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J Am Acad Dermatol. 2019 Mar;80(3):701-713. doi: 10.1016/j.jaad.2018.09.058. Epub 2018 Oct 18.

Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014.

Author information

1
Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
2
University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: fengx358@umn.edu.
3
Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
4
Department of Dermatology, University of California San Francisco, San Francisco, California.
5
Department of Dermatology, Columbia University, New York, New York.
6
Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec.
7
University of Louisville, Louisville, Kentucky.
8
Associates in Dermatology, Fort Myers, Florida.
9
Department of Dermatology, University of Cincinnati, Cincinnati, Columbus.
10
Division of Dermatology, University of Ottawa, Ontario, Canada.
11
Department of Dermatology, Pennsylvania State University, State College, Pennsylvania.
12
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
13
Ohio State University, Columbus, Ohio.
14
Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
15
Department of Dermatology, Keck School of Medicine, Los Angeles, California.

Abstract

BACKGROUND:

Nickel is a common allergen.

OBJECTIVE:

To examine the epidemiology of nickel sensitivity in North America.

METHODS:

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

RESULTS:

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

LIMITATIONS:

Tertiary referral population.

CONCLUSIONS:

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

KEYWORDS:

North American Contact Dermatitis Group; allergic contact dermatitis; nickel

PMID:
30342160
DOI:
10.1016/j.jaad.2018.09.058
[Indexed for MEDLINE]

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