…”

mentioning

confidence: 99%

Nickel and cobalt allergy before and after nickel regulation – evaluation of a public health intervention

Thyssen

2011

Contact Dermatitis

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Over the 20th century, the frequent use of nickel in consumer products resulted in an increasing prevalence of nickel allergy. Risk items included suspenders in the 1950s-1960s; buttons, zippers and rivets in the 1970s; and ear-piercing jewellery in the 1980s. When subjects allergic to nickel were exposed to nickel in high concentrations, it often resulted in allergic nickel contact dermatitis and hand eczema. In 1990, the Danish government began to regulate consumer nickel exposure as a response to the increasing nickel allergy problem. In 1994, the EU Nickel Directive was passed, a regulation that was based on the Danish and Swedish nickel regulations. These major public health interventions were expected to change the epidemiology of nickel allergy and dermatitis in Europe. Furthermore, it was debated whether nickel would be replaced by cobalt in inexpensive jewellery and result in higher prevalence of cobalt allergy. An evaluation of the possible effects of the European nickel regulations is of importance to ensure protection of consumers and dermatitis patients. This doctoral thesis aimed to evaluate the effects of regulatory interventions on nickel exposure by investigating the development of nickel allergy and dermatitis before and after nickel regulation. Furthermore, a change in the association between nickel allergy and hand eczema was evaluated. The nickel spot test was validated to determine its value when used for screening purposes. Possible explanations for the persistence of nickel allergy were explored including genetic predisposition and consumer nickel exposure from jewellery and accessories. A cobalt spot test was developed and validated. Finally, it was evaluated whether a cobalt allergy epidemic had replaced the nickel allergy epidemic after nickel regulation in terms of increasing cobalt sensitization and cobalt exposure. The thesis showed that the prevalence of nickel allergy decreased significantly after nickel regulation in young Danish women from the general population (18-35 years) and in young Danish female dermatitis patients from a university patch test clinic (0-30 years). Stratification by ear-piercing status revealed that women ear pierced before 1990 had a significantly higher prevalence of nickel allergy and dermatitis than women ear pierced after 1990. Furthermore, the association between hand eczema and nickel allergy decreased in young women aged 18-35 years when a comparison was made between women who were patch tested and questioned in, respectively, 1990 and 2006. Despite the decreasing prevalence of nickel allergy, this condition remains prevalent in young Danish women, as about 10% are nickel allergic. Genetic predisposition to nickel allergy was evaluated by investigating the possible association between filaggrin null mutation status and nickel allergy. A positive association was found but it was also concluded that environmental nickel exposure is of much greater importance. Thus, of 354 consumer items purchased from 36 different stores in Copenhagen, 22% released ni...

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Epidemiology of nickel allergy: results of a follow‐up analysis of patients with positive patch tests to nickel

Cited by 25 publications

References 1 publication

Periumbilical Allergic Contact Dermatitis: Blue Jeans or Belt Buckles?

Periumbilical Allergic Contact Dermatitis: Blue Jeans or Belt Buckles?

Is contact allergy in man lifelong?

Nickel and cobalt allergy before and after nickel regulation – evaluation of a public health intervention

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