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Journal of the American Academy of Dermatology
Volume 44, n° 4
pages 616-623 (avril 2001)
Doi : 10.1067/mjd.2001.110873
accepted : 15 August 2000
Flare-up reactions after oral challenge with nickel in relation to challenge dose and intensity and time of previous patch test reactions

Monica Hindséna, Magnus Bruzea, O.B. Christensenb
Malmö, Sweden 
From the Department of Occupational and Environmental Dermatology,a and the Department of Dermatology,b University Hospital Malmö 


Background: In this study we have taken an interest in systemic exposure to nickel in patients with delayed hypersensitivity to nickel. Objective: The aim of the study was to more closely investigate the importance of factors such as ingested nickel dose, time interval between nickel patch testing and oral nickel challenge as well as degree of nickel hypersensitivity in relation to flare-up reactions. Methods: Thirty nickel-sensitive female subjects were patch tested with a serial dilution of nickel sulfate in water on 4 different test occasions during a period of 7 months. One month after the last patch test the patients were randomly divided into 3 different groups. The patients in the groups were challenged orally with a placebo capsule, 1.0 mg nickel, or 3.0 mg nickel. Results: None of the patients challenged with placebo had flare-up reactions of earlier patch test sites, but 2 of the patients challenged with 1.0 mg nickel and all of the patients challenged with 3.0 mg nickel had flare-up reactions. There were significantly more flare-up reactions of the most recent patch test sites (1 month) compared with the most distant (8 months) test sites. There was also a statistically significant positive correlation between the intensity of previous positive patch tests and the flare-up reactions. Conclusion: In the assessment of the possibility of systemic allergic contact dermatitis from nickel, the dose as well as the intensity and time since previous nickel eczema have to be considered. (J Am Acad Dermatol 2001;44:616-23.)

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 Supported by grants from the Swedish Council for Work Life Research and the Swedish Foundation for Health Care Sciences and Allergy Research.
 Reprint requests: Monica Hindsén, Department of Occupational and Environmental Dermatology, University Hospital Malmö, S-205 02 Malmö, Sweden.
 J Am Acad Dermatol 2001;44:616-23

© 2001  American Academy of Dermatology, Inc. Published by Elsevier Masson SAS@@#104157@@
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