Is nickel allergy an occupational disease? Discussion of the occupational relevance of a type IV allergy to nickel (II) sulfate using case reports

Abstract

Type IV sensitization to nickel (II) sulfate is common in the general population. Nickel can be found in different metals leading to occupational exposition in industrial professions. The individual clinical relevance of nickel allergy can easily be identified but it can be difficult to assess if nickel allergy was acquired privately or occupationally. The problem if nickel allergy fulfills the criteria of an occupational skin disease is presented in three case reports. The occupational relevance of a type IV sensitization to nickel in a chemical laboratory assistant, a flight attendant and a cashier are discussed. Important conditions for acquiring nickel allergy are contact with nickel-plated and nickel-releasing materials, the kind of skin contact, the status of the epidermal barrier, and the individual working conditions with an increased bioavailability of nickel. In cases of type IV sensitization to nickel, the affected person cannot continue to work in metal plating or with contact to nickel-plated metals. The causal relationship between the type IV sensitization to nickel and the occupation needs to be clarified in each individual case. In general, occupationally caused nickel allergy is rare and the occupational relevance of nickel allergy is often overestimated.

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

“…Pressure, sweat, moisture, and friction may increase the severity of nickel hypersensitivity. Occupational exposure to sufficient concentrations of nickel induces and provokes hand contact dermatitis [11, 16]. …”

“…The individual clinical relevance of nickel allergy can easily be identified but it can be difficult to assess if nickel allergy was acquired privately or occupationally [16]. Hairdressers/beauticians were the most affected group followed by house workers (housewives, cleaners, housekeepers) in our series of patients.…”

“…Thirty to forty per cent of nickel-sensitive people develop hand eczema, which may become recurrent or chronic, affecting their ability to work and causing large expenses for the society [15]. The individual clinical relevance of nickel allergy can easily be identified but it can be difficult to assess if nickel allergy is acquired privately or occupationally [16]. …”

Induction of autoimmunity in brown Norway rats by oral and parenteral administration of nickel chloride

“…Allergic contact dermatitis induced by nickel has been shown to be due to a T-cell mediated delayed hypersensitivy reaction to hapten. 19 To the author's knowledge, this study is probably the first attempt to explore the role of nickel in inducing autoantibodies in genetically immunosusceptible rats.…”

Nickel Allergy in Adults in the US

“…8,9 Occupational sources seem to be a lower source of overall sensitization, but occupational dermatitis contributes significantly to the associated cost of nickel allergy (especially in the context of hand eczema). 10 The estimated annual societal cost per patient with occupational hand eczema in Germany is €8799 (US $9575)Vsimilar to the cost of patients with psoriasis and atopic dermatitis. 11 The majority of the cost was found to be related to productivity loss resulting from disability.…”