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Sanz-Correa J, Sanz-Sanchez T, Díaz-Díaz RM. Concordance of different sources for nickel sulphate patch testing. Contact Dermatitis 2024. [PMID: 39016190 DOI: 10.1111/cod.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Juan Sanz-Correa
- Department of Dermatology and Venereology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Spain
| | - Tatiana Sanz-Sanchez
- Department of Dermatology and Venereology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Spain
- Universidad Europea, Villaviciosa de Odon, Madrid, Spain
| | - Rosa M Díaz-Díaz
- Department of Dermatology and Venereology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Spain
- Universidad Europea, Villaviciosa de Odon, Madrid, Spain
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2
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Tjen VH, Yang PZ. Nickel-related hypersensitivity reactions following endovascular interventions: A review of current evidence. Sci Prog 2023; 106:368504231200626. [PMID: 37872684 PMCID: PMC10594965 DOI: 10.1177/00368504231200626] [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: 10/25/2023]
Abstract
INTRODUCTION Nickel is a principal alloying agent in the production of vascular endoprostheses, despite persisting as the most habitually identified allergen. Variable nickel-related hypersensitivity manifestations following endovascular intervention were reported, challenging established paradigms in treatment and accuracy of prognostic assessments. The objective of this review is to critically evaluate current metrics to maximise patient-related outcomes. METHODS A literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement. Patients indicative of nickel hypersensitivity reaction following endovascular intervention were discerned. A positive reaction was defined by patch testing, histological analysis, or anamnesis indicative of nickel hypersensitivity. Morphology of implicating prostheses, adverse events and postoperative complications, clinical course, diagnostic and therapeutic strategies alongside patient prognosis were recorded. RESULTS Nickel-related hypersensitivity reactions following endovascular repair were identified in 36 patients with a median age of 44.5 years. 20 patients received nitinol-containing intervention. 28 (77.8%) patients are female. Multi-organ adverse reactions occurred in 21 (58.3%) patients with variable latency. 14 (38.9%) patients were presented with neurological adverse reactions manifesting mainly as unilateral hemiparesis. Dermatological reactions implicated 16 (44.4%) patients. Miscellaneous manifestations include suicidal ideation. 13 (36.1%) patients displayed previous metal intolerance and 32 (88.9%) patients had positive patch testing for nickel. Histological analysis of lesions and prostheses indicated lymphocytic infiltration. 5 (13.9%) patients experienced device-specific reactions as in-stent restenosis or auxiliary distal vessel stenosis. 11 (30.1%) patients received solely medical therapy and 5 (13.9%) patients received solely surgical therapy. 19 (52.7%) patients underwent both medical (oral corticosteroid) and surgical therapy (device retrieval). 26 (77.1%) patients achieved symptomatic cessation, 6 (16.7%) patients exhibited symptomatic persistence and 0 patients died. CONCLUSION Prophylactic pre-assessment for a history of metal allergy and consideration of prostheses alternatives is recommended to minimise reaction risk and severity. Despite nickel's predominant usage, information paucity urges additional studies to emphasise its implications and maximise patient outcomes.
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Affiliation(s)
| | - Paul Zichu Yang
- School of Medicine, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Mahler V, Uter W. Epicutaneous Patch Testing in Type IV Allergy Diagnostics: State of the Art and Best Practice Recommendations. Handb Exp Pharmacol 2022; 268:405-433. [PMID: 34312717 DOI: 10.1007/164_2021_508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This chapter summarises all relevant aspects of patch testing, closely following recommendations outlined in a recent European, and a German S3 guideline on diagnostic patch testing with contact allergens and medicinal products (drugs). Patch testing is indicated in patients suspected of suffering, or having been suffering, from delayed-type hypersensitivity leading to allergic contact dermatitis or other skin and mucosal diseases. Sections of this chapter include detailed indications, reasons for possibly postponing the test, considerations on choosing haptens (contact allergens) to test, various aspects of the application of patch test allergen preparations (storage, dosing) and of testing with individual materials provided by the patients. Special aspects of patch testing in cutaneous adverse drug reactions, children, or occupational contact dermatitis are outlined. Supplemental test methods, notably the repeated open application test, are briefly described. Finally, the final evaluation in terms of assessment of clinical relevance of reactions and patient counselling are outlined.
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Affiliation(s)
- Vera Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft-Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3 guidelines: Epicutaneous patch testing with contact allergens and drugs - Short version, Part 1. J Dtsch Dermatol Ges 2020; 17:1076-1093. [PMID: 31631537 DOI: 10.1111/ddg.13956] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note: This publication is part 1 of the short version of the S3 guidelines for "Epicutaneous patch testing using contact allergens and drugs" (registry no. 013 - 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org. The method report is available as online publication (https://www.awmf.org/leitlinien/detail/ll/013-018.html) and contains the evidence tables in its appendix.
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Affiliation(s)
- Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Paul-Ehrlich-Institut, Langen, Germany
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Detlef Becker
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Jochen Brasch
- Department of Dermatology, Venereology und Allergology, University Medical Center, Kiel, Germany
| | - Kristine Breuer
- Dermatology Practice (Dermatologie Reinbek), Reinbek, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology und Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans Drexler
- Institute for Occupational, Social and Environmental Medicine, Friedrich--Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Burkhard Kreft
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Silvia Pleschka
- German Allergy and Asthma Foundation (Deutscher Allergie- und Asthmabund e.V.), Mönchengladbach, Germany
| | - Maria Portisch
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Petra Spornraft-Ragaller
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Medical Center, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, , Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology und Allergology, Charité - UniversityMedicine, Berlin, Germany
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Medical Faculty, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft‐Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3‐Leitlinie: Durchführung des Epikutantests mit Kontaktallergenen und Arzneimitteln – Kurzfassung Teil 1. J Dtsch Dermatol Ges 2019; 17:1075-1093. [DOI: 10.1111/ddg.13956_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
- Paul‐Ehrlich‐Institut Langen
| | - Alexander Nast
- Division of Evidence‐Based Medicine (dEBM)Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin Berlin
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | | | - Jochen Brasch
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Schleswig‐Holstein Kiel
| | | | - Heinrich Dickel
- Klinik für DermatologieVenerologie und AllergologieSt. Josef‐Hospital Ruhr‐Universität Bochum Bochum
| | - Hans Drexler
- Institut für Arbeits‐, Sozial‐ und Umweltmedizin der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena Jena
| | - Johannes Geier
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück Osnabrück
| | - Burkhard Kreft
- Klinik und Poliklinik für Dermatologie und VenerologieUniversitätsklinikum Halle (Saale) Halle
| | | | - Hans Merk
- Univ.‐Professor für Dermatologie & AllergologieDirektor (em.) der Hautklinik – RWTH Aachen University Aachen
| | - Hagen Ott
- Hannoversche Kinderheilanstalt (HKA): Kinder‐ und Jugendkrankenhaus auf der Bult Hannover
| | | | - Maria Portisch
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Petra Spornraft‐Ragaller
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | - Elke Weisshaar
- Berufsdermatologie, Hautklinik, Universitätsklinikum Heidelberg Heidelberg
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und VenerologieMedizinische Hochschule Hannover Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie Charité ‐ Universitätsmedizin Berlin Berlin
| | - Axel Schnuch
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Wolfgang Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)Medizinische Fakultät der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
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6
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Stingeni L, Bianchi L, Hansel K, Corazza M, Gallo R, Guarneri F, Patruno C, Rigano L, Romita P, Pigatto PD, Calzavara-Pinton P. Italian Guidelines in Patch Testing - adapted from the European Society of Contact Dermatitis (ESCD). GIORN ITAL DERMAT V 2019; 154:227-253. [DOI: 10.23736/s0392-0488.19.06301-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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7
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Björk AK, Bruze M, Engfeldt M, Nielsen C, Svedman C. The reactivity of the back revisited. Are there differences in reactivity in different parts of the back? Contact Dermatitis 2016; 76:19-26. [PMID: 27593358 DOI: 10.1111/cod.12657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the contact dermatitis literature, it is regularly stated that the patch test reactivity on various areas of the back differs, which might have a large impact on the reproducibility of patch testing. OBJECTIVES To investigate the reproducibility of patch testing on the upper back with regard to the left as opposed to the right side, and the medial as opposed to the lateral part of the upper back. The reproducibility over time and with regard to the reactivity pattern was also investigated. METHODS Thirty-one subjects with contact allergy to the metals gold (n = 19) or nickel (n = 12) were patch tested with serial dilutions, in triplicate applications, on different locations on the upper back. The Friedman test was used for statistical calculations. RESULTS No significant differences in the reactivity of the back were found. In all gold-allergic patients and 11 of 12 nickel-allergic patients, the allergy could be reproduced with regard to previous patch testing, but the degree of reactivity differed. CONCLUSIONS When a high level of standardization of the patch test technique with the same test system was used, there were no differences in patch test reactions and sites of application on the upper back.
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Affiliation(s)
- Ann-Kristin Björk
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Christel Nielsen
- R&D Centre Skåne, Skåne University Hospital, 22185, Lund, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
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8
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Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, John SM, Lidén C, Lindberg M, Mahler V, Matura M, Rustemeyer T, Serup J, Spiewak R, Thyssen JP, Vigan M, White IR, Wilkinson M, Uter W. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis 2015; 73:195-221. [PMID: 26179009 DOI: 10.1111/cod.12432] [Citation(s) in RCA: 928] [Impact Index Per Article: 103.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
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Affiliation(s)
- Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Kristiina Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, 00250 Helsinki, Finland
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Klaus E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
| | - Andreas Bircher
- Allergy Unit, Department of Dermatology, University Hospital and University of Basel, 4031 Basel, Switzerland
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, SE-20502 Malmö, Sweden
| | - Alicia Cannavó
- Hospital Municipal de Vicente López 'Profesor Bernard Houssay', Buenos Aires, Argentina
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, 08003 Barcelona, Spain
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital K. U. Leuven, B-3000 Leuven, Belgium
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, D-49069 Osnabrueck, Germany
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Magnus Lindberg
- Department of Dermatology, University Hospital Örebro, SE-70185 Örebro, Sweden
| | - Vera Mahler
- Allergy Unit, Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mihály Matura
- Unit of Occupational and Environmental Dermatology, Centre for Occupational and Environmental Medicine, SLSO, SE-11365 Stockholm, Sweden
| | - Thomas Rustemeyer
- Department of Dermatology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Jørgen Serup
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Jacob P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Martine Vigan
- Department of Dermatology, CHRU Besançon, 25030 Besançon Cedex, France
| | - Ian R White
- Department of Cutaneous Allergy, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, UK
| | | | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany
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9
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Heim KE, McKean BA. Children’s clothing fasteners as a potential source of exposure to releasable nickel ions. Contact Dermatitis 2009; 60:100-5. [DOI: 10.1111/j.1600-0536.2008.01487.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Giusti F, Seidenari S. Reproducibility of atopy patch tests with Dermatophagoides: a study on 85 patients with atopic dermatitis. Contact Dermatitis 2004; 50:18-21. [PMID: 15059098 DOI: 10.1111/j.0105-1873.2004.00277.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopy patch tests (APTs) are considered a useful addition to standard testing procedures for the identification of allergens triggering the appearance of eczema in patients with atopic dermatitis (AD). The aim of the study was to evaluate the reproducibility of APTs with house dust mites by simultaneously patch testing AD patients. 85 subjects affected by AD, 36 males and 48 females, aged from 1 to 52 years, were patch tested with Dermatophagoides mix (D. pteron/D. farinae) 20% pet. In our patients, the percentage of agreement between the frequency of positive and negative responses to Dermatophagoides mix was 96.7%. Reproducibility was highly satisfactory, as evaluated by k-value (0.953). As regards the agreement in the intensity of APT responses to Dermatophagoides mix between the right and left sides, we found that reproducibility was also highly satisfactory (k = 0.851). In conclusion, for Dermatophagoides APTs, the agreement rate was similar to that of standard patch tests, and therefore APTs may be considered sufficiently reproducible to be employed as a diagnostic testing procedure.
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Affiliation(s)
- Francesca Giusti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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11
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Abstract
Metals play a vital role in human, animal and plant physiology, and important research, past and ongoing, is directed towards exploring the interrelated mechanisms that govern their penetration through skin. Much insight has been gained through these efforts, but our understanding of the process is still incomplete, mainly due to the failure to allow for the effects of chemical speciation of metallic elements, especially the transition metals. Also, the skin as target organ presents imponderable and wide margins of variability. In vivo permeability is subject to homeostasis regulating the overall organism; in vitro, the sections of skin used for diffusion experiments are likely to present artifacts. Endeavors to define rules governing skin penetration to give predictive quantitative structure-diffusion relationships for metallic elements for risk assessment purposes have been unsuccessful, and penetration of the skin still needs to be determined separately for each metal species, either by in vitro or in vivo assays. Phenomena observed by us and other investigators, which appear to determine the process of skin permeation for a number of metals, are reviewed, separating the exogenous factors from the characteristics of the skin or other endogenous factors.
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Affiliation(s)
- J J Hostynek
- Department of Dermatology, UCSF School of Medicine, Box 0989, 90 Medical Centre Way, SURGE 110, San Francisco, CA 94143-0989, USA.
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12
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Abstract
Nickel allergic contact dermatitis is the most prevalent allergy in North America, with an incidence of 14.3%. It is on the rise from 10 years ago, when the incidence was 10%. This has been presumed to represent an increased exposure to nickel in the environment-especially in costume jewelry and belt buckles. We examined a group of 30 pediatric patients who had either a personal history of umbilical or wrist dermatitis, or a family history of nickel allergic contact dermatitis. All of these patients had a positive patch test to nickel sulfate 5%. Moreover, 50% of patients had an id reaction; all of these patients had positive patch tests that were papular in nature, similar to their papular id reaction. We posit that the presence of a positive family history may be a positive predictor of nickel allergic contact dermatitis, requiring nickel avoidance, especially in atopic children. Based on the high level of positive reactions in patients with umbilical dermatitis and an id reaction, patch testing to nickel in these patients is most likely to yield a useful result. Knowledge of reactivity to nickel would then allow parents and patients to initiate nickel avoidance earlier in life.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
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13
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Affiliation(s)
- L Räsänen
- Department of Dermatology, University Hospital of Kuopio, Finland
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