Epidemiology of Nickel Sensitivity: Retrospective Cross-Sectional Analysis of North American Contact Dermatitis Group (NACDG) Data 1994-2014

Publication date: Available online 18 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Erin M. Warshaw, Amy J. Zhang, Joel G. DeKoven, Howard I. Maibach, Donald V. Belsito, Denis Sasseville, Joseph F. Fowler, Anthony F. Fransway, Toby Mathias, Melanie D. Pratt, James G. Marks, Kathryn A. Zug, Matthew J. Zirwas, James S. Taylor, Vincent A. DeLeo

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 1994-2014. Nickel sensitivity was defined as a positive patch test to nickel. We evaluated frequency of nickel sensitivity and patient demographics. For each positive nickel reaction, we tabulated clinical relevance, occupational relatedness, and exposure sources.

Results

Average frequency of nickel sensitivity was 17.5% (1994-2014). Nickel sensitivity significantly increased over time (14.3% 1994-1996 to 20.1% 2013-2014, p<0.0001). Nickel sensitive patients were significantly more likely to be female, young, non-Caucasian, atopic (eczema and asthma), and/or have dermatitis affecting the face, scalp, ears, neck, arm, or trunk (p values ≤0.0474). Overall, 55.5% of reactions were currently clinically relevant; this frequency significantly increased over time (44.1% 1994-1996 to 51.6% 2013-2014, p<0.0001). Occupational relatedness was 3.7% overall with a significant decrease over time (7.9% 1994-1996 to 1.9% 2013-2014, p<0.0001). Jewelry was the most common source.

Limitations

Tertiary referral population.

Conclusions

Nickel allergy is of significant 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.