Reactivity to patch tests with nickel sulfate and fragrance mix in infants

Abstract

The pattern of patch test reactivity to nickel sulfate and fragrance mix was studied with respect to patch test performance, reproducibility and clinical relevance in a population of unselected infants followed prospectively from birth to 18 months of age. TRUE Testtrade mark patches with nickel sulfate in 3 concentrations, 200, 66 and 22 microg/cm(2), and fragrance mix 430 microg/cm(2) were used. A likely case of nickel sensitivity was defined as a reproducible positive reaction with at least homogeneous erythema and palpable infiltration occurring at least 2x and present at both the 12 and 18 months follow-up. 543 infants (268 girls and 275 boys) were tested at least 1x, 304 were tested at both 12 and 18 months. The prevalence of a reproducible positive reaction to nickel was 8.6% (20 girls and 6 boys). A transient positive reaction was observed in 111 children. Clinical relevance of nickel sensitivity was found in only 1 child. No reproducible positive reaction to fragrance mix was found. The high proportion of transient patch test reactivity to nickel sulfate 200 microg/cm(2) indicates that this standard concentration used for adults cannot be applied to infants. The interpretation of a single positive nickel patch test in infants must be assessed with caution and it is probably of non-specific or irritant nature.

Allergic Contact Dermatitis in Children

“…Hjorth (Hjorth, 1981) thought that patch test reactions in infants were predominantly irritant reactions, especially when testing with nickel sulfate. In a study of Jøhnke et al (Jøhnke et al, 2004) it was confirmed that increasing numbers of infants positively patch tested to nickel sulfate but most reactions were transient and probably irritant or non-specific nature. Experimental CA to plants of the Rhus genus has also been induced in infants, showing that sensitization is possible (Epstein, 1961).…”

“…Of these, about 56-93% was of current relevance (Weston & Weston, 1984;Pevny et al, 1984b;Fisher, 1994a;Rudzki & Rebandel, 1996;Stables et al, 1996;Manzini et al, 1998;Bruckner et al, 2000;Machovcová et al, 2001;Wöhrl et al, 2003;Heine et al, 2004;Lewis et al, 2004;Jøhnke et al, 2004;Vozmediano & Hita, 2005;Wahlberg & Lindberg, 2006;Goossens & Morren, 2006;Jacob et al, 2008). Among the children with a positive patch test 3.2% to 54.4% had multiple contact allergies (Mortz & Andersen, 1999).…”

“…Nickel was the top allergen in children in 14 of the 17 studies of patch testing summarized by Mortz and Andersen (Mortz & Andersen, 1999). Even in younger children nickel allergy is not uncommon (Jøhnke et al, 2004). Published rates of nickel sensitization in children range between 10% and 24% (Wöhrl et al, 2003;Heine et al, 2004;Lewis et al, 2004;Seidenari et al, 2005;Vozmediano & Hita, 2005;Clayton et al, 2006;Militello et al, 2006;Goossens & Morren, 2006;Milingou et al, 2010).…”

Contact Dermatitis in Children

“…Nickel is the most widespread allergen in the general population (Heim & McKean, 2009;Johnke et al, 2004) and is most often identified as the leading allergen in children (Tables 1 & 2). It accounts for up to 14.9% of positive patch tests (Dotterud and Falk, 1995) in asymptomatic children and is generally more frequent in females (Beattie et al, 2007;Brasch & Geier, 1997;Giordano-Labadie et al, 1999).…”

“…Importantly, young infants may also be sensitized to nickel. In a study of 543 infants followed from birth to age 18 months, 8.6% showed a reproducible positive reaction to this metal (Johnke et al, 2004). Ear piercing is often considered the major risk factor for becoming sensitized to nickel (Smith-Sivertsen et al, 1999).…”