nickel allergic contact dermatitis; sensitization; diagnosis; prevention strategy; therapy and management Archives

Tag Archive for: nickel allergic contact dermatitis; sensitization; diagnosis; prevention strategy; therapy and management

Nickel Workshop

June 27, 2016/in Allergic Contact Dermatitis Facts, Regulation and Policy/by Sharon Jacob MD

On June 23, 2016, a historic event occurred – the first US Nickel Workshop. Thought leaders from medicine, industry and regulation came together to discuss the issue of nickel dermatitis, appropriate uses of nickel, and the integral role of nickel in society at the first North American Workshop on Nickel Dermatitis. This workshop was sponsored and coordinated by the Nickel Institute, who brought toxicologists and dermatologists together with conscientious companies representing various consumer product sectors. The group stressed the importance of nickel release, not nickel content in determining risk of becoming allergic to nickel and having a nickel dermatitis reaction if you are already allergic to nickel.

Removing nickel from our environment is not possible, because it is one of the most abundant metals on our planet and it has many beneficial uses where it cannot be reasonably substituted (e.g. stainless steel) . What is possible, though, is to use it in the safest ways possible. For example, nickel is safely used in several types of stainless steels. Nickel is also used as nickel-plated carbon fibers in the composite case of personal cell phones to keep our brains safe from the electromagnetic energy generated from by cell phone use. A top priority was discussed at the nickel workshop of removing high nickel-release materials from use in piercing posts (used in jewelry) by using appropriate low nickel-releasing materials (e.g. surgical stainless steel, high quality gold, etc.) since piercing directly introduces releasednickel to an open wound. This is especially important for children who, if sensitized, have a lifetime to deal with the consequences.

The Nickel Institute will be putting together a full report from the Nickel Workshop, which will be made available online on the Nickel Institute website at https://www.nickelinstitute.org Dr. Jennifer Chen, MD, a dermatologist from Stanford University, presented the background of nickel allergy in the US at the Nickel Workshop in addition to developing an outreach education webinar on this topic available to the public https://www.dermatitisacademy.com/webinars/ The webinar discusses that EU regulations have decreased nickel allergy in ear pierced young women from 16.6% down to 6.9%. The estimated savings of $2 billion over the last 20 years is massive and that could translate into an even bigger savings with the US population.

At the Nickel Workshop, Dr. Sharon Jacob, MD, a dermatologist from Loma Linda presented the situation of nickel dermatitis in children in North America, noting that nickel allergy is found at an early age and is thought to be largely due to ear piercing in young girls. She reported that an estimated 11% of the US general population is currently sensitized to nickel, which includes an estimated 8,133,603 children! She also stated that a significant proportion of these could be prevented by utilizing safer metals in piercing. Dr. Jacob ended her presentation at the Nickel Workshop with a slide that said:

‘You can’t tell an adult they can’t pierce and smoke… but you can protect a child.’

To learn more about nickel allergy and sensitization, please visit the Dermatitis Academy page dedicated to nickel https://www.dermatitisacademy.com/nickel-page/ which includes information on the low nickel diet, how to DMG test metal objects to screen for nickel release, a quiz on sources of nickel and a general population questionnaire on nickel sensitization. https://emg.wufoo.com/forms/nickel-allergic-contact-dermatitis-survey/

DMG sensitivity

June 27, 2016/in Nickel Contact Dermatitis/by Sharon Jacob MD

The DMG has modest sensitivity:

“The sensitivity of the DMG test was 59.3% and the specificity was 97.5% based on DMG-test results and nickel release concentrations determined by the EN 1811 reference method. … The EN 1811, a European standard reference method developed by the European Committee for Standardization (CEN), is fine-tuned to estimate nickel release around the limit value of the EU Nickel Directive from products intended to come into direct and prolonged skin contact.”

Direct and prolonged contact with FREE RELEASED nickel is what leads to sensitization and skin rashes (allergic contact dermatitis). Because of the DMG sensitivity issue (not always detecting) – consumers should not rely on this 100% but rather use if for screening.

Past exposure studies may have underestimated nickel release from consumer items.”

Management of Nickel Allergy

May 27, 2016/in Allergic Contact Dermatitis Facts, Nickel Contact Dermatitis/by Sharon Jacob MD

Nickel allergy affects individuals of all ages and proves to be the number one sensitizing agent worldwide. Correct diagnosis is vital, as the localized or diffuse reactions that are associated with nickel allergic contact dermatitis may be confused with other conditions – resulting in delay of the appropriate care. Due to the increasing number of cases, there is an outstanding necessity to understand the source of sensitization, diagnosis, preventative/therapeutic strategies, and prognosis of nickel article.

This review by Chandler Rundle, BS. MSI, Loma Linda University of Management of contact dermatitis due to nickel allergy: an update. Fernanda Torres, Maria das Graças, Mota Melo, Antonella Tosti. In CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY, Vol 38 – 2009, pg 39-48 highlights:

Introduction

Worldwide, the prevalence of nickel allergic contact dermatitis is about 8.6%. While prevalence in young women is approximately 17%
A genetic predisposition may cause a higher prevalence of nickel allergy.
In the United States, as much as 16.2% of the US population has had a reaction to nickel.

Source of Sensitization

Sensitization can occur from exogenous (skin contact) or endogenous (oral, inhalation) exposure with products containing nickel.
Nickel allergy may be associated with other metal allergies, such as chromium and cobalt and allergy to one metal may increase the reactivity to another metal.

Diagnosis

Clinical features of nickel allergic contact dermatitis include localized primary eruptions, characterized by recurrent lesions at sites of direct contact with nickel.
Sensitized individuals may experiences systemic allergic contact dermatitis (reactions at distant sites or from an inhalational, ingestion, implantation dose). Reactions occur in a dose-response relationship
While nickel contact allergy is diagnosed with patch testing, the test only measures sensitization; not clinical disease
Positive patch tests to nickel are seen in 10-30% of women, 2-8% of males, 15.9% of children, and 13.7% of individuals older than 65.
Dimethylgloxime (DMG) spot-test is a method used to identify items that contain nickel. Items with a positive result may induce dermatitis.
Other methods, such as oral provocation (stimulation), lymphocyte proliferation, and the prick test, can also be used to detect nickel allergic contact dermatitis, but are not routinely suggested.

Preventative Strategies

The most sure way to prevent recurrence of dermatitis is to avoid skin contact with items that release nickel.
Additional measures, such as use of antiperspirants or decrease in smoking, can decrease the recurrence of allergic contact dermatitis.

Therapeutic Strategies

Nickel allergic contact dermatitis may have varying clinical manifestations. Thus, it is important to recognize that these manifestations may require different forms of therapy.
Steroids, calcineurin inhibitors, psoralen plus UV-A, disulfiram, binding agents/barrier creams, and posttibly a low nickel diet serve as therapies in differing capacities.

Occupational Allergy

Occupational allergy often presents as hand eczema, which can lead to the inability to work.
In addition to preventative and therapeutic strategies needed to prevent recurrence, conditions in the workplace environment must also be improved.

Prognosis

Nickel sensitization is a lifelong condition, but with early diagnosis and proper management (through avoidance), prognosis of this condition is often good and remission sustained.
Factors that may worsen the prognosis include, ‘continuous nickel exposure, involvement of the hands, secondary bacterial infection, history of atopic dermatitis, and multiple contact allergies.’ [Multiple contact allergies – polysensitization]