Nickel allergy common in children, significantly higher in girls.
Nickel sensitivity appears to be common in children, and more frequent in girls than boys, said Erin M. Warshaw, MD, MS, of the University of Minnesota, Minneapolis, and her associates.
'Although nickel sensitivity is reported to be problematic in children, the pediatric population is often underrepresented in large-scale epidemiologic studies," they added.
In this retrospective, cross-sectional study of 1,894 children aged 18 years or younger tested by the North American Contact Dermatitis Group (NACDG) between 1994 and 2014, 23.7% of those patch tested were found to be sensitive to nickel. This included 6.5% who were 5 years or younger, 34.2% who were 6-12 years, and 59.4% who were 13-18 years.
Among all three patient groups, jewelry was the most common source of nickel sensitivity (36.4%), and this sensitivity was found to increase with age (5 years and younger, 20.7%; 6-12 years, 28.3%; and 13-18 years, 42.9%; P = .0006).
More than two-thirds of positive patch test reactions to nickel were found to be extreme or strong, Dr. Warshaw and her colleagues reported in the Journal of the American Academy of Dermatology.
Notably, girls were significantly more likely to exhibit nickel sensitivity than boys, a result the authors credit to "trends and social norms."
Citing a separate study conducted recently by NACDG on the correlation between piercing and nickel sensitivity across all ages, researchers found that females were significantly more likely to have piercings than were males, and with age, they speculated, "girls may be more likely to encounter high nickel release through piercing jewelry, bracelets, necklaces, hair clips, etc., resulting in higher proportions of girls than boys with nickel allergy."
Nickel release, not nickel content, is an important factor in cases of nickel allergic contact dermatitis, the authors added. For nickel release to occur, prolonged skin contact is required. According to the European Chemicals Agency, prolonged exposure is defined as more than 10 minutes over three or more occasions within a 2-week period or more than 30 minutes over one or more occasion within the same 2 weeks.
The research was funded by the Minneapolis Veterans Affairs Medical Center, and in part, by the Nickel Producers Environmental Research Association. Three of the researchers have ties to various pharmaceutical companies and other organizations. Dr. Warshaw and the remaining researchers had no relevant financial disclosures.
SOURCE: Warshaw EM et al. J Am Acad Dermatol. 2018 Apr 14. doi: 10.1016/j. jaad.2018.02.071.
COMMENTARY BY DR. EICHENFIELD
WATCH OUT FOR THE JEWELRY
Jewelry wearing in children, particularly piercing jewelry, is presumably contributing to nickel exposure and rates of nickel allergy in this population, as is shown in the study by Warshaw et al. High rates of nickel sensitivity were found in more than 20% of the children aged 5 years and younger, increasing to 23% in those aged 13-18 years! Erin M. Warshaw, MD, pointed out that most of the positive patch tests used to diagnose nickel sensitivity were strong and were more common in girls. We should be alert for allergic contact dermatitis from earrings and jewelry, which in practice most commonly is seen with silver jewelry. While in Europe, there has been regulation to minimize nickel release, this isn't the case in the United States, so that nickel used in earrings and other jewelry may be more allergenic.
BY JILL D. PIVOVAROV
Please Note: Illustration(s) are not available due to copyright restrictions.
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|Author:||Pivovarov, Jill D.|
|Date:||Jun 1, 2019|
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