Nickel contact allergy

Veien NK, Menne T. 1990. Nickel contact allergy and a nickel-restricted diet. Seminars in Dermatology 9(3) 197-205. 

Edman B, Janzon L (1989) Social and demographic aspects of nickel contact allergy. In Maibach HI, Menn T (eds) Nickel and the skin immunology and toxicology. CRC Press, Boca Raton, Florida, pp 207-214... 

Fullerton A, Menne T (1995) In vitro and in vivo evaluation of the effect of barrier gels in nickel contact allergy. Contact Dermatitis 32 100-106... 

Nethercott JR (1982) Results of routine patch testing of 200 patients in Toronto, Canada. Contact Dermatitis 8 389-395 Nethercott J, Fowler J, Kauffman L, et al. (1996) Human response to repetitive hexavalent chromium challenge at 25 pg/ml in water. Jadassohn Centenary Congress, London Niklasson B, Bjorkner B, et al. (1996) In vivo evaluation of an active barrier cream in nickel contact allergy. Jadassohn Centenary Congress, London... 

Moller H. 1984. Attempts to induce contact allergy to nickel in the mouse. Contact Dermatitis 10 65-68. 

Uter, W., Pfahlberg, A., Gefeller, O., Geier, J., and Schnuch, A., Risk factors for contact allergy to nickel — results of a multifactorial analysis, Contact Dermatitis, 48, 33, 2003. 

Francomano, M., Bertoni, L., and Seidenari, S. Sensitive skin as subclinical expression of contact allergy to nickel sulfate, Contact Dermatitis, 42, 169, 2000. 

Contact allergy to topically applied aluminium compounds is rare but skin sensitization has been described (54). In one case the use of a cream for acne and hyperpigmentation was followed by dermatitis, and patch tests were positive to both aluminium sulfate and aluminium chloride. A more typical antecedent of sensitization is the injection of aluminium-adsorbed vaccines, and such patients may present with a granulomatous nodule at the site. Mixed contact sensitivity to nickel and aluminium has been reported to respond to antihistamine therapy (55). 

S., Meinertz, T., and Hamm, C.W. (2000) Nickel and molybdenum contact allergies in patients with coronary in-stent restenosis. Lancet, 356, 1895-1897. 

SoLTERMANN, W. Toxic epidermal necrolysis (LyelL). Syndrom oder besonders schwere Verlaufsform einer Allergodermie Dermatologica (Basel) 118, 265—278 (1959). Stewart, S. G., and F. E. Cormia Experimental nickel dermatitis. J. Allergy 5,575-582 (1934). Vandenberg, j. j., and W. L. Epstein Experimental nickel contact sensitization in man. J. invest. Derm. 41, 413—418 (1963). 

In 84 male woodwork teachers there was a high incidence of allergic reactions to colophony using patch tests to a supplemented European standard series and acetone extracts of wood dust of pine, spruce, juniper, and birch 19% had mild hand eczema and there was contact allergy to several allergens in the working environment, including benzisothiazolin-3-one, nickel, formaldehyde, and colophony [52 ]. 

It is generally believed that individuals with demonstrated contact allergy to allergens commonly occurring in the environment, such as nickel, chromium, and paraphenylene diamine, retain their sensitivity throughout their lives and must therefore entirely avoid the eliciting allergens to prevent relapse. The risk... 

Nickel allergy is the most frequent contact allergy in the industrialised world and an important cause of hand eczema. Nickel allergy predominantly affects young girls and women sensitised by jewellery and other personal items. A hundred years ago, however, nickel dermatitis was an occupational disease that affected men. Occupational exposure to this metal is still a major factor in eliciting and maintaining hand eczema. 

Table 1. Some major nickel alloys, their applications, content and probability of causing contact allergy (based on personal communication from GN Flint, Nickel Development Institute 1998, and Flint 1998) ...

Alloy and applications Typical Nickel content (%) Other elements (%) Probability of causing contact allergy... 

A, Alloys that behave similarly to nickel B, Alloys that react very slowly with sweat and are unlikely to cause contact allergy C, Alloys that only in exceptional circumstances will react with sweat and are most unlikely to cause contact allergy... 

The major health effect of nickel and its compounds is contact allergy and allergic contact dermatitis as a result of skin exposure to nickel ions, Ni(II). Inhalation exposure to soluble nickel and nickel oxides/sulfides has caused nasal and pulmonary cancer in workers in nickel refineries although there are no convincing data on carcinogenicity for metallic nickel dust in humans. Exposure to nickel or nickel compounds via routes other than inhalation has not been shown to increase the cancer risk in humans (Aitio 1995). Inhalation of nickel compounds may induce asthma however, nickel-induced asthma is rare. 

Hand eczema and contact allergy was studied in hospital employees in Finland (Lammintausta et al. 1982). Nickel allergy was found in 9.1% of the 536 workers tested and 60% of all nickel-sensitive persons had a history of hand eczema (Table 3). The 20-month prevalence of hand eczema was 41% among 1857 women employed in wet hospital work in Sweden (Table 3), and the most important risk factors were a history of earlier hand eczema, followed by a history of metal dermatitis (Nilsson and Back 1986). 

Three common contact allergens diagnosed by standard patch testing - chromium, cobalt, and nickel - head every list of metal contact sensitivity (Chaps. 66-68). Concerning some of the metals reviewed below, cases of occupational contact dermatitis are rarely seen today or are at least not reported. The reason is probably due to extensive preventive measures, including reduced exposure and automation (Chap. 52). However, even if a contact allergy is acquired non-occupationally, there is always a risk of relapses at renewed exposure in an occupational setting. 

Results from patch tests performed with impure preparations and with an insufficient number of controls for irritancy imply that some anecdotal reports on contact allergy to metals, such as antimony, iron, lead, silver, manganese, and zinc, may be questioned. Scientifically, as well as from a clinical point of view, it is somewhat challenging that nickel, chromium, and cobalt are so dominant, while the other metals in the periodic table of elements play such a minor role. 

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