Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014

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 Marks, Kathryn A. Zug, Matthew J. Zirwas, James S. Taylor, Vincent A. DeLeo

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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.

Original languageEnglish (US)
Pages (from-to)701-713
Number of pages13
JournalJournal of the American Academy of Dermatology
Volume80
Issue number3
DOIs
StatePublished - Mar 1 2019

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Contact Dermatitis
Nickel
Epidemiology
Cross-Sectional Studies
North America
Jewelry
Patch Tests
Dermatitis
Atopic Dermatitis
Occupational Exposure
Scalp
Allergens
Ear
Hypersensitivity
Arm
Neck
Referral and Consultation
Asthma
Public Health
Demography

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Warshaw, Erin M. ; Zhang, Amy J. ; DeKoven, Joel G. ; Maibach, Howard I. ; Belsito, Donald V. ; Sasseville, Denis ; Fowler, Joseph F. ; Fransway, Anthony F. ; Mathias, Toby ; Pratt, Melanie D. ; Marks, James ; Zug, Kathryn A. ; Zirwas, Matthew J. ; Taylor, James S. ; DeLeo, Vincent A. / Epidemiology of nickel sensitivity : Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014. In: Journal of the American Academy of Dermatology. 2019 ; Vol. 80, No. 3. pp. 701-713.
@article{18299c4e28794304ab22006e639c76e8,
title = "Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014",
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.",
author = "Warshaw, {Erin M.} and Zhang, {Amy J.} and DeKoven, {Joel G.} and Maibach, {Howard I.} and Belsito, {Donald V.} and Denis Sasseville and Fowler, {Joseph F.} and Fransway, {Anthony F.} and Toby Mathias and Pratt, {Melanie D.} and James Marks and Zug, {Kathryn A.} and Zirwas, {Matthew J.} and Taylor, {James S.} and DeLeo, {Vincent A.}",
year = "2019",
month = "3",
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Warshaw, EM, Zhang, AJ, DeKoven, JG, Maibach, HI, Belsito, DV, Sasseville, D, Fowler, JF, Fransway, AF, Mathias, T, Pratt, MD, Marks, J, Zug, KA, Zirwas, MJ, Taylor, JS & DeLeo, VA 2019, 'Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014', Journal of the American Academy of Dermatology, vol. 80, no. 3, pp. 701-713. https://doi.org/10.1016/j.jaad.2018.09.058

Epidemiology of nickel sensitivity : Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014. / Warshaw, Erin M.; Zhang, Amy J.; DeKoven, Joel G.; Maibach, Howard I.; Belsito, Donald V.; Sasseville, Denis; Fowler, Joseph F.; Fransway, Anthony F.; Mathias, Toby; Pratt, Melanie D.; Marks, James; Zug, Kathryn A.; Zirwas, Matthew J.; Taylor, James S.; DeLeo, Vincent A.

In: Journal of the American Academy of Dermatology, Vol. 80, No. 3, 01.03.2019, p. 701-713.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epidemiology of nickel sensitivity

T2 - Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014

AU - Warshaw, Erin M.

AU - Zhang, Amy J.

AU - DeKoven, Joel G.

AU - Maibach, Howard I.

AU - Belsito, Donald V.

AU - Sasseville, Denis

AU - Fowler, Joseph F.

AU - Fransway, Anthony F.

AU - Mathias, Toby

AU - Pratt, Melanie D.

AU - Marks, James

AU - Zug, Kathryn A.

AU - Zirwas, Matthew J.

AU - Taylor, James S.

AU - DeLeo, Vincent A.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

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DO - 10.1016/j.jaad.2018.09.058

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VL - 80

SP - 701

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JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

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