Correspondence
Nickel Allergy in Danish Women before and after Nickel Regulation
N Engl J Med 2009; 360:2259-2260May 21, 2009
- Article
To the Editor:
Over the 20th century, the prevalence of nickel allergy increased in Western Europe and the United States1; this increase has been attributed to increased skin exposure to nickel in buttons, zippers, and other objects, earrings in particular. Nickel allergy may lead to nickel dermatitis at the site of contact and is a risk factor for hand eczema.2 In 1990, the Danish government began regulating the release of nickel from consumer products including jewelry.3 We investigated the association between the initiation of nickel regulation and the prevalence of nickel allergy and nickel dermatitis.
We studied participants who were 18 to 69 years of age from two independent, random samples from the general population in Copenhagen: one identified in 1990 (543 participants) and the other in 2006 (3338 participants). All participants underwent nickel patch testing using the thin-layer rapid use epicutaneous (T.R.U.E.) test. Participants completed a questionnaire asking whether they had ever had their ears pierced, and if so, in what year, and whether they had ever had eczema on the skin under their watch strap, under the button of their jeans, or at the site of earrings (suggesting nickel dermatitis). We hypothesized that the prevalence of nickel allergy and nickel dermatitis would decrease after nickel regulation, primarily among younger participants, in whom exposure to nickel would most likely be less than in older participants. We focused on women (274 women in 1990 and 1843 women in 2006), as the prevalence of ear piercing and nickel allergy is high in this subgroup.
A history of ear piercing was significantly associated with nickel allergy and nickel dermatitis in the 1990 study (Table 1Table 1
Prevalences of Nickel Allergy and Nickel Dermatitis in Two Independent Populations of Women, from 1990, When Nickel Regulation Began, and 2006.), and the prevalence of dermatitis was significantly higher among women with nickel allergy than among those without allergy (81.2% vs. 30.5%, P<0.001). Prevalences of nickel allergy and nickel dermatitis were significantly lower among women who had their ears pierced after the start of nickel regulation in 1990 (between 1990 and 2006) than among women who had their ears pierced before 1990 (allergy, 6.9% vs. 15.6%; P=0.004; and dermatitis, 30.5% vs. 44.1%; P=0.004). As expected, the decrease in prevalence was most pronounced among women 18 to 35 years of age. The prevalences of nickel allergy and nickel dermatitis were significantly higher among women whose ears were pierced between 1990 and 2006 than among those whose ears were never pierced. This may be explained by exposure to jewelry purchased outside Denmark, by exposures not affected by the nickel regulation,4 by a lack of compliance of manufacturers with the regulation, or by insufficiency of the regulation. The prevalence of nickel allergy among men was nonsignificantly higher among those with ears pierced before 1990 than those with ears pierced between 1990 and 2006 (6.5% vs. 3.3%).Although the study design makes it impossible to determine cause and effect, these results suggest that regulatory control of nickel exposure may reduce the prevalence of nickel allergy.
Jacob Pontoppidan Thyssen, M.D.
Jeanne Duus Johansen, M.D., Ph.D.
Torkil Menné, M.D., Ph.D.
Gentofte Hospital, DK-2900 Hellerup, Denmark
jacpth01@geh.regionh. dk Niels Henrik Nielsen, M.D., Ph.D.
Bagsværd Dermatology Clinic, DK-2880 Bagsværd, DenmarkAllan Linneberg, M.D., Ph.D.
Glostrup Hospital, DK-2600 Glostrup, DenmarkSupported by the Danish Board of Health, the Danish Environmental Protection Agency, the Copenhagen County Research Foundation, the Aase and Einar Danielsens Foundation, the Velux Foundation, ALK Abelló, Denmark, and the Danish Scientific Research Council. MEKOS Laboratories and ALK Abelló, Denmark, donated some of the T.R.U.E. tests.
No potential conflict of interest relevant to this letter was reported.
4 References1
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- Citing Articles (38)
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Beata Krecisz, Dorota Chomiczewska, Cezary Palczynski, Marta Kiec-Swierczynska. (2012) Contact allergy to metals in adolescents. Nickel release from metal accessories 7 years after the implementation of the EU Nickel Directive in Poland. Contact Dermatitisno-no
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Gideon P. Smith, Andrew G. Franks, David E. Cohen. 2012. Systemic Allergic Dermatitis in Total Knee Arthroplasty. , 728-733.
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Peter Jensen, Jeanne D. Johansen, Claus Zachariae, Torkil Menné, Jacob P. Thyssen. (2011) Excessive nickel release from mobile phones-a persistent cause of nickel allergy and dermatitis. Contact Dermatitis 65:6, 354-358
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Marc Schmidt, Matthias Goebeler. (2011) Nickel allergies: paying the Toll for innate immunity. Journal of Molecular Medicine 89:10, 961-970
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J.P. Thyssen, T. Menné, C. Lidén, I.R. White, J. White, R. Spiewak, J.D. Johansen. (2011) Excessive nickel release from earrings purchased from independent shops and street markets - a field study from Warsaw and London. Journal of the European Academy of Dermatology and Venereology 25:9, 1021-1026
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Jacqueline Biesterbos, Carola Lidén, Pieter van der Valk. (2011) Nickel on the Dutch market: 10 years after entry into force of the EU Nickel Directive. Contact Dermatitis 65:2, 115-117
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Jacob P. Thyssen, Wolfgang Uter, Torkil Menné, Carola Lidén. (2011) Revision of the European standard for control of the EU nickel restriction - a probable improvement for European citizens. Contact Dermatitis 65:1, 60-61
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M. Osler, A. Linneberg, C. Glumer, T. Jorgensen. (2011) The cohorts at the Research Centre for Prevention and Health, formerly 'The Glostrup Population Studies'. International Journal of Epidemiology 40:3, 602-610
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Jacob P. Thyssen, Wolfgang Uter, John McFadden, Torkil Menné, Radoslaw Spiewak, Martine Vigan, Ana Gimenez-Arnau, Carola Lidén. (2011) The EU Nickel Directive revisited-future steps towards better protection against nickel allergy. Contact Dermatitis 64:3, 121-125
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Hiromitsu NONAKA, Tokio NAKADA, Masafumi IIJIMA, Howard I. MAIBACH. (2011) Metal patch test results from 1990-2009. The Journal of Dermatology 38:3, 267-271
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Jacqueline Biesterbos, Kerem Yazar, Carola Lidén. (2010) Nickel on the Swedish market: follow-up 10 years after entry into force of the EU Nickel Directive. Contact Dermatitis 63:6, 333-339
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J.P. Thyssen, J.D. Johansen, A. Linneberg, T. Menné, N.H. Nielsen, M. Meldgaard, P.B. Szecsi, S. Stender, B.C. Carlsen. (2010) The association between null mutations in the filaggrin gene and contact sensitization to nickel and other chemicals in the general population. British Journal of Dermatology 162:6, 1278-1285
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Carsten R. Hamann, Dathan J. Hamann, Quinlan J. Hamann, Curtis P. Hamann, Waranya Boonchai, Lin-Feng Li, Jacob P. Thyssen. (2010) Assessment of nickel release from earrings randomly purchased in China and Thailand using the dimethylglyoxime test. Contact Dermatitis 62:4, 232-240
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Jacob P. Thyssen, Jeanne D. Johansen, Allan Linneberg, Torkil Menné. (2010) The epidemiology of hand eczema in the general population - prevalence and main findings. Contact Dermatitis 62:2, 75-87
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J.P. Thyssen, J.D. Johansen, T. Menné, C. Lidén, M. Bruze, I.R. White. (2010) Hypersensitivity reactions from metallic implants: a future challenge that needs to be addressed. British Journal of Dermatology 162:2, 235-236
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Miloslav Pouzar, Miroslav Schmidt, Anna Krejčová, Tomáš Černohorský. (2010) Nickel Release from Piercing Jewellery. SRX Chemistry 2010, 1-6
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Jacob Pontoppidan Thyssen, Allan Linneberg, Torkil Menné, Niels Henrik Nielsen, Jeanne Duus Johansen. (2009) The association between hand eczema and nickel allergy has weakened among young women in the general population following the Danish nickel regulation: results from two cross-sectional studies. Contact Dermatitis 61:6, 342-348
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Jacob Pontoppidan Thyssen, Stig Storgaard Jakobsen, Kåre Engkilde, Jeanne Duus Johansen, Kjeld Søballe, Torkil Menné. (2009) The association between metal allergy, total hip arthroplasty, and revision. Acta Orthopaedica 80:6, 646-652
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Jacob Pontoppidan Thyssen, Kristina Milting, Anne Bregnhøj, Heidi Søsted, Jeanne Duus Johansen, Torkil Menné. (2009) Nickel allergy in patch-tested female hairdressers and assessment of nickel release from hairdressers' scissors and crochet hooks. Contact Dermatitis 61:5, 281-286
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J.P. Thyssen, A. Linneberg, T. Menné, N.H. Nielsen, J.D. Johansen. (2009) Contact allergy to allergens of the TRUE-test (panels 1 and 2) has decreased modestly in the general population. British Journal of Dermatology 161:5, 1124-1129
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Jacob Pontoppidan Thyssen, Torkil Menné, Jeanne Duus Johansen. (2009) Nickel release from inexpensive jewelry and hair clasps purchased in an EU country — Are consumers sufficiently protected from nickel exposure?. Science of The Total Environment 407:20, 5315-5318
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