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Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis
Jonathan I Silverberg1,2, Nisha Patel1, Erin M Warshaw3,4,5
1From the Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA.
Dermatitis : Contact, Atopic, Occupational, Drug
|December 5, 2023
Summary
Metal allergy, including nickel, cobalt, and chromium, is common. This study analyzed patch test data, finding concurrent metal sensitization in 6% of patients, with jewelry as a frequent source.
Area of Science:
- Dermatology
- Allergology
- Toxicology
Background:
- Allergic contact dermatitis (ACD) is often triggered by metals, with simultaneous sensitization to multiple metals being a clinical concern.
- Understanding the patterns of single versus multiple metal sensitization is crucial for accurate diagnosis and management of ACD.
Purpose of the Study:
- To evaluate the characteristics and associations of positive patch test (PT) reactions to nickel, cobalt, and chromium.
- To differentiate between solitary and concurrent metal sensitization and identify related dermatitis sites and allergen sources.
Main Methods:
- Retrospective analysis of PT results for nickel, cobalt, and chromium from the North American Contact Dermatitis Group (2001-2018).
- Inclusion of 43,522 patients, assessing reaction relevance, dermatitis location, and identified metal sources.
Main Results:
- 18.0% had nickel allergy, 7.3% cobalt, and 3.0% chromium.
- 87.9% had no relevant metal reactions, 9.4% one, and 2.7% multiple.
- Concurrent sensitization to multiple metals occurred in 6% of patients, with jewelry being a common source for nickel and cobalt.
Conclusions:
- Concurrent metal sensitization is present in a significant minority of patients with metal allergy.
- Dermatitis distribution varies with the number of relevant metal sensitizations.
- Allergen sources differ between solitary and multiple metal sensitivities, highlighting the need for comprehensive allergen identification.
