Scientific Publications Database
Article Title: Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014Authors: Warshaw, Erin M.; Zhang, Amy J.; DeKoven, Joel G.; Maibach, Howard I.; Belsito, Donald V.; Sasseville, Denis; Fowler, Joseph F., Jr.; Fransway, Anthony F.; Mathias, Toby; Pratt, Melanie D.; Marks, James G., Jr.; Zug, Kathryn A.; Zirwas, Matthew J.; Taylor, James S.; DeLeo, Vincent A.
Journal: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Volume 80 Issue 3
Date of Publication:2019
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.