Tag Archive for: nickel allergy

Nickel Navigator App

Achieve success with your low nickel diet

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In addition to the resources you can find at the Dermatitis Academy low nickel diet page, you can now increase your chances for success with the Nickel Navigator App. The app helps track your daily diet nickel intake! According to Rebelytics, the creators of the app, it is a “…support tool for individuals on a low-nickel diet.” The app helps you create a food journal to track your nickel intake. You can also browse though the food groups to see which foods are the lowest or highest in nickel, and you can search for a particular food and drill down into its data to understand how its nickel content varies. Rebelytics compiled this data from “more than 100 scientific sources, including national food studies and journal articles”. Interestingly, the average values can be weighted to the individual’s location so that the most geographically relevant sources are given priority. The app is easy to use, however for those that want to analyze the raw data this is readily available on their website.

Fibroblasts and oral-induced tolerance against nickel…

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‘Differences in human gingival and dermal fibroblasts may contribute to oral-induced tolerance against nickel’…

present results unveil new aspects of oral-induced tolerance and provide additional information for current knowledge, which indicates that oral Ni2 challenge before piercings may prevent Ni hypersensitivity…

Read more here:http://www.ncbi.nlm.nih.gov/pubmed/27264456

 

 

Nickel Summit Webinar

Nickel Contact Dermatitis Summit Webinar

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Nickel Contact Dermatitis Summit

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested patients of all ages worldwide, which we call attention to as the Nickel Contact Dermatitis Summit approaches.  And yet, nickel sensitivity is a much wider problem than the documentation suggests, as Peltonen alarmingly and poignantly pointed out over 30 years ago: “half of the subjects sensitized to nickel have never consulted a doctor because of their nickel dermatitis; still fewer have visited a dermatologist”.    In the US we are in the midst of a prospering hidden nickel epidemic akin to that seen in Europe prior to nickel regulation legislation.  There are millions of adults and children sensitized each year – the rates are UNACCEPTABLE, because this is a PREVENTABLE cause of allergic contact dermatitis.  The Nickel Summit webinar by Dr. Jennifer Chen discusses the impact of nickel allergy in the US and the lack of regulation.

 

Article Synopsis

Below is a summary of an article speaking more to this topic.

Synopsis by Janna Vassantachart, MD Loma Linda University School of Medicine

Article: Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel Allergy in US Adults-A 53-Year Review of Indexed Cases. Dermatitis. 2015 Jul 14.

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested US patients of all ages. In 1994, the European Union (EU) decreased rates of sensitization by enacting a Nickel Directive to regulate nickel release to no more than 0.5 µg/cm2/week. No such directive currently exists in the USA.

This study conducted a literature review of peer-reviewed adult nickel dermatitis cases published within the United States to identify trends over the past decades, sources of nickel sensitization, and regional variations.  It highlights the problem we are encountering at the top of the nickel contact dermatitis summit.   The results of the study demonstrated:

  • Between 1962 and 2015, there were 74 articles published reporting 18,251 cases of nickel sensitivity in US adults.
  • Over the past decades, the frequency of published articles on nickel sensitivity has continuously increased with a significant correlation (r = 0.798, P = 0.057). Compared to only one article published between 1960 and 1970, in the last 5 years, 30 articles have been published.
  • Five articles reported occupational exposures such as a stethoscope, chalk, and a military-issued lanyard chain from an identification neck tag (aka ‘‘dog tag’’). The most commonly reported nonoccupational sources were Essure contraceptive microinserts and Amplatzer septal occluders for atrial septal defects.
  • Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis.

Most nickel dermatitis cases seen clinically are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic towards the nickel summit. However, this study reveals that even the literature has seen a significant increase in published cases over the past decades. Rising rates of US nickel ACD highlight the need for medical professionals, legislators, and manufacturers to advocate for an EU-like Nickel Directive to regulate the release of free nickel.

 

 

Photo of positive DMG test

Electronics cause nickel rash (iPad)

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Nickel sensitization (and the clinical manifestation of nickel allergic contact dermatitis) is an issue that affects individuals of all ages. Nickel allergic contact dermatitis may present as a diffuse, or localized reaction, often leading the allergy to be confused with other conditions such as atopic dermatitis. While cases of nickel allergy are increasing, the cause of sensitization may not always be clear. Allergens must be identified, and actions must be taken to prevent contact.

This review by Chandler Rundle, BS. MSI, Loma Linda University of  iPad – Increasing Nickel Exposure in Children.  Sharon E. Jacob, MD and Shehla Admani, MD  In PEDIATRICS, Vol 134 – Issue 2 – 2014 highlights that:

*Flares of atopic dermatitis may be associated with increased contact with items containing nickel.

*Electronic devices, including the iPad, are a potential source of nickel sensitization in children.

*To prevent sensitization from electronics (and flares of allergic contact dermatitis), measures should be taken to minimize contact, such as including a case or duct tape as a barrier.

*With the increasing prevalence of nickel allergy among the pediatric population, identifying relevant allergens must become a priority in order to prevent AD flares.

Goblin's Copper Nickel Policy

Time for Nickel Policy

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Goblin’s Copper –The Time For a Nickel-Directed US Health Policy is Here. In THE DERMATOLOGIST, Vol 23 – Issue 3 – March 2015, pg 18-21

By Sharon E. Jacob, MD, Alina Goldenberg, MAS, Nanette Silverberg, MD, Luz Fonacier, MD, Bruce Brod, MD, Richard Usatine, MD, Robert Sidbury, MD, MPH, James Young, DO, Anthony Fransway, MD, Jonathan Silverberg, MD, PhD, MPH, Albert Yan, MD, and Janice L. Pelletier, MD, FAAP

Review by Chandler Rundle, BS. MSI, Loma Linda University

For years, nickel sensitization has plagued individuals of all ages. Nickel allergy can present as a localized or diffuse reaction, leading the reaction to often be confused with other conditions such as atopic dermatitis. Cases of nickel allergy are increasing, but there is minimal legislation on nickel restriction. The Jacob et al. article reviews/highlights that:

*International initiatives that regulated the allowable amount of nickel release from items inserted in piercings limited to <0.2 μg/cm2/week has led to decreased sensitization rates and a cost savings of $2 billion US dollars over a twenty year period.*A significant percentage of the clinical cases are unpublished – hence underrepresented.
* Half of the subjects sensitized to nickel have never consulted a doctor because of their nickel dermatitis
*Rates of nickel dermatitis have risen significantly. While awareness of nickel dermatitis has heightened as a public health issue.
* United States legislation has yet to formulate regulation of nickel in products – as Europe did in the 1990’s.

Nickel Contact Dermatitis

Nickel Contact Dermatitis in US Adults-A 53-Year Review- Synopsis

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Authors: Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel Allergy in US Adults-A 53-Year Review of Indexed Cases. Dermatitis. 2015 Jul 14.

Synopsis by Janna Vassantachart, MSIV — Loma Linda University School of Medicine

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested US patients of all ages. In 1994, the European Union (EU) decreased rates of sensitization by enacting a Nickel Directive to regulate nickel release to no more than 0.5 µg/cm2/week. No such directive currently exists in the USA.
This study conducted a literature review of peer-reviewed adult nickel dermatitis cases published within the United States to identify trends over the past decades, sources of nickel sensitization, and regional variations. The results of the study demonstrated:
• Between 1962 and 2015, there were 74 articles published reporting 18,251 cases of nickel sensitivity in US adults.
• Over the past decades, the frequency of published articles on nickel sensitivity has continuously increased with a significant correlation (r = 0.798, P = 0.057). Compared to only one article published between 1960 and 1970, in the last 5 years, 30 articles have been published.
• Five articles reported occupational exposures such as a stethoscope, chalk, and a military-issued lanyard chain from an identification neck tag (aka ‘‘dog tag’’). The most commonly reported nonoccupational sources were Essure contraceptive microinserts and Amplatzer septal occluders for atrial septal defects.
• Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis.

Most nickel dermatitis cases seen clinically are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic. However, this study reveals that even the literature has seen a significant increase in published cases over the past decades. Rising rates of US nickel ACD highlight the need for medical professionals, legislators, and manufacturers to advocate for an EU-like Nickel Directive to regulate the release of free nickel.

nickel allergy cartoon

Detection of Nickel Sensitization – Article Review

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Original article: HERE

Rietschel RL, Fowler JF, Warshaw EM, Belsito D, DeLeo VA, Maibach HI, Marks JG, Mathias CG, Pratt M, Sasseville D, Storrs FJ, Taylor JS, Zug KA. Detection of Nickel Sensitivity has Increased in North American Patch-test Patients. Dermatitis. 2008 Jan-Feb;19(1):16-9.

Review by Daniel No, BA. MSIII Loma Linda University School of Medicine

The prevalence of nickel contact allergy has steadily increased in men and women since the 1990s. The authors, Rietschel et al., enrolled 25,626 patients during the years 1992 to 2004 to undergo patch testing to detect nickel sensitivity. The data from this study demonstrated:

  • The nickel sensitization rate has steady increased from 14.5% in 1992 to 18.8% in 2004. The upward trend further emphasizes the importance of public awareness and education of nickel contact dermatitis. significant impact this allergen has on the North American population.
  • Females from 2001 to 2004 were 1.1 to 1.2 times more likely to be sensitive to nickel in comparison to females tested from 1992 to 2000. Similar results were found in the male population, however, the findings were not statistically significant.
  • Younger males (< 19 years old) were 2.33 times more likely to be sensitive to nickel than their older counterparts. Similarly, younger females were found to be 1.51 times more likely to be nickel sensitive.
  • The patch test is essential in identifying specific allergens in allergic contact dermatitis. Patches containing 2.5% nickel sulfate were applied and left in place for 2 days and subsequently interpreted when removed. A follow-up interpretation was conducted one to five days later.
Easter Bunny Allergic Contact Dermatitis

Chocolate Easter Egg Systemic Allergic Contact Dermatitis

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Easter Bunny Allergic Contact Dermatitis

Original article:

Sharon E. Jacob, MD, Dathan Hamann, BS, Alina Goldenburg, BA, Elizabeth A. Connelly, MD Easter Egg Hunt Dermatitis: Systemic Allergic Contact Dermatitis Associated with Chocolate Ingestion PEDIATRIC DERMATOLOGY, Vol 32 ¡ No 2 ¡ 2015 pg 231-233

Review by James (Keith) Parker, BS. MSI, Loma Linda University

The North American Contact Dermatitis Group has found that there is a strong co-occurrence of allergic contact dermatitis (ACD) and atopic dermatitis (AD) in children.

Nickel is an especially common contact allergen in children, with an estimated prevalence of 26.2% in patch tested children!

Patients with ACD may experience systemic contact dermatitis (SCD) after ingestion of certain foods or certain drugs. Dietary restrictions can be used to avoid flares of ACD. The Jacob et al[i]. article reviewed a series of four case reports of nickel-sensitized children with AD that showed:

* Avoidance of “everyday” foods such as: peanuts, peanut butter, chocolate, oats, and processed American cheese – cleared 60 to 80% of their dermatitis when used along with standard therapeutics that had failed alone previously

* Each child had a flare about 48 to 96 hours after Easter Sunday

* Without their parents knowledge the children had binged on chocolate

* It is recommended to consider restricting chocolate consumption in children with nickel sensitization and widespread dermatitis

* The following foods contain 11 micrograms to more than 100 micrograms per serving of nickel: sunflower seeds – oat ring cereal – chocolate candy bars – chocolate syrup – granola with raisins – lima beans – chocolate chip cookies – brownies – pinto beans

 

[i] Sharon E. Jacob, MD, Dathan Hamann, BS, Alina Goldenburg, BA, Elizabeth A. Connelly, MD Easter Egg Hunt Dermatitis: Systemic Allergic Contact Dermatitis Associated with Chocolate Ingestion PEDIATRIC DERMATOLOGY, Vol 32 ¡ No 2 ¡ 2015 pg 231-233

Article by Peter Gust

 

Nickel-Free Alternatives

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nickel contact dermatitis exampleRaise Awareness

Original Study:
Hannah Hill, BS, Alina Goldenberg, MD, MAS, Michael Patrick Sheehan, MD, Amy Patel, BS, and Sharon E. Jacob, MD
DERMATITIS, Vol 26 ¡ No 6 ¡ November/December, 2015, pg 245-253

Review by James (Keith) Parker, BS. MSI, Loma Linda University

Nickel is the most prevalent confirmed contact allergen worldwide. The range of objects that contain nickel is wide, from laptops, personal care products, food, underwires and claps in bras, tools, jeans snaps and zippers, and a host of others. The Hill et al. article(CITE) reviews/highlights that:

* Retailors that sell ‘nickel free’ products should be required to meet safety standards, as issued in the European Nickel Directive.

* The growing number of retailors specifically that sell ‘nickel free’ (low nickel release) products is growing, many of which can be found online:
Costco sells nickel free eyeglasses; Calvin Klein and Levis sell nickel free jeans; EyeCareCosmetics and RMS Beauty sell nickel free makeup, Nonickel.com sells belts, buckles, watches and jewelry.

* Dimethylglyoxime/ammonia (or DMG-ammonia) – a simple product that can be used to test if there is releasable nickel in any metallic object, the test turns the applicator pink if there is enough nickel to cause a problem in a sensitized person. Dormer, NoNickel and Smartpractice are manufacturers/distributors of the nickel test kits.

* Items that contain sentimental value (heirlooms, wedding rings) could be treated with an enamel or rhodium plating.