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Endocrine, Metabolic & Immune Disorders - Drug Targets

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ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

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Review Article

Nickel Allergy of the Skin and Beyond

Author(s): Malena Gergovska, Razvigor Darlenski* and Jana Kazandjieva

Volume 20, Issue 7, 2020

Page: [1003 - 1009] Pages: 7

DOI: 10.2174/1871530320666200228124453

Price: $65

Abstract

Background: Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema.

Objective: The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented.

Methods: Electronic databases on this topic was carried out using PubMed-Medline.

Results: The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared.

Conclusion: The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.

Keywords: Contact dermatitis, diet, hand eczema, metal implant, nickel allergy, specific nickel-scavenging agents, treatment.

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Graphical Abstract

[1]
The International Nickel Company. Romance of nickel; New York, 1960.
[2]
Lidén, C. Nickel in jewellery and associated products. Contact Dermat., 1992, 26(2), 73-75.
[http://dx.doi.org/10.1111/j.1600-0536.1992.tb00887.x] [PMID: 1633708]
[3]
Liden, C.; Bruze, M.; Menne, T. Contact Dermatitis; Berlin Heidelberg Springer , 2006, pp. 537-568.
[4]
Thyssen, J.P.; Linneberg, A.; Menné, T.; Johansen, J.D. The epidemiology of contact allergy in the general population--prevalence and main findings. Contact Dermat., 2007, 57(5), 287-299.
[http://dx.doi.org/10.1111/j.1600-0536.2007.01220.x] [PMID: 17937743]
[5]
Andersen, K.E.; White, I.R.; Goossens, A. Allergens from the standard series. Menné, T.; Lepoittevin, J., P. Contact dermatitis, 4th ed; Frosch, P.J., Ed.; Springer: New York, 2006, p. 455.
[http://dx.doi.org/10.1007/3-540-31301-X_29]
[6]
Mortz, C.G.; Lauritsen, J.M.; Bindslev-Jensen, C.; Andersen, K.E. Nickel sensitization in adolescents and association with ear piercing, use of dental braces and hand eczema. Acta Derm. Venereol., 2002, 82(5), 359-364.
[http://dx.doi.org/10.1080/000155502320624096] [PMID: 12430735]
[7]
Basketter, D.A.; Briatico-Vangosa, G.; Kaestner, W.; Lally, C.; Bontinck, W.J. Nickel, cobalt and chromium in consumer products: a role in allergic contact dermatitis? Contact Dermat., 1993, 28(1), 15-25.
[http://dx.doi.org/10.1111/j.1600-0536.1993.tb03318.x] [PMID: 8428439]
[8]
Basketter, D.A.; Angelini, G.; Ingber, A.; Kern, P.S.; Menné, T. Nickel, cobalt and chromium in consumer products: a role in allergic contact dermatitis? Contact Dermat., 2003, 49, 1-7.
[http://dx.doi.org/10.1111/j.0105-1873.2003.00149.x]
[9]
Hallab, N.; Merritt, K.; Jacobs, J.J. BMS-CDT-2019-HT8-946-2 J Bone Joint Surg Am., 2001, 83(A), 428-36..
[10]
Morwood, M.P.; Garrigues, G.E. Shoulder arthroplasty in the patient with metal hypersensitivity. J. Shoulder Elbow Surg., 2015, 24(7), 1156-1164.
[http://dx.doi.org/10.1016/j.jse.2015.01.015] [PMID: 25799922]
[11]
Disegi, J.A.; Eschbach, L. Stainless steel in bone surgery. Injury, 2000, 31(4)(Suppl. 4), 2-6.
[http://dx.doi.org/10.1016/S0020-1383(00)80015-7] [PMID: 11270076]
[12]
Foussereau, J.; Laugier, P. Allergic eczemas from metallic foreign bodies. Trans. St Johns Hosp. Dermatol. Soc., 1966, 52(2), 220-225.
[PMID: 5999235]
[13]
Benson, M.K.; Goodwin, P.G.; Brostoff, J. Metal sensitivity in patients with joint replacement arthroplasties. BMJ, 1975, 4(5993), 374-375.
[http://dx.doi.org/10.1136/bmj.4.5993.374] [PMID: 1192078]
[14]
Christiansen, K.; Holmes, K.; Zilko, P.J. Metal sensitivity causing loosened joint prostheses. Ann. Rheum. Dis., 1980, 39(5), 476-480.
[http://dx.doi.org/10.1136/ard.39.5.476] [PMID: 7436578]
[15]
Wendy, Z.W.; Teo, W. Metal hypersensitivity reactions to orthopedic implants. Dermatol. Ther. (Heidelb.), 2017, 7(1), 53-64.
[http://dx.doi.org/10.1007/s13555-016-0162-1]
[16]
Hostynek, J.J. Sensitization to nickel: Etiology, epidemiology, immune reactions, prevention, and therapy. Rev. Environ. Health, 2006, 21(4), 253-280.
[http://dx.doi.org/10.1515/REVEH.2006.21.4.253] [PMID: 17243350]
[17]
Dotterud, L.K. The prevalence of allergic contact sensitization in a general population in Tromsø, Norway. Int. J. Circumpolar Health, 2007, 66(4), 328-334.
[http://dx.doi.org/10.3402/ijch.v66i4.18275] [PMID: 18018846]
[18]
Christensen, O.B. Nickel dermatitis. An update. Dermatol. Clin., 1990, 8(1), 37-40.
[http://dx.doi.org/10.1016/S0733-8635(18)30518-7] [PMID: 2406062]
[19]
Peltonen, L. Nickel sensitivity in the general population. Contact Dermat., 1979, 5(1), 27-32.
[http://dx.doi.org/10.1111/j.1600-0536.1979.tb05531.x] [PMID: 421456]
[20]
Nielsen, N.H.; Menné, T. Allergic contact sensitization in an unselected Danish population. The Glostrup Allergy Study, Denmark. Acta Derm. Venereol., 1992, 72(6), 456-460.
[PMID: 1362844]
[21]
Freireich-Astman, M.; David, M.; Trattner, A. Standard patch test results in patients with contact dermatitis in Israel: Age and sex differences. Contact Dermat., 2007, 56(2), 103-107.
[http://dx.doi.org/10.1111/j.1600-0536.2007.01004.x] [PMID: 17244079]
[22]
Ertam, I.; Turkmen, M.; Alper, S. Patch-test results of an academic department in Izmir, Turkey. Dermatitis, 2008, 19(4), 213-215.
[http://dx.doi.org/10.2310/6620.2008.08004] [PMID: 18674457]
[23]
DeKoven, J.G.; Warshaw, E.M.; Zug, K.A.; Maibach, H.I.; Belsito, D.V.; Sasseville, D.; Taylor, J.S.; Fowler, J.F., Jr; Mathias, C.G.T.; Marks, J.G.; Pratt, M.D.; Zirwas, M.J.; DeLeo, V.A. North American contact dermatitis group patch test results: 2015-2016. Dermatitis, 2018, 29(6), 297-309.
[http://dx.doi.org/10.1097/DER.0000000000000417] [PMID: 30422882]
[24]
Brandão, M.H.; Gontijo, B.; Girundi, M.A.; de Castro, M.C. Ear piercing as a risk factor for contact allergy to nickel. J. Pediatr. (Rio J.), 2010, 86(2), 149-154.
[http://dx.doi.org/10.2223/JPED.1980] [PMID: 20361123]
[25]
Todd, D.J.; Burrows, D. Nickel allergy in relationship to previous oral and cutaneous nickel contact. Ulster Med. J., 1989, 58(2), 168-171.
[PMID: 2603268]
[26]
Kolokitha, O.E.; Kaklamanos, E.G.; Papadopoulos, M.A. Prevalence of nickel hypersensitivity in orthodontic patients: A meta-analysis. Am. J. Orthod. Dentofacial Orthop., 2008, 134(6), 722.e1-722.e12.
[http://dx.doi.org/10.1016/j.ajodo.2008.01.013] [PMID: 19061797]
[27]
Magina, S.; Barros, M.A.; Ferreira, J.A.; Mesquita-Guimarães, J. Atopy, nickel sensitivity, occupation, and clinical patterns in different types of hand dermatitis. Am. J. Contact Dermat., 2003, 14(2), 63-68.
[http://dx.doi.org/10.1097/01634989-200306000-00003] [PMID: 14749022]
[28]
Liden, C. Handbook of occupational dermatitis; Berlin, Heidelberg, 2000, pp. 524-533.
[29]
Diepgen, T.L.; Fartasch, M.; Hornstein, O.P. Evaluation and relevance of atopic basic and minor features in patients with atopic dermatitis and in the general population. Acta Derm. Venereol. Suppl. (Stockh.), 1989, 144, 50-54.
[PMID: 2800907]
[30]
Novak, N.; Baurecht, H.; Schäfer, T.; Rodriguez, E.; Wagenpfeil, S.; Klopp, N.; Heinrich, J.; Behrendt, H.; Ring, J.; Wichmann, E.; Illig, T.; Weidinger, S. Loss-of-function mutations in the filaggrin gene and allergic contact sensitization to nickel. J. Invest. Dermatol., 2008, 128(6), 1430-1435.
[http://dx.doi.org/10.1038/sj.jid.5701190] [PMID: 18049447]
[31]
Jindal, R.; Sharma, N.L.; Mahajan, V.K.; Tegta, G.R. Contact sensitization in venous eczema: preliminary results of patch testing with Indian standard series and topical medicaments. Indian J. Dermatol. Venereol. Leprol., 2009, 75(2), 136-141.
[http://dx.doi.org/10.4103/0378-6323.48657] [PMID: 19293499]
[32]
Barber, K.A.; Cronin, E. Patch and photopatch testing in chronic actinic dermatitis. Contact Dermat., 1984, 10(2), 69-73.
[http://dx.doi.org/10.1111/j.1600-0536.1984.tb00338.x] [PMID: 6713843]
[33]
Thierse, H.J.; Gamerdinger, K.; Junkes, C.; Guerreiro, N.; Weltzien, H.U. T cell receptor (TCR) interaction with haptens: Metal ions as non-classical haptens. Toxicology, 2005, 209(2), 101-107.
[http://dx.doi.org/10.1016/j.tox.2004.12.015] [PMID: 15767020]
[34]
Gawkrodger, D.J. Nickel dermatitis: how much nickel is safe? Contact Dermat., 1996, 35(5), 267-271.
[http://dx.doi.org/10.1111/j.1600-0536.1996.tb02386.x] [PMID: 9007370]
[35]
Thomas, P.; Thomsen, M. Implant allergies. Hautarzt, 2010, 61(3), 255-262.
[http://dx.doi.org/10.1007/s00105-009-1907-x] [PMID: 20204719]
[36]
Pacheco, K.A. Allergy to Surgical Implants. J. Allergy Clin. Immunol. Pract., 2015, 3(5), 683-695.
[http://dx.doi.org/10.1016/j.jaip.2015.07.011] [PMID: 26362550]
[37]
Morgan, L.G.; Flint, G.N. Nickel alloys and coatings: Release of nickel. Nickel and the skin: Immunology and toxicology; Maibach, H.I; Menné, T., Ed.; CRC: Boca Raton, 1989, pp. 45-54.
[38]
Hemingway, J.D.; Molokhia, M.M. The dissolution of metallic nickel in artificial sweat. Contact Dermat., 1987, 16(2), 99-105.
[http://dx.doi.org/10.1111/j.1600-0536.1987.tb01388.x] [PMID: 3568645]
[39]
Cramers, M.; Lucht, U. Metal sensitivity in patients treated for tibial fractures with plates of stainless steel. Acta Orthop. Scand., 1977, 48(3), 245-249.
[http://dx.doi.org/10.3109/17453677708988763] [PMID: 920115]
[40]
Fisher, A.A. Allergic dermatitis persumably due to metallic foreign bodies containing nickel or cobalt. Cutis, 1977, 19(3), 285-286, passim.
[PMID: 844331]
[41]
Mitchelson, A.J.; Wilson, C.J.; Mihalko, W.M.; Grupp, T.M.; Manning, B.T.; Dennis, D.A.; Goodman, S.B.; Tzeng, T.H.; Vasdev, S.; Saleh, K.J. Biomaterial hypersensitivity: Is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty. BioMed Res. Int., 2015, 2015 137287
[http://dx.doi.org/10.1155/2015/137287] [PMID: 25883940]
[42]
Rietschel, R.L. Fowle,r J.F.; Warshaw, E.M. Detection of nickel sensitivity has increased in North American patch-test patients. Dermatitis, 2008, 19, 16-19.
[http://dx.doi.org/10.2310/6620.2008.06062] [PMID: 18346391]
[43]
Thyssen, J.P.; Linneberg, A.; Menné, T.; Nielsen, N.H.; Johansen, J.D. Contact allergy to allergens of the TRUE-test (panels 1 and 2) has decreased modestly in the general population. Br. J. Dermatol., 2009, 161(5), 1124-1129.
[http://dx.doi.org/10.1111/j.1365-2133.2009.09325.x] [PMID: 19857210]
[44]
Lu, L.K.; Warshaw, E.M.; Dunnick, C.A. Prevention of nickel allergy: The case for regulation? Dermatol. Clin., 2009, 27(2), 155-161. [vi-vii.]
[http://dx.doi.org/10.1016/j.det.2008.11.003] [PMID: 19254659]
[45]
Thienpont, E.; Berger, Y. No allergic reaction after TKA in a chrome-cobalt-nickel-sensitive patient: case report and review of the literature. Knee Surg. Sports Traumatol. Arthrosc., 2013, 21(3), 636-640.
[http://dx.doi.org/10.1007/s00167-012-2000-z] [PMID: 22488014]
[46]
Amini, M.; Mayes, W.H.; Tzeng, A.; Tzeng, T.H.; Saleh, K.J.; Mihalko, W.M. Evaluation and management of metal hypersensitivity in total joint arthroplasty: A systematic review. J. Long Term Eff. Med. Implants, 2014, 24(1), 25-36.
[http://dx.doi.org/10.1615/JLongTermEffMedImplants.2014010277] [PMID: 24941403]
[47]
Wall, L.M. Nickel penetration through rubber gloves. Contact Dermat., 1980, 6(7), 461-463.
[http://dx.doi.org/10.1111/j.1600-0536.1980.tb05566.x] [PMID: 7214888]
[48]
Moseley, J.C.; Allen, H.J., Jr Polyurethane coating in the prevention of nickel dermatitis. Arch. Dermatol., 1971, 103(1), 58-60.
[http://dx.doi.org/10.1001/archderm.1971.04000130060008] [PMID: 5539504]
[49]
van Ketel, W.G.; Bruynzeel, D.P. Chelating effect of EDTA on nickel. Contact Dermat., 1984, 11(5), 311-314.
[http://dx.doi.org/10.1111/j.1600-0536.1984.tb01016.x] [PMID: 6441675]
[50]
van Ketel, W.G.; Bruynzeel, D.P. The possible chelating effect of sodium diethyldithiocarbamate (DDC) in nickel allergic patients. Patch test procedures with nickel on DDC pretreated skin. Derm. Beruf Umwelt, 1982, 30(6), 198-202.
[PMID: 6297866]
[51]
Gawkrodger, D.J.; Healy, J.; Howe, A.M. The prevention of nickel contact dermatitis. A review of the use of binding agents and barrier creams. Contact Dermat., 1995, 32(5), 257-265.
[http://dx.doi.org/10.1111/j.1600-0536.1995.tb00778.x] [PMID: 7634778]
[52]
Memon, A.A.; Molokhia, M.M.; Friedmann, P.S. The inhibitory effects of topical chelating agents and antioxidants on nickel-induced hypersensitivity reactions. J. Am. Acad. Dermatol., 1994, 30(4), 560-565.
[http://dx.doi.org/10.1016/S0190-9622(94)70062-1] [PMID: 8157781]
[53]
Allenby, C.F.; Goodwin, B.F.J. Influence of detergent washing powders on minimal eliciting patch test concentrations of nickel and chromium. Contact Dermat., 1983, 9(6), 491-499.
[http://dx.doi.org/10.1111/j.1600-0536.1983.tb04470.x] [PMID: 6418438]
[54]
Res, V.; Sykora, J. In vitro testing of ointments designed to protect the skin from damage by chromium and nickel. Dermatol. Wochenschr., 1965, 151, 1327-1340.
[55]
Kurtin, A.; Orentreich, N. Chelation deactivation of nickel ion in allergic eczematous sensitivity. J. Invest. Dermatol., 1954, 22(6), 441-445.
[http://dx.doi.org/10.1038/jid.1954.61] [PMID: 13174863]
[56]
Wöhrl, S.; Kriechbaumer, N.; Hemmer, W.; Focke, M.; Brannath, W.; Götz, M.; Jarisch, R. A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals. Contact Dermat., 2001, 44(4), 224-228.
[http://dx.doi.org/10.1034/j.1600-0536.2001.044004224.x] [PMID: 11260238]
[57]
Jarisch, R.; Ballczo, H.; Richter, W. Nickel allergy – elimination of the harmful agent with cation exchangers. Z. Hautkr., 1975, 50, 33-39.
[PMID: 3037]
[58]
Briand, E. Reducing metal-induced contact dermatitis by using a protective skincare, Oral communication, in Free communications in nflammation & Infectious diseases (including allergies), 24th Congress of the EADV , 2015.
[59]
Kaaber, K.; Menne, T.; Tjell, J.C.; Veien, N. Antabuse treatment of nickel dermatitis. Chelation--A new principle in the treatment of nickel dermatitis. Contact Dermat., 1979, 5(4), 221-228.
[http://dx.doi.org/10.1111/j.1600-0536.1979.tb04855.x] [PMID: 498765]
[60]
Christensen, O.B.; Kristensen, M. Treatment with disulfiram in chronic nickel hand dermatitis. Contact Dermat., 1982, 8(1), 59-63.
[http://dx.doi.org/10.1111/j.1600-0536.1982.tb04137.x] [PMID: 7067441]
[61]
Pigatto, P.D.; Gibelli, E.; Fumagalli, M.; Bigardi, A.; Morelli, M.; Altomare, G.F. Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx. Contact Dermat., 1990, 22(1), 27-31.
[http://dx.doi.org/10.1111/j.1600-0536.1990.tb01501.x] [PMID: 2138953]
[62]
Sharma, A.D. Relationship between nickel allergy and diet. Indian J. Dermatol. Venereol. Leprol., 2007, 73(5), 307-312.
[http://dx.doi.org/10.4103/0378-6323.35733] [PMID: 17921609]
[63]
Kaaber, K.; Veien, N.K.; Tjell, J.C. Low nickel diet in the treatment of patients with chronic nickel dermatitis. Br. J. Dermatol., 1978, 98(2), 197-201.
[http://dx.doi.org/10.1111/j.1365-2133.1978.tb01622.x] [PMID: 629873]
[64]
Veien, N.K.; Hattel, T.; Justesen, O.; Nørholm, A. Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema. Contact Dermat., 1983, 9(5), 402-406.
[http://dx.doi.org/10.1111/j.1600-0536.1983.tb04437.x] [PMID: 6226480]
[65]
Christensen, O.B.; Möller, H. External and internal exposure to the antigen in the hand eczema of nickel allergy. Contact Dermat., 1975, 1(3), 136-141.
[http://dx.doi.org/10.1111/j.1600-0536.1975.tb05354.x] [PMID: 797515]
[66]
Andersen, K.E.; Nielsen, G.D.; Flyvholm, M.A.; Fregert, S.; Gruvberge, B. Nickel in tap water. Contact Dermat., 1983, 9(2), 140-143.
[http://dx.doi.org/10.1111/j.1600-0536.1983.tb04321.x] [PMID: 6851522]
[67]
Duffus, J.H. Assessment of the potential for health problems associated with the export of sulfidic nickel concentrate through the port of Esperance, 2009.Source: Department of Health, Government of Western Australia:; www.public.health.wa.gov.au(Accessed on February 15, 2011)..
[68]
Hindsén, M.; Bruze, M.; Christensen, O.B. Flare-up reactions after oral challenge with nickel in relation to challenge dose and intensity and time of previous patch test reactions. J. Am. Acad. Dermatol., 2001, 44(4), 616-623.
[http://dx.doi.org/10.1067/mjd.2001.110873] [PMID: 11260535]

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