Usage test with palladium‐coated earrings in patients with contact allergy to palladium and nickel

Abstract

There is a low risk of eczema in palladium-allergic and nickel-allergic individuals when they wear jewellery coated with pure palladium, but further studies are needed to determine whether palladium, when present in alloys, could cause allergic reactions. PdCl2 , like NiSO4 .6H2 O, shows variability in patch test reactivity over time. Furthermore, Na2 PdCl4 seems to be a more sensitive test substance than PdCl2 for the detection of palladium allergy.

Sensitization to palladium in Europe

“…Tillman et al. investigated the minimal elicitation concentration (MEC) in 40 Pd‐sensitized patients ; they found considerable variation in MEC, ranging from 0.035% to 3.5%. Unfortunately, in this study, concentrations between 1.0% and 3.5% were not investigated.…”

“…In an earlier study, 0.3%, 1.0% and 3.0% Na 2 PdCl 4 were tested in 20 patients to evaluate the irritancy of the different test concentrations (51); 1 positive reaction was found for 1%, and 4 positive reactions for 3%. Tillman et al investigated the minimal elicitation concentration (MEC) in 40 Pd-sensitized patients (45); they found considerable variation in MEC, ranging from 0.035% to 3.5%. Unfortunately, in this study, concentrations between 1.0% and 3.5% were not investigated.…”

“…Despite the above, Pd‐sensitized patients rarely react to metallic Pd , suggesting that Pd sensitization is not of significant clinical relevance in most cases of skin exposure.…”

“…However, solitary positive reactions to Pd (Pd monosensitization) are being reported, and have appeared to be more prevalent during recent years (46). Recently, sodium tetrachloropalladate (Na 2 PdCl 4 ) 3% in petrolatum has been shown to be a more sensitive patch test allergen than the commonly used palladium dichloride (PdCl 2 ) (45,51,52). This complicates the relationship between clinical symptoms and Pd allergy even more, as a considerable number of Pd-sensitized patients with clinically relevant symptoms may be missed with the use of a suboptimal test allergen.…”

Palladium‐induced granulomas analysed with inductively coupled plasma mass spectrometry

“…This raises the question of whether contact sensitization alone is enough to cause granulomas, as the clinical relevance of palladium hypersensitivity remains uncertain. Tillman et al investigated the wearing of palladium‐coated earrings, and found no skin reactions in 40 subjects who showed positive patch tests to palladium . Another possibility is that palladium permeates through the skin, causing a foreign body reaction.…”