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Nickel contact hypersensitivity in children
Nanette B Silverberg1, Jonah Licht, Suzanne Friedler
1Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA. Nsilverberg@slrhc.org
Insights
Nickel allergy is increasing, affecting 14.3% of North Americans. Early patch testing for nickel allergy is recommended, especially for children with dermatitis or family history, to enable timely nickel avoidance.
Area of Science:
- Dermatology
- Allergology
- Pediatrics
Background:
- Nickel allergic contact dermatitis (NACD) is the most prevalent allergy in North America, with a 14.3% incidence.
- NACD incidence has risen from 10% a decade ago, presumed due to increased environmental nickel exposure, particularly from costume jewelry and belt buckles.
- Pediatric patients with a history of umbilical or wrist dermatitis, or a family history of NACD, were studied.
Purpose of the Study:
- To investigate the prevalence and predictors of nickel allergy in pediatric patients.
- To evaluate the utility of patch testing in identifying nickel allergy in at-risk children.
- To inform early nickel avoidance strategies for children, especially those with atopic dermatitis.
Main Methods:
- A cohort of 30 pediatric patients with a history of dermatitis or family history of NACD underwent patch testing with nickel sulfate 5%.
- Presence of id reactions and the nature of patch test reactions (papular) were recorded.
- Statistical analysis was performed to identify predictors of NACD.
Main Results:
- All 30 pediatric patients exhibited positive patch tests to nickel sulfate.
- Fifty percent of patients experienced an id reaction, with papular reactions consistent with their patch tests.
- A positive family history of NACD was identified as a potential positive predictor for developing the allergy.
Conclusions:
- Patch testing for nickel allergy is highly effective in pediatric patients with umbilical dermatitis and id reactions.
- Family history may predict the development of NACD, highlighting the importance of nickel avoidance in atopic children.
- Early identification of nickel reactivity enables timely intervention and nickel avoidance, crucial for managing this prevalent allergy.
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.