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Wennervaldt M, Vaher H, Ahlström MG, Bischofberger N, Menné T, Thyssen JP, Johansen JD, Bonefeld CM. Subclinical immune responses to nickel in sensitized individuals-a dose-response study. Contact Dermatitis 2024; 91:1-10. [PMID: 38577784 DOI: 10.1111/cod.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/10/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Nickel is the leading cause of contact allergy in Europe, with 14.5% of the adult population being sensitized. Despite regulations limiting nickel release from consumer items, the incidence and prevalence of nickel allergy remain high. OBJECTIVE To investigate the clinical and subclinical immune response to low-dose nickel exposure on nickel pre-exposed skin to assess the adequacy of current regulatory limits. METHOD Nickel-allergic and healthy controls were patch tested with nickel twice with a 3-4 weeks interval. The first exposure used the diagnostic concentration of 2000 μg/cm2 nickel sulphate, and the same skin areas were then re-exposed to 0.2, 0.5, 12.8 and 370 μg/cm2 nickel sulphate. After 48 h, the patch reactions were examined for clinical signs of eczema, and skin biopsies were collected. The transcriptomic immune profile was analysed with Nanostring nCounter and quantitative polymerase chain reaction. RESULTS Two nickel-allergic participants (15%) had clinical reactions to the regulatory limiting doses for nickel (0.2/0.5 μg/cm2) following re-exposure. There was immune activation in all skin areas following re-exposure to nickel, predominantly mediated by up-regulation of cytokines and chemokines. In all nickel re-exposed skin areas, 81 genes were up-regulated independent from the clinical response. In skin areas exposed to 0.2 μg/cm2, 101 immune-related genes were differentially expressed, even when no clinical response was observed. Healthy controls showed up-regulation of three genes in response to nickel re-exposures without any clinical reactions. CONCLUSION Immune activation can be induced in skin with local memory to nickel upon challenge with nickel doses within the regulatory limits. Our findings suggest that the regulatory limits in the European nickel regulation may not provide sufficient protection for consumers against low-dose exposures.
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Affiliation(s)
- Michael Wennervaldt
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Helen Vaher
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Malin G Ahlström
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Nuno Bischofberger
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Torkil Menné
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Charlotte M Bonefeld
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, The LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
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Zeverdegani SK, Mohebian Z. Assessing the health risks of dermal exposure to heavy metals dust among nail salon technicians. Work 2024; 78:1069-1079. [PMID: 38217566 DOI: 10.3233/wor-230336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Nail salon technicians are susceptible to potential exposure to a diverse array of hazardous chemicals in the form of dust or vapors. One of the main routes of exposure is dermal contact. OBJECTIVE The aim of present study was to health risk assessment of dermal exposure to dust containing heavy metals in nail salon technicians. METHODS Dust sampling was done on the work surface of 20 available nail salon technicians. The concentration of five metals including cadmium, lead, chromium, nickel, and manganese were determined using ICP-MS. Afterwards, the United States Environmental Protection Agency (USEPA) guideline was used to estimate the potential health risks, including carcinogenic and non-carcinogenic risks, associated with the analyzed metals. RESULTS Results indicated the mean concentrations of Pb, Cd, Ni, Cr and Mn were 0.7953±0.4373, 0.0952±0.0264, 0.7666±0.8629, 0.4900±0.5994 and 1.134±0.4736, respectively. The hazard quotient (HQ) of all metals was within the permissible value, while hazard index (HI) was greater than 1. The probability of cancer risk (CR) resulting from dermal exposure to Ni, Cd and Cr exceeded the acceptable risk levels (10-6-10-4), but CR calculated for Pb was less than allowable value. CONCLUSION Implementation of engineering controls such as downdraft vented nail tables and portable source capture systems is necessary. Besides, the use of personal protective equipment such as disposable nitrile gloves, N95 respirator masks, and ensuring proper training on safe work practices is recommended.
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Affiliation(s)
- Sara Karimi Zeverdegani
- Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Mohebian
- Department of Occupational Health Engineering, Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Pereira-Nunes J, Vasconcelos-Castro S, Fontoura-Matias J, Preto-Gomes N, Marinho-Cunha A, Soares-Oliveira M. Preoperative Metal Patch Testing and Titanium Bar Use Criteria in Nuss Procedure: A 56-Patients' Cohort Study. Eur J Pediatr Surg 2022. [PMID: 35668642 DOI: 10.1055/a-1868-6224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nuss procedure is the main reason for metal implants use by pediatric and thoracic surgeons. There is an ongoing debate on how to avoid allergic complications. Herein we describe our 8-year experience with systematic preoperative metal patch testing and our selective titanium bar use in Nuss procedure. MATERIALS AND METHODS This is a single center retrospective observational cohort study of patients who underwent the Nuss procedure from 2013 to 2020. Preoperative metal patch testing was done in all cases. Criteria for titanium bar utilization were: a positive test for a major component of the stainless-steel bar; or a positive metal patch test and a positive history of atopy, food or metal allergy, or previous allergic reaction to an implant or device. RESULTS In total, 56 patients were included. Most were male (91.1%) with a median age of 15.0 (13.0-22.0) years old. 19.6% had a positive preoperative metal patch test and 54.5% of these had no personal history of atopy. Stainless-steel bars were used in 27.3% of those patients and titanium bars were used in 72.7%. One patient had a documented minor allergy reaction. None of the 56 patients required early bar removal. CONCLUSION Our study suggests that routine preoperative allergy testing and a judicious use of titanium bar are safe and avoid metal allergic complications.
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Affiliation(s)
- Joana Pereira-Nunes
- Department of Pediatrics, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sofia Vasconcelos-Castro
- Department of Pediatric Surgery, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Portugal
| | - José Fontoura-Matias
- Department of Pediatrics, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Preto-Gomes
- Department of Dermatology, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Porto, Portugal
| | - Ana Marinho-Cunha
- Department of Dermatology, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Porto, Portugal
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário de São João Ringgold Standard Institution, Porto, Portugal
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Ion Release and Surface Changes of Nickel-Titanium Archwires Induced by Changes in the pH Value of the Saliva-Significance for Human Health Risk Assessment. MATERIALS 2022; 15:ma15061994. [PMID: 35329446 PMCID: PMC8954586 DOI: 10.3390/ma15061994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023]
Abstract
The aim of this study was to explore whether changes in the salivary pH influence mechanical properties, surface roughness, and ion release from NiTi archwires with various surface coatings, and discuss the clinical significance of the findings. The uncoated, rhodium-coated, and nitrified NiTi wires were immersed into artificial saliva of different pH values (4.8, 5.1, 5.5, and 6.6). Released nickel and titanium ions were measured with inductively coupled plasma-optical emission spectroscopy at the end of 28 days. Atomic force microscopy was used to measure the arithmetic average surface roughness Ra, the root-mean-square roughness Rq, and the maximum height of the asperities RZ. The nanoindentation hardness (HIT) and Young's modulus (EIT) measurements were performed. The change in the pH of artificial saliva is inversely proportional to the release of titanium from both coated and uncoated wires, and the release of nickel from uncoated wires. The surface roughness parameters of both coated and uncoated wires are unaffected by the change in the pH of artificial saliva. The change in the pH of saliva has minor influence on the hardness and Young's modulus of elasticity of both coated and uncoated wires. The concentration of released metal ions measured was below the recommended upper limit for daily intake; nevertheless, hypersensitivity effects cannot be excluded, even at lower concentrations and at low pH.
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Wennervaldt M, Ahlström MG, Menné T, Haulrig MB, Alinaghi F, Thyssen JP, Johansen JD. Chromium and cobalt release from metallic earrings from the Danish market. Contact Dermatitis 2021; 85:523-530. [PMID: 34148232 DOI: 10.1111/cod.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chromium and cobalt are important skin sensitizers. It has, however, been difficult to identify causative exposures. Studies on nickel allergy have demonstrated piercing as critical for both sensitization and elicitation. It may be speculated that the same applies for chromium and cobalt. OBJECTIVE To examine the content and release of chromium and cobalt from earrings randomly purchased in Denmark. METHODS Three hundred four earrings were examined with x-ray fluorescence (XRF) spectrometry. Earrings with measured content of chromium or cobalt were spot tested with diphenylcarbazide spot test (n = 166) or Nitroso-R spot-test (n = 99), respectively. Chromium and cobalt release were quantified in a selected subsample (n = 100) with the artificial sweat test (EN 1811). RESULTS Chromium was present in 54.6% (166/304) of earrings and cobalt was present in 72.0% (219/304),- measured by XRF. All chromium spot tests for chromium VI were negative. The cobalt spot test was positive for one component. Chromium release was found from 59/100 (median concentration = -0.06 μg/cm2 /week) and cobalt release from 29/100 (median concentration = -0.06 μg/cm2 /week) of earrings in tested subsample. CONCLUSION Earrings for piercing release chromium and cobalt and may on a case basis be a source of chromium and cobalt allergy.
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Affiliation(s)
- Michael Wennervaldt
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Malin G Ahlström
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark.,Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Torkil Menné
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Morten B Haulrig
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Farzad Alinaghi
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
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Wennervaldt M, Ahlström MG, Menné T, Thyssen JP, Johansen JD. Nickel release from metallic earrings: A survey of the Danish market and validation of the nickel spot test. Contact Dermatitis 2021; 85:178-185. [PMID: 33713466 DOI: 10.1111/cod.13832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Exposure to nickel-releasing ear-piercing jewellery may explain the persistently high prevalence of nickel allergy in Europe. While nickel release from earrings is regulated, field studies show that the regulation is not always respected. More knowledge is needed regarding the risk of piercing exposure including suitable screening methods. OBJECTIVE To examine the proportion of earrings on the Danish market that release more nickel than allowed, and to validate the use of the dimethylglyoxime (DMG) test as a screening tool. METHODS A total of 304 earrings were purchased and tested with the DMG test and X-ray fluorescence spectrometry. The level of nickel release was quantified in a selected subsample of 100 earrings by the European reference test EN 1811. The DMG spot test was validated against EN 1811 at different thresholds. RESULTS Excessive nickel release according to the European regulation was found in 45 (14.8%) tested earrings. The sensitivity of the DMG test decreased with reduced levels of nickel release (sensitivity of 45.2% at ≥0.2 μg/cm2 /week vs 61.1% at >0.5 μg/cm2 /week). CONCLUSION Excessive nickel release is common in earrings on the Danish market. Because of low sensitivity, the DMG test has limited use in screening of earrings for research but may still be used clinically.
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Affiliation(s)
- Michael Wennervaldt
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Malin G Ahlström
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Torkil Menné
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
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Abstract
Nickel remains the most commonly identified contact allergen. However, it has proven difficult to demonstrate significant skin-sensitizing activity for nickel in toxicology tests, which typically have indicated a weak skin sensitization potential. Information indicates that in vivo assays are not predictive of dermal sensitization hazard or potency for nickel due to a human-specific mechanistic route for nickel sensitization that animals lack. A similar rationale will apply to in vitro alternatives-although these currently have limited ability to determine intrinsic potency. Generally, in silico methods are not designed for metal allergens and cannot contribute to the analysis. For ethical reasons, human experimental work has been limited, with a single study suggesting moderate potency. Accordingly, it seems reasonable to conclude that the high frequency of contact allergy to nickel in humans is a function of both its intermediate potency coupled with a high level of dermal exposure, particularly to damaged/inflamed skin.
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Affiliation(s)
- David Basketter
- From the DABMEB Consultancy Ltd, Bedfordshire, United Kingdom
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Ahlström MG, Johansen JD. Allergic Contact Dermatitis in Humans: Experimental and Quantitative Aspects. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang B, Su Y, Tian L, Peng S, Ji R. Heavy metals in face paints: Assessment of the health risks to Chinese opera actors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 724:138163. [PMID: 32408442 DOI: 10.1016/j.scitotenv.2020.138163] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/14/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
The actors in Chinese operas are exposed to heavy metals through the face paints that they use but the resulting health risks are unknown. We therefore conducted a survey of face paint use by Chinese opera actors and then assayed 91 paint samples of various paint brands and colors for their contents of eight heavy metals. The potential health risks of heavy metal exposure due to face paint use were determined as well. The average concentrations of As, Cd, Co, Cr, Cu, Ni, Pb, and Zn were 1.8, 0.6, 4.4, 23.1, 610, 7.6, 16.2, and 10,415 μg/g, respectively, and at least four of the eight elements were detected in all samples. Samples from the most frequently paint brands were the most highly contaminated, especially with Zn, whose mass contribution was extremely high (18.3%). Moreover, contamination of the paint was color-specific, with significantly higher heavy metal levels in brown (As, Cr, and Ni), black (Co and Zn), red (Pb), and green (Cu) paints. The total carcinogenic risk posed by the metals in 25 paint samples ranged between 0.01% and 0.96%, with the highest risk that of Cr. Thus, lifetime exposure to Cr-containing paints would result in a high probability of the actor developing cancer. The findings of our study highlight the need for Chinese regulations addressing the heavy metals in face paints, especially Cr. Capsule: Chinese opera actors have a high probability of developing cancer due to a lifetime exposure to high levels of heavy metals in their face paints.
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Affiliation(s)
- Bin Wang
- School of Resources and Environmental Engineering, Hefei University of Technology, Hefei 230000, China; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Yu Su
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China.
| | - Liyan Tian
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Shuchuan Peng
- School of Resources and Environmental Engineering, Hefei University of Technology, Hefei 230000, China.
| | - Rong Ji
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
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Thyssen JP, Ahlström MG, Bruze M, Rustemeyer T, Lidén C. Metals. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_35-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Abstract
Nickel (Ni) metal and Ni compounds are widely used in applications like stainless steel, alloys, and batteries. Nickel is a naturally occurring element in water, soil, air, and living organisms, and is essential to microorganisms and plants. Thus, human and environmental nickel exposures are ubiquitous. Production and use of nickel and its compounds can, however, result in additional exposures to humans and the environment. Notable human health toxicity effects identified from human and/or animal studies include respiratory cancer, non-cancer toxicity effects following inhalation, dermatitis, and reproductive effects. These effects have thresholds, with indirect genotoxic and epigenetic events underlying the threshold mode of action for nickel carcinogenicity. Differences in human toxicity potencies/potentials of different nickel chemical forms are correlated with the bioavailability of the Ni2+ ion at target sites. Likewise, Ni2+ has been demonstrated to be the toxic chemical species in the environment, and models have been developed that account for the influence of abiotic factors on the bioavailability and toxicity of Ni2+ in different habitats. Emerging issues regarding the toxicity of nickel nanoforms and metal mixtures are briefly discussed. This review is unique in its covering of both human and environmental nickel toxicity data.
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Ahlström MG, Thyssen JP, Wennervaldt M, Menné T, Johansen JD. Nickel allergy and allergic contact dermatitis: A clinical review of immunology, epidemiology, exposure, and treatment. Contact Dermatitis 2019; 81:227-241. [DOI: 10.1111/cod.13327] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Malin G. Ahlström
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jacob P. Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Michael Wennervaldt
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Torkil Menné
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - Jeanne D. Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
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Ahlström MG, Johansen JD. Allergic Contact Dermatitis in Humans: Experimental and Quantitative Aspects. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_14-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nixon RL, Higgins CL, Maor D, Rajgopal Bala H, Lalji A, Heim KE. Does clinical testing support the current guidance definition of prolonged contact for nickel allergy? Contact Dermatitis 2018; 79:356-364. [PMID: 30216527 PMCID: PMC6749565 DOI: 10.1111/cod.13095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Background The European Chemical Agency (ECHA) definition of prolonged contact was introduced in 2014 and has not been evaluated clinically. Objectives To assess whether nickel‐sensitized individuals react on patch testing with high nickel‐releasing metal discs for short and repetitive periods. Materials and methods We patch tested 45 nickel‐sensitized individuals double‐blind with 2 different types of high nickel‐releasing discs for 10, 30 and 60 minutes on 3 occasions over a period of 2 weeks, and for 1 longer period. Discs were tested for nickel release. Results Nickel release from both discs significantly exceeded the 0.5 μg Ni/cm2/week limit of the EU REACH nickel restriction. However, only 1 individual tested had a largely dose‐dependent allergic reaction. Conclusions The majority of nickel‐allergic subjects did not react to nickel discs after 2 hours or after repetitive exposures of up to 30 minutes on 3 occasions over a period of 2 weeks. The length of time needed to cause nickel allergic contact dermatitis in most nickel‐allergic individuals is longer than the ECHA guidance definition. Longer test times are needed to define the time required to cause dermatitis in most nickel‐allergic individuals. As a limitation, the test conditions did not adequately assess real‐life factors such as friction, which is relevant for some uses of nickel.
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Affiliation(s)
- Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Claire L Higgins
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Danit Maor
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Harini Rajgopal Bala
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Alka Lalji
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
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Bogen KT, Garry MR. Risks of Allergic Contact Dermatitis Elicited by Nickel, Chromium, and Organic Sensitizers: Quantitative Models Based on Clinical Patch Test Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:1036-1051. [PMID: 29023909 DOI: 10.1111/risa.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/30/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Risks of allergic contact dermatitis (ACD) from consumer products intended for extended (nonpiercing) dermal contact are regulated by E.U. Directive EN 1811 that limits released Ni to a weekly equivalent dermal load of ≤0.5 μg/cm2 . Similar approaches for thousands of known organic sensitizers are hampered by inability to quantify respective ACD-elicitation risk levels. To help address this gap, normalized values of cumulative risk for eliciting a positive ("≥+") clinical patch test response reported in 12 studies for a total of n = 625 Ni-sensitized patients were modeled in relation to observed ACD-eliciting Ni loads, yielding an approximate lognormal (LN) distribution with a geometric mean and standard deviation of GMNi = 15 μg/cm2 and GSDNi = 8.0, respectively. Such data for five sensitizers (including formaldehyde and 2-hydroxyethyl methacrylate) were also ∼LN distributed, but with a common GSD value equal to GSDNi and with heterogeneous sensitizer-specific GM values each defining a respective ACD-eliciting potency GMNi /GM relative to Ni. Such potencies were also estimated for nine (meth)acrylates by applying this general LN ACD-elicitation risk model to respective sets of fewer data. ACD-elicitation risk patterns observed for Cr(VI) (n = 417) and Cr(III) (n = 78) were fit to mixed-LN models in which ∼30% and ∼40% of the most sensitive responders, respectively, were estimated to exhibit a LN response also governed by GSDNi . The observed common LN-response shape parameter GSDNi may reflect a common underlying ACD mechanism and suggests a common interim approach to quantitative ACD-elicitation risk assessment based on available clinical data.
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Bregnbak D, Thyssen JP, Jellesen MS, Zachariae C, Johansen JD. Experimental patch testing with chromium-coated materials. Contact Dermatitis 2017; 76:333-341. [PMID: 28120332 DOI: 10.1111/cod.12747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/17/2016] [Accepted: 11/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chromium coatings on metal alloys can be decorative, and prevent corrosion and metal ion release. We recently showed that handling of a chromium-containing disc resulted in chromium deposition on the skin. OBJECTIVES To examine patch test reactivity to chromium-coated discs. METHODS We included 15 patients: 10 chromium-allergic patients, and 5 patients without chromium allergy. All were patch tested with potassium dichromate, cobalt chloride, nickel sulfate, and nine different metallic discs. The chromium-allergic patients were also patch tested with serial dilutions of potassium dichromate. RESULTS Positive/weaker reactions were observed to disc B (1 of 10), disc C (1 of 10), and disc D, disc E, and disc I (4 of 10 each). As no controls reacted to any of the discs, the weak reactions indicate allergic reactions. Positive patch test reactions to 1770 ppm chromium(VI) in the serial dilutions of potassium dichromate were observed in 7 of 10 patients. When the case group was narrowed down to include only the patients with a current positive patch test reaction to potassium dichromate, elicitation of dermatitis by both chromium(III) and chromium(VI) discs was observed in 4 of 7 of patients. CONCLUSIONS Many of the patients reacted to both chromium(III) and chromium(VI) surfaces. Our results indicate that both chromium(VI) and chromium(III) pose a risk to chromium-allergic patients.
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Affiliation(s)
- David Bregnbak
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - Morten S Jellesen
- Department of Mechanical Engineering, Materials and Surface Engineering, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
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Fischer LA, Johansen JD, Voelund A, Lidén C, Julander A, Midander K, Menné T, Thyssen JP. Elicitation threshold of cobalt chloride: analysis of patch test dose-response studies. Contact Dermatitis 2015; 74:105-9. [DOI: 10.1111/cod.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Louise A. Fischer
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; DK-2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; DK-2900 Hellerup Denmark
| | - Aage Voelund
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; DK-2900 Hellerup Denmark
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Anneli Julander
- Institute of Environmental Medicine, Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Klara Midander
- Institute of Environmental Medicine, Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Torkil Menné
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; DK-2900 Hellerup Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; DK-2900 Hellerup Denmark
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20
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Pot L, Coenraads P, Goebel C, Blömeke B. Assessment of the elicitation response in subjects weakly sensitized top-phenylenediamine. Br J Dermatol 2014; 172:138-44. [DOI: 10.1111/bjd.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- L.M. Pot
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - P.J. Coenraads
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - C. Goebel
- The Procter and Gamble Company; Central Product Safety; Darmstadt Germany
| | - B. Blömeke
- Department of Environmental Toxicology; University Trier; Trier Germany
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21
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Bando K, Takahashi H, Kinbara M, Tanaka Y, Kuroishi T, Sasaki K, Takano-Yamamoto T, Sugawara S, Endo Y. Resin monomers act as adjuvants in Ni-induced allergic dermatitis in vivo. J Dent Res 2014; 93:1101-7. [PMID: 25252875 DOI: 10.1177/0022034514552674] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Resin monomers (RMs) are inflammatory agents and are thought to cause allergic contact dermatitis (ACD). However, mouse models are lacking, possibly because of the weak antigenicities of RMs. We previously reported that inflammatory substances can promote the allergic dermatitis (AD) induced by intradermally injected nickel (Ni-AD) in mice. Here, we examined the effects of RMs on Ni-AD. To sensitize mice to Ni, a mixture containing non-toxic concentrations of NiCl2 and an RM [either methyl methacrylate (MMA) or 2-hydroxyethyl methacrylate (HEMA)] was injected intraperitoneally or into ear-pinnae intradermally. Ten days later, a mixture containing various concentrations of NiCl2 and/or an RM was intradermally injected into ear-pinnae, and ear-swelling was measured. In adoptive transfer experiments, spleen cells from sensitized mice were transferred intravenously into non-sensitized recipients, and 24 h later NiCl2 was challenged to ear-pinnae. Whether injected intraperitoneally or intradermally, RM plus NiCl2 mixtures were effective in sensitizing mice to Ni. AD-inducing Ni concentrations were greatly reduced in the presence of MMA or HEMA (at the sensitization step from 10 mM to 5 or 50 µM, respectively, and at the elicitation step from 10 µM to 10 or 100 nM, respectively). These effects of RMs were weaker in IL-1-knockout mice and in macrophage-depleted mice. Cell-transfer experiments in IL-1-knockout mice indicated that both the sensitization and elicitation steps depended on IL-1. Challenge with an RM alone did not induce allergic ear-swelling in mice given the same RM + NiCl2 10 days before the challenge. These results suggest that RMs act as adjuvants, not as antigens, to promote Ni-AD by reducing the AD-inducing concentration of Ni, and that IL-1 and macrophages are critically important for the adjuvant effects. We speculate that what were previously thought of as "RM-ACD" might include ACD caused by antigens other than RMs that have undergone promotion by the adjuvant effects of RMs.
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Affiliation(s)
- K Bando
- Division of Molecular Regulation Division of Orthodontics and Dentofacial Orthopedics
| | - H Takahashi
- Division of Molecular Regulation Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Sendai 980-8575, Japan
| | - M Kinbara
- Division of Molecular Regulation Division of Orthodontics and Dentofacial Orthopedics
| | - Y Tanaka
- Division of Molecular Regulation
| | | | - K Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Sendai 980-8575, Japan
| | | | | | - Y Endo
- Division of Molecular Regulation
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Marinovich M, Boraso MS, Testai E, Galli CL. Metals in cosmetics: An a posteriori safety evaluation. Regul Toxicol Pharmacol 2014; 69:416-24. [DOI: 10.1016/j.yrtph.2014.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 11/24/2022]
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Abstract
The aim of this paper is to review the current literature on allergy in orthodontics and to identify the predisposing factors and the implications of the allergic reaction in the management of patients during orthodontic treatment. A computerized literature search was conducted in PubMed for articles published on allergy in relation to orthodontics. The MeSH term used was allergy and orthodontics. Allergic response to alloys in orthodontics, particularly nickel, has been extensively studied and several case reports of nickel-induced contact dermatitis have been documented. Current evidence suggests that the most common allergic reaction reported in orthodontics is related to nickel in orthodontic appliances and allergic response is more common in women due to a previous sensitizing exposure from nickel in jewellery. Studies have implicated allergy in the etiology of hypo-dontia. It has also been considered as a high-risk factor for development of extensive root resorption during the course of orthodontic treatment. This review discusses the relationship and implications of allergy in orthodontics.
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Affiliation(s)
- Sunitha Chakravarthi
- Department of Orthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Sridevi Padmanabhan
- Department of Orthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Arun B Chitharanjan
- Department of Orthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Toxic metals contained in cosmetics: A status report. Regul Toxicol Pharmacol 2014; 68:447-67. [DOI: 10.1016/j.yrtph.2014.02.003] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/30/2014] [Accepted: 02/01/2014] [Indexed: 11/17/2022]
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25
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Spiewak R, Pietowska J, Curzytek K. Nickel: a unique allergen – from molecular structure to European legislation. Expert Rev Clin Immunol 2014; 3:851-9. [DOI: 10.1586/1744666x.3.6.851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Cheong SH, Choi YW, Choi HY, Byun JY. Nickel and cobalt release from jewellery and metal clothing items in Korea. Contact Dermatitis 2013; 70:11-8. [PMID: 24152201 DOI: 10.1111/cod.12141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/20/2013] [Accepted: 07/23/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND In Korea, the prevalence of nickel allergy has shown a sharply increasing trend. Cobalt contact allergy is often associated with concomitant reactions to nickel, and is more common in Korea than in western countries. OBJECTIVE The aim of the present study was to investigate the prevalence of items that release nickel and cobalt on the Korean market. MATERIALS AND METHODS A total of 471 items that included 193 branded jewellery, 202 non-branded jewellery and 76 metal clothing items were sampled and studied with a dimethylglyoxime (DMG) test and a cobalt spot test to detect nickel and cobalt release, respectively. RESULTS Nickel release was detected in 47.8% of the tested items. The positive rates in the DMG test were 12.4% for the branded jewellery, 70.8% for the non-branded jewellery, and 76.3% for the metal clothing items. Cobalt release was found in 6.2% of items. Among the types of jewellery, belts and hair pins showed higher positive rates in both the DMG test and the cobalt spot test. CONCLUSION Our study shows that the prevalence of items that release nickel or cobalt among jewellery and metal clothing items is high in Korea.
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Affiliation(s)
- Seung Hyun Cheong
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, 158-710, Korea
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27
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de Waard-van der Spek FB, Andersen KE, Darsow U, Mortz CG, Orton D, Worm M, Muraro A, Schmid-Grendelmeier P, Grimalt R, Spiewak R, Rudzeviciene O, Flohr C, Halken S, Fiocchi A, Borrego LM, Oranje AP. Allergic contact dermatitis in children: which factors are relevant? (review of the literature). Pediatr Allergy Immunol 2013; 24:321-9. [PMID: 23373713 DOI: 10.1111/pai.12043] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children.
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Affiliation(s)
- Flora B de Waard-van der Spek
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam and KinderHaven Havenziekenhuis, Rotterdam, The Netherlands.
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28
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Thyssen JP, Giménez-Arnau E, Lepoittevin JP, Menné T, Boman A, Schnuch A. The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals Part I. Contact Dermatitis 2012; 66 Suppl 1:11-24. [DOI: 10.1111/j.1600-0536.2011.02004_2.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Thyssen JP, Giménez-Arnau E, Lepoittevin JP, Menné T, Boman A, Schnuch A. The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals Part II. Contact Dermatitis 2012; 66 Suppl 1:25-52. [DOI: 10.1111/j.1600-0536.2011.02004_3.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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De Brouwere K, Buekers J, Cornelis C, Schlekat CE, Oller AR. Assessment of indirect human exposure to environmental sources of nickel: oral exposure and risk characterization for systemic effects. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 419:25-36. [PMID: 22285091 DOI: 10.1016/j.scitotenv.2011.12.049] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/20/2011] [Accepted: 12/22/2011] [Indexed: 05/25/2023]
Abstract
This paper describes the indirect human exposure to Ni via the oral route for the regional scale in the EU, together with a method to assess additional local exposure from industrial emissions. The approach fills a gap in the generic REACH guidance which is inadequate for assessing indirect environmental exposure of metals. Estimates of regional scale Ni dietary intake were derived from Ni dietary studies performed in the EU. Typical and Reasonable Worst Case dietary Ni intakes for the general population in the EU were below the oral Derived No Effect Level (DNEL) of Ni sulfate for systemic effects. Estimates for the Ni dietary intake at the local scale take into account the influence of aerial Ni deposition and transfer from soil to crops grown near industrial plants emitting Ni. The additional dietary exposure via this local contribution was small. Despite the use of conservative parameters for these processes, this method may underestimate dietary exposure around older industrial sites because REACH guidance does not account for historical soil contamination. Nevertheless, the method developed here can also be used as a screening tool for community-based risk assessment, as it accounts for historical soil pollution. Nickel exposure via drinking water was derived from databases on Ni tap water quality. A small proportion of the EU population (<5%) is likely to be exposed to tap water exceeding the EU standard (20 μg Ni/l). Taking into account the relative gastrointestinal absorption of Ni from water (30%) versus from solid matrices (5%), water intake constitutes, after dietary intake, the second most important pathway for oral Ni intake. Incidental ingestion of Ni from soil/dust at the regional scale, and also at the local scale, was low in comparison with dietary intake.
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Affiliation(s)
- Katleen De Brouwere
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium.
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31
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Thyssen JP. Nickel and cobalt allergy before and after nickel regulation - evaluation of a public health intervention. Contact Dermatitis 2011; 65 Suppl 1:1-68. [DOI: 10.1111/j.1600-0536.2011.01957.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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Thyssen JP, Johansen JD, Lidén C, Møller P, Jellesen MS, Menné T. Clinical work-up of a highly reactive nickel-allergic patient. Contact Dermatitis 2011; 65:51-3. [DOI: 10.1111/j.1600-0536.2011.01910.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Abstract
Children's clothes with metal snaps are a potential source of nickel exposure to consider in infants and very young children. Further more avoidance of this exposure may help prevent nickel sensitization.
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Affiliation(s)
- Sharon E Jacob
- University of California, San Diego and Rady Children's Hospital, San Diego, California, USA.
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Abstract
Nickel is the most common allergen causing allergic contact dermatitis in patch-tested children, especially in female children. Allergy to this metal can manifest in a variety of ways. In this case series, we present four children to illustrate the different presentations of nickel allergy confirmed by patch testing. Localized, id, and systemic nickel reactions are reviewed, as well as the diagnosis and management of nickel allergic contact dermatitis. While localized dermatitis in areas of direct contact to the allergen is the most common and easiest form of nickel allergy to identify, recognition of varying presentations is critical as these can result in more chronic and severe symptoms, and can be misdiagnosed as atopic dermatitis.
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Affiliation(s)
- Jessica W Hsu
- San Diego School of Medicine, University of California, San Diego, California, USA
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35
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Fischer LA, Menné T, Voelund A, Johansen JD. Can exposure limitations for well-known contact allergens be simplified? An analysis of dose-response patch test data. Contact Dermatitis 2011; 64:337-42. [DOI: 10.1111/j.1600-0536.2011.01876.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Thyssen JP, Uter W, McFadden J, Menné T, Spiewak R, Vigan M, Gimenez-Arnau A, Lidén C. The EU Nickel Directive revisited-future steps towards better protection against nickel allergy. Contact Dermatitis 2011; 64:121-5. [DOI: 10.1111/j.1600-0536.2010.01852.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jensen P, Thyssen JP, Johansen JD, Skare L, Menné T, Lidén C. Occupational hand eczema caused by nickel and evaluated by quantitative exposure assessment. Contact Dermatitis 2010; 64:32-6. [DOI: 10.1111/j.1600-0536.2010.01819.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kinbara M, Sato N, Kuroishi T, Takano-Yamamoto T, Sugawara S, Endo Y. Allergy-inducing nickel concentration is lowered by lipopolysaccharide at both the sensitization and elicitation steps in a murine model. Br J Dermatol 2010; 164:356-62. [DOI: 10.1111/j.1365-2133.2010.10016.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thyssen JP, Menné T. Metal allergy--a review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol 2010; 23:309-18. [PMID: 19831422 DOI: 10.1021/tx9002726] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1-3% are allergic to cobalt and chromium. Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.
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Affiliation(s)
- Jacob P Thyssen
- National Allergy Research Centre and Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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Ehrnrooth M, Kerosuo H. Face and neck dermatitis from a stainless steel orthodontic appliance. Angle Orthod 2010; 79:1194-6. [PMID: 19852615 DOI: 10.2319/092908-509r.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although nickel is the most common cause of contact allergy, nickel-containing orthodontic appliances seldom cause adverse reactions that result in discontinuation of treatment. We report on an eruption of dermatitis in the face and neck of an adult female patient after placement of a rapid maxillary expansion appliance (RME). Because the patient suspected nickel allergy, her tolerance to the appliance material was tested intraorally before treatment by cementing bands on four teeth for a week. No visible adverse reactions were seen during the test. One week after cementation of the RME appliance, the patient reported strong itching of the face and a red rash. Clinical examination showed itchy papular erythema on the face and neck. No intraoral reactions or symptoms were present. The RME appliance was removed, and symptoms disappeared in 4 to 5 days. The patient was referred for a nickel patch test, which gave a strong positive result. Adverse patient reactions of potential allergic origin should be diagnosed carefully, and their possible impact on further treatment should be evaluated accordingly.
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Thyssen J, Johansen J, Menné T, Lidén C, Bruze M, White I. Hypersensitivity reactions from metallic implants: a future challenge that needs to be addressed. Br J Dermatol 2010; 162:235-6. [DOI: 10.1111/j.1365-2133.2009.09526.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thyssen JP, Linneberg A, Menné T, Nielsen NH, Johansen JD. No association between nickel allergy and reporting cosmetic dermatitis from mascara or eye shadow: a cross-sectional general population study. J Eur Acad Dermatol Venereol 2009; 24:722-5. [DOI: 10.1111/j.1468-3083.2009.03506.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Thyssen JP, Johansen JD, Carlsen BC, Menné T. Prevalence of nickel and cobalt allergy among female patients with dermatitis before and after Danish government regulation: A 23-year retrospective study. J Am Acad Dermatol 2009; 61:799-805. [DOI: 10.1016/j.jaad.2009.03.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/20/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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47
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Thyssen JP, Menné T, Johansen JD. Nickel release from inexpensive jewelry and hair clasps purchased in an EU country - Are consumers sufficiently protected from nickel exposure? THE SCIENCE OF THE TOTAL ENVIRONMENT 2009; 407:5315-5318. [PMID: 19631967 DOI: 10.1016/j.scitotenv.2009.06.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/19/2009] [Accepted: 06/23/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Nickel allergic subjects are at risk factor of acquiring hand eczema. In 1990 and 1994, respectively, Denmark and member states in the EU regulated nickel release from selected consumer products. The intention was that the nickel epidemic could be controlled and prevented if the general population was protected from high cutaneous nickel concentrations. Despite a decrease, the prevalence of nickel allergy remains high as nearly 10% of young women are nickel allergic. OBJECTIVE This study aimed to perform dimethylglyoxime (DMG) testing of inexpensive jewelry and hair clasps purchased from random stores in Copenhagen, Denmark to detect the proportion of items that may result in nickel allergy. METHODS Inexpensive jewelry and hair clasps were purchased from 36 stores and street vendors in Copenhagen and were later tested for nickel release using the DMG test. RESULTS The study showed that 19.3% hair clasps, 14.8% earrings, and 12.9% necklaces intended for adult women released an excessive amount of nickel. Of 25 stores visited, 36.0% sold DMG positive jewelry. For items designed for children, excessive nickel release was identified in hair clasps (79.4%) and in finger rings (20%). Four (50.0%) of 8 children clothing stores sold jewelry that released too much nickel. DISCUSSION Excessive nickel release has been regulated since 1990 in Denmark. However, 1/5 of purchased items released nickel in concentrations that may lead to nickel allergy. Especially hair clasps intended for children released an excessive amount of nickel.
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Affiliation(s)
- Jacob Pontoppidan Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, 2900Hellerup, Denmark.
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48
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Fischer L, Menné T, Avnstorp C, Kasting G, Johansen J. Hydroxyisohexyl 3-cyclohexene carboxaldehyde allergy: relationship between patch test and repeated open application test thresholds. Br J Dermatol 2009; 161:560-7. [DOI: 10.1111/j.1365-2133.2009.09256.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Julander A, Hindsén M, Skare L, Lidén C. Cobalt-containing alloys and their ability to release cobalt and cause dermatitis. Contact Dermatitis 2009; 60:165-70. [PMID: 19260915 DOI: 10.1111/j.1600-0536.2008.01497.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cobalt, nickel, and chromium are important skin sensitizers. However, knowledge about cobalt exposure and causes of cobalt sensitization is limited. OBJECTIVES To study release of cobalt, nickel, and chromium from some cobalt-containing hard metal alloys and to test reactivity to the materials in cobalt-sensitized patients. METHODS Discs suitable for patch testing were made of some hard metal alloys. Cobalt, nickel, and chromium release from the materials was determined by immersion in artificial sweat (2 min, 1 hr, 1 day, and 1 week). Patch test reactivity to the discs and to serial dilutions of cobalt and nickel was assessed in previously patch-tested dermatitis patients (19 cobalt positive and 18 cobalt-negative controls). RESULTS All discs released cobalt, nickel, and chromium. Some discs released large amounts of cobalt (highest concentration: 290 microg/cm(2)/week). Seven discs elicited three or more positive test reactions. CONCLUSIONS The concentration of released cobalt was high enough to elicit allergic contact dermatitis in cobalt-sensitized patients. As the materials in the discs are used in wear parts of hard metal tools, individuals with contact allergy to cobalt may develop hand eczema when handling such materials.
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Affiliation(s)
- Anneli Julander
- Occupational and Environmental Dermatology, Department of Medicine in Solna, Karolinska Institutet, Stockholm, Sweden
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Lidén C, Skare L, Nise G, Vahter M. Deposition of nickel, chromium, and cobalt on the skin in some occupations – assessment by acid wipe sampling. Contact Dermatitis 2008; 58:347-54. [DOI: 10.1111/j.1600-0536.2008.01326.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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