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Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014 - 11/02/19

Doi : 10.1016/j.jaad.2018.09.058 
Erin M. Warshaw, MD, MS a, b, Amy J. Zhang, BA c, , Joel G. DeKoven, MD d, Howard I. Maibach, MD e, Donald V. Belsito, MD f, Denis Sasseville, MD g, Joseph F. Fowler, MD h, Anthony F. Fransway, MD i, Toby Mathias, MD j, Melanie D. Pratt, MD k, James G. Marks, MD l, Kathryn A. Zug, MD m, Matthew J. Zirwas, MD n, James S. Taylor, MD o, Vincent A. DeLeo, MD p
a Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota 
b Department of Dermatology, University of Minnesota, Minneapolis, Minnesota 
c University of Minnesota Medical School, Minneapolis, Minnesota 
d Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada 
e Department of Dermatology, University of California San Francisco, San Francisco, California 
f Department of Dermatology, Columbia University, New York, New York 
g Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec 
h University of Louisville, Louisville, Kentucky 
i Associates in Dermatology, Fort Myers, Florida 
j Department of Dermatology, University of Cincinnati, Cincinnati, Columbus 
k Division of Dermatology, University of Ottawa, Ontario, Canada 
l Department of Dermatology, Pennsylvania State University, State College, Pennsylvania 
m Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 
n Ohio State University, Columbus, Ohio 
o Department of Dermatology, Cleveland Clinic, Cleveland, Ohio 
p Department of Dermatology, Keck School of Medicine, Los Angeles, California 

Correspondence to: Amy Zhang, BA, Dept 111K, 1 Veterans Dr, Minneapolis, MN 55417.Dept 111K, 1 Veterans DrMinneapolisMN55417

Abstract

Background

Nickel is a common allergen.

Objective

To examine the epidemiology of nickel sensitivity in North America.

Methods

Retrospective, cross-sectional analysis of 44,097 patients patch tested by the North American Contact Dermatitis Group from 1994 to 2014. Nickel sensitivity was defined as a positive patch test for nickel. We evaluated the frequency of nickel sensitivity and patient demographics. For each positive reaction to nickel, we tabulated clinical relevance, occupational relatedness, and exposure sources.

Results

The average frequency of nickel sensitivity was 17.5% (1994-2014). Nickel sensitivity significantly increased over time (from 14.3% in 1994-1996 to 20.1% in 2013-2014 [P < .0001]). Nickel-sensitive patients were significantly more likely to be female, young, nonwhite, and atopic (have eczema and asthma) and/or have dermatitis affecting the face, scalp, ears, neck, arm, or trunk (P values ≤ .0474). Overall, 55.5% of reactions were currently clinically relevant; this percentage significantly increased over time (from 44.1% in 1994-1996 to 51.6% in 2013-2014 [P < .0001]). The rate of occupational relatedness was 3.7% overall, with a significant decrease over time (from 7.9% in 1994-1996 to 1.9% in 2013-2014 [P < .0001]). Jewelry was the most common source of nickel contact.

Limitations

Tertiary referral population.

Conclusions

Nickel allergy is of substantial public health importance in North America. The frequency of nickel sensitivity in patients referred for patch testing has significantly increased over a 20-year period.

Le texte complet de cet article est disponible en PDF.

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

Abbreviations used : ACD, CI, EU, NACDG, NOS, RR, SANR


Plan


 Funding sources: Supported in part by the Nickel Producers Environmental Research Association and in part with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
 Disclosure: Dr Taylor is a consultant for Johnson & Johnson, Monsanto, Equinox Group, and Kao Brands; a stockholder for Johnson & Johnson, Express Scripts, Opko Health, Allergan, Astra Zeneca, and Merck; and an author for Decision Support in Medicine; in addition, he has a nondependent child who is employed by Pfizer. Dr Zirwas is part owner of AsepticMD; he is a speaker, consultant, and investigator for Regeneron/Sanofi; a speaker for Genentech/Novartis; a consultant for Fit Bit, L'Oreal, and Menlo; and an investigator for Leo, Janssen, Incyte, Foamix, DS Biopharma, and UCB. Dr Warshaw, Ms Zhang, Dr Mathias, 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.
 Reprints not available from the authors.


© 2018  Publié par Elsevier Masson SAS.
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