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Epidemiology of pediatric nickel sensitivity: Retrospective review of North American Contact Dermatitis Group (NACDG) data 1994-2014 - 19/09/18

Doi : 10.1016/j.jaad.2018.02.071 
Erin M. Warshaw, MD, MS a, b, c, , Kelly A. Aschenbeck, BS a, c, Joel G. DeKoven, MD d, Howard I. Maibach, MD e, James S. Taylor, MD f, Denis Sasseville, MD g, Donald V. Belsito, MD h, Joseph F. Fowler, MD i, Kathryn A. Zug, MD j, Matthew J. Zirwas, MD k, Anthony F. Fransway, MD l, Vincent A. DeLeo, MD h, James G. Marks, MD m, Melanie D. Pratt, MD n, Toby Mathias, MD o
a Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota 
b Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota 
c University of Minnesota School of Medicine, Minneapolis, Minnesota 
d Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada 
e Department of Dermatology, University of California San Francisco, San Francisco, California 
f Department of Dermatology, Cleveland Clinic, Cleveland, Ohio 
g Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada 
h Department of Dermatology, Keck School of Medicine, Los Angeles, California 
i University of Louisville, Louisville, Kentucky 
j Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 
k Ohio State University, Columbus, Ohio 
l Associates in Dermatology, Fort Myers, Florida 
m Department of Dermatology, Pennsylvania State University, State College, Pennsylvania 
n Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada 
o Department of Dermatology, University of Cincinnati, Cincinnati, Ohio 

Correspondence to: Erin M. Warshaw, MD, MS, Dept 111K 1 Veterans Dr, Minneapolis, MN 55417.Dept 111K 1 Veterans DrMinneapolisMN55417

Abstract

Background

Nickel is a common allergen responsible for allergic contact dermatitis.

Objective

To characterize nickel sensitivity in children and compare pediatric cohorts (≤5, 6-12, and 13-18 years).

Methods

Retrospective, cross-sectional analysis of 1894 pediatric patients patch tested by the North American Contact Dermatitis Group from 1994 to 2014. We evaluated demographics, rates of reaction to nickel, strength of nickel reactions, and nickel allergy sources.

Results

The frequency of nickel sensitivity was 23.7%. Children with nickel sensitivity were significantly less likely to be male (P < .0001; relative risk, 0.63; 95% confidence interval, 0.52-0.75) or have a history of allergic rhinitis (P = .0017; relative risk, 0.74; 95% confidence interval, 0.61-0.90) compared with those who were not nickel sensitive. In the nickel-sensitive cohort, the relative proportion of boys declined with age (44.8% for age ≤5, 36.6% for age 6-12, and 22.6% for age 13-18 years). The most common body site distribution for all age groups sensitive to nickel was scattered/generalized, indicating widespread dermatitis. Jewelry was the most common source associated with nickel sensitivity (36.4%).

Limitations

As a cross-sectional study, no long-term follow-up was available.

Conclusions

Nickel sensitivity in children was common; the frequency was significantly higher in girls than in boys. Overall, sensitivity decreased with age. The most common source of nickel was jewelry.

Le texte complet de cet article est disponible en PDF.

Key words : allergic contact dermatitis, children, jewelry, nickel, North American Contact Dermatitis Group, pediatric

Abbreviations used : ACD, CI, NACDG, RR


Plan


 Funding sources: Supported by resources and facilities at the Minneapolis Veterans Affairs Medical Center and in part by the Nickel Producers Environmental Research Association.
 Disclosure: Dr Mathias serves as a consultant for Kao Brands. Dr Taylor has served as a consultant for Johnson & Johnson and Kao Brands; is a common stock holder of Johnson & Johnson, Express Scripts, Opko Health, Allergan, Astra Zeneca, and Merck; is an author for Decision Support in Medicine; and has a nondependent child who is employed by Pfizer. Dr Zirwas serves as a speaker for Regeneron/Sanofi and Genentech, is a consultant for L'Oreal, and is a principal investigator for Janssen and Leo. Dr Warshaw, Ms Aschenbeck, Dr DeKoven, Dr Maibach, Dr Sasseville, Dr Belsito, Dr Fowler, Dr Zug, Dr Fransway, Dr DeLeo, Dr Marks, and Dr Pratt have no conflicts of interest to disclose.
 The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.
 Reprints not available from the authors.


© 2018  Publié par Elsevier Masson SAS.
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Vol 79 - N° 4

P. 664-671 - octobre 2018 Retour au numéro
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