Nickel, chromium and cobalt: the relevant allergens in allergic contact dermatitis. Comparative study between two periods: 1995-2002 and 2003-2015

Abstract

BackgroundMetals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects.ObjectivesTo analyze and compare with previous studies the profile of metal sensitization between 2003-2015.MethodsPatients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology.ResultsOf the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001).Study limitationsThe study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives.ConclusionThe sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.

Delayed hypersensitivity to palladium dichloride: 15‐year retrospective study in a skin allergy unit

“…However, so far, this has not been seriously contemplated in Europe or the United States, in part because hypersensitivity to palladium is frequently associated with hypersensitivity to nickel . In our study, >90% of the patients with palladium allergy were co‐sensitized to nickel; this finding is similar to the 94% reported by Durosauro et al Some authors do not see the relevance of a positive patch test recation to palladium . Co‐sensitization to several metals would complicate the identification of sources of exposure, and therefore the assessment of the relevance of a positive reaction .…”

“…[8][9][10]13 In our study, >90% of the patients with palladium allergy were co-sensitized to nickel; this finding is similar to the 94% reported by Durosauro et al 13 Some authors do not see the relevance of a positive patch test recation to palladium. 3,7,9,10,13 Co-sensitization to several metals would complicate the identification of sources of exposure, and therefore the assessment of the relevance of a positive reaction. 7 According to Faurscho et al, hypersensitivity to palladium could almost be considered to be an indicator of nickel allergy.…”

“…Metal allergies are the most frequent causes of allergic contact dermatitis in our setting . The metal salts included in most baseline series are nickel sulfate, potassium dichromate, and cobalt chloride .…”

“…Metal allergies are the most frequent causes of allergic contact dermatitis in our setting. [1][2][3] The metal salts included in most baseline series are nickel sulfate, potassium dichromate, and cobalt chloride. [3][4][5] The reported prevalence of hypersensitivity to nickel sulfate in the European population ranges from 8% to 20%, despite regulations implemented in the EU with regard to this metal.…”

“…[1][2][3] The metal salts included in most baseline series are nickel sulfate, potassium dichromate, and cobalt chloride. [3][4][5] The reported prevalence of hypersensitivity to nickel sulfate in the European population ranges from 8% to 20%, despite regulations implemented in the EU with regard to this metal. [4][5][6][7] Palladium is a ubiquitous metal belonging to the platinum group.…”