Nickel Allergy in Adults in the US: 1962 to 2015

Changing trends of contact allergens: A 40-year retrospective study from a referral centre in northern Taiwan

BACKGROUND

The common contact allergens may change over time as the environmental exposure changes.

OBJECTIVES

To identify the prevalence rates and changing trends of contact allergens in Taiwan over a 40-year period.

MATERIALS & METHODS

The patch testing results of a referral centre from 1978 to 2018 were retrospectively reviewed. The study population was divided into four groups according to 10-year intervals. The prevalence rates of contact sensitization to each agent and the clinical relevance were analysed. For patients with positive reactions to relevant allergens, the occupations and sites of dermatitis were analysed.

RESULTS

From 1978 to 2018, a total of 4005 patients underwent patch testing. Successively increasing trends of positive reactions to cobalt, fragrance mix I, and para-phenylenediamine (PPD) were found. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was an emerging contact allergen. Hairdressers, cosmetologists, and aromatherapists became the occupations most commonly having positive reactions in the most recent 10 years. In the first two decades, the face and neck were the most commonly affected areas. Later, hands became the most commonly affected sites.

CONCLUSIONS

The prevalence rates of positive reactions to cobalt, fragrance mix I, and PPD increased successively. MCI/MI was an emerging contact allergen of special concern.

Surgical explantation of atrial septal closure devices for refractory nickel allergy symptoms

OBJECTIVES

Systemic allergic reactions to nickel alloys in percutaneous atrial septal defect occlusion devices have a poorly defined natural history. We describe our experience of surgical removal of the offending device in a series of patients with nickel allergy and refractory symptoms.

METHODS

Patients with atrial septal defect device explants for nickel allergy were reviewed. Administered questionnaires focused on symptoms, quality of life, and satisfaction along with the 36-Item Short Form Health Survey to measure physical and mental health postsurgery.

RESULTS

Atrial septal defect devices were removed for nickel allergy in 58 patients during the past 10 years. The median age was 42 years (range, 24-71 years) and 95% were women. Explantation occurred at a median of 8 years (range, 6 months-18 years) after insertion. Symptoms included fatigue (82%), chest pain (78%), headache (73%), and palpitation (58%). Surveys were available for 45 patients: 58% rated their quality of life as poor and 69% were not at all satisfied with their device. Postexplant, all patients reported improvement in their symptoms, with 18 patients (42%) noting complete resolution. In 12 patients prospectively studied, the preoperative scores in physical and mental health domains were lower than the validation group, indicating significant disability. Similarly, there was marked improvement in each domain postremoval.

CONCLUSIONS

Patients with nickel allergy and severe refractory symptoms after atrial septal defect device implantation experience profound resolution of symptoms and improved quality of life after removal. Nickel allergy should be considered before device insertion, and a low threshold should exist for surgical removal for refractory symptoms.

Associations of Nickel Co-Reactions and Metal Polysensitization in Adults

BACKGROUND

Allergic contact dermatitis to metals is a significant clinical and public health problem. Little is known about the determinants of polysensitization to metals.

OBJECTIVE

The aim of the study was to determine the frequency and predictors of nickel co-reactions and metal polysensitization.

METHODS

This is a retrospective chart review of 686 adults (age ≥ 18 years) who were patch tested from 2014 to 2017.

RESULTS

Overall, 267 patients (38.9%) had 1 or more positive patch-test reactions to a metal allergen, most commonly nickel (17.4%), mercury (12.3%), and palladium (9.2%). Nickel reactions were inversely associated with age (logistic regression; adjusted odds ratio [95% confidence interval], 0.39 [0.29-0.78]). Among patients with positive reactions to nickel, 34.5%, 15.1%, and 5.0% had positive reactions to 1, 2, or 3 additional metals, respectively. The most common nickel co-reactors were palladium, mercury, and gold. Polysensitization to metals occurred in 11.8% of patients. Polysensitization to metal allergens was associated with female sex (6.67 [1.01-44.21]) and inversely associated with age (0.40 [0.18-0.88]).

CONCLUSIONS

Nickel-sensitized patients have high rates of metal co-reactions. Polysensitization to metals is common in adults. These results may help guide future strategies for allergen avoidance.

Nickel exposure from keys: a Brazilian issue

Keys are a significant source of exposure to metal allergens and can be a relevant problem for nickel-allergic individuals. This study aimed to perform nickel and cobalt spot testing among the 5 most common Brazilian brands of keys. Among the tested keys, 100% showed positive result to nickel spot test, 83,3% presented strong positive reaction. 50% exhibited cobalt release as well. Nickel release from keys is very common in our country and may cause a negative impact on sensitized individual's quality of life. Study's results highlight the importance of establishing directives to regulate nickel release in Brazil.

Contact Urticaria to Nickel: A Series of 11 Patients Who Were Prick Test Positive and Patch Test Negative to Nickel Sulfate 2.5% and 5.0

BACKGROUND

Nickel is the most common allergen found by patch testing; however, not all cases of nickel allergy are type 4 (delayed) allergies. Contact urticaria (CU) to nickel (immediate reaction) has been reported; however, few seem to evaluate it as per a recent published survey of American Contact Dermatitis Society members.

OBJECTIVE

The aim of the study was to present a series of patients who had clinical histories suggestive of nickel allergy and yet were patch test negative but prick test positive to nickel, thus demonstrating CU.

METHODS

We reviewed the charts of 11 patients who were patch test negative but prick test positive.

RESULTS

All 11 patients demonstrated evidence of CU by prick testing (or closed chamber test in 1). None were patch test positive to nickel 2.5% or 5.0%. Four patients' histories mentioned reactions to various jewelry/earrings within minutes, whereas 2 histories mentioned reacting within a few hours. These histories are consistent with CU. Others (except 1 patient) recalled reacting to jewelry/earrings but did not recall a time frame.

CONCLUSIONS

Our series suggests that CU to nickel may be far more common than anticipated and should be evaluated with prick testing when patients' history suggests nickel allergy and yet they are patch test negative.

Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts

PURPOSE OF REVIEW

To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization.

RECENT FINDINGS

Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement.

SUMMARY

Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.