The American Contact Dermatitis Society has proclaimed nickel as its 2008 Allergen of the Year because of its rise as a cause of significant contact dermatitis in the United States, particularly among children.
“To dismiss nickel's importance and relevance to public health and skin disease, would be a mistake,” said Dr. Kathryn A. Zug in an article scheduled for publication in the Jan./Feb. issue of Dermatitis.
The metal can be found in coins, jewelry, buckles, pant snaps, tools, and other products, noted Dr. Zug of the of the department of dermatology at Dartmouth Hitchcock Medical Center, Lebanon, N.H.
Data from the North American Contact Dermatitis Group (NACDG) have shown that the number of patients who patch-tested positive for nickel grew from 11% in 1985-1990 to 19% in 2003-2004. Of 391 children who were patch-tested by the group from 2001 to 2004, 28% had a positive patch test to nickel, and 26% were thought to have a nickel allergy of either current or past relevance.
“NACDG data [also] show that as in adult females, nickel sensitization in girls is on the rise,” wrote Dr. Zug, the immediate past president of the American Contact Dermatitis Society, who cowrote the article with Rachel Kornik, a fourth-year medical student at Dartmouth.
The prevalence of nickel allergy in girls and women is probably mostly due to ear piercing and sensitization from some jewelry, Dr. Zug said in an interview. Sensitization is higher in men with pierced ears.
Health providers should also consider:
▸ Complications related to biomedical devices. Although reactions to medical-grade stainless steel is uncommon in nickel-sensitized patients, orthopedic surgeons and orthodontists still consult dermatologists about the safety of metal medical devices, the authors wrote. In addition, in patients who undergo endovascular stenting, evidence that nickel allergy is associated with stent restenosis “remains in question.”
▸ Ingestion of dietary nickel. Nickel is found in foods such as legumes, nuts, grains, chocolate, and fish, as well as medications and vitamins.
▸ Prevention of contact allergy to nickel is challenging. The best approach is to find ways to reduce sensitization. Regulation of nickel release from consumer goods “would be a challenging but potentially successful solution,” wrote the authors, who reported no conflicts of interest.