Patch Testing with a Large Series of Metal Allergens: Findings from More Than 1,000 Patients in One Decade at Mayo Clinic

Abstract

Background:

The standard allergen series used in patch testing contains metals that most commonly cause allergic contact dermatitis, but testing with additional metal allergens is warranted for select patients.

Objective:

To report our experience with patch testing of metals.

Methods:

We retrospectively analyzed outcomes of 1,112 patients suspected of having metal allergies. Patients were seen from January 1, 2000, through December 31, 2009. Patch testing was performed with 42 metal preparations (6 in the standard series, 36 in the metal series).

Results:

Patch testing most commonly was performed for patients with oral disease (almost half the patients), hand dermatitis, generalized dermatitis, and dermatitis affecting the lips, legs, arms, trunk, or face. At least one positive reaction was reported for 633 patients (57%). Metals with the highest allergic patch-test reaction rates were nickel, gold, manganese, palladium, cobalt, Ticonium, mercury, beryllium, chromium, and silver. Metals causing no allergic patch-test reactions were titanium, Vitallium, and aluminum powder. Metals with extremely low rates of allergic patch-test reactions included zinc, ferric chloride, and tin. Reaction rates varied depending on metal salt, concentration, and timing of readings.

Conclusion:

Many metals not in the standard series were associated with allergic patch-test reactions. The many questions raised by these findings, concerning patch testing with individual metals, will be the subject of future studies.

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References

Durosaro

, el-Azhary

. A 10-year retrospective study on palladium sensitivity. Dermatitis, 2009; 20:208-13.

Wetter

, Yiannias

, Prakash

, et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: an analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol, 2010; 63:789-98, doi:10.1016/j.jaad.2009.11.033.

Wetter

, Davis

, Yiannias

, et al. Patch test results from the Mayo Clinic Contact Dermatitis Group, 1998-2000. J Am Acad Dermatol, 2005; 53:416-21, doi:10.1016/j.jaad.2005.04.077.

Hougeir

, Yiannias

, Hinni

, et al. Oral metal contact allergy: a pilot study on the cause of oral squamous cell carcinoma. Int J Dermatol, 2006; 45:265-71, doi:10.1111/j.1365-4632.2004.02417.x.

Reed

, Davis

, Nakamura

, et al. Retrospective evaluation of patch testing before or after metal device implantation. Arch Dermatol, 2008; 144:999-1007, doi:10.1001/archderm.144.8.999.

Nonaka

, Nakada

, Iijima

, Maibach

. Metal patch test results from 1990-2009. J Dermatol, 2011; 38:267-71, doi:10.1111/j.1346-8138.2010.00980.x.

Marks

Jr , Belsito

, DeLeo

, et al. North American Contact Dermatitis Group patch-test results, 1998 to 2000. Am J Contact Dermat, 2003; 14:59-62.

Marks

Jr , Belsito

, DeLeo

, et al. North American Contact Dermatitis Group patch-test results, 1996-1998. Arch Dermatol, 2000; 136:272-3, doi:10.1001/archderm.136.2.272.

Pratt

, Belsito

, DeLeo

, et al. North American Contact Dermatitis Group patch-test results, 2001-2002 study period [published erratum appears in Dermatitis. 2005; 16:106] Dermatitis, 2004; 15:176-83.

10.

Warshaw

, Belsito

, DeLeo

, et al. North American Contact Dermatitis Group patch-test results, 2003-2004 study period. Dermatitis, 2008; 19:129-36.

11.

Zug

, Warshaw

, Fowler

Jr , et al. Patch-test results of the North American Contact Dermatitis Group 2005-2006 [published erratum appears in Dermatitis 2009;20:300]. Dermatitis, 2009; 20:149-60.

12.

Davis

, Scalf

, Yiannias

, et al. Changing trends and allergens in the patch test standard series: a Mayo Clinic 5-year retrospective review, January 1, 2001, through December 31, 2005. Arch Dermatol, 2008; 144:67-72, doi:10.1001/archdermatol.2007.2.

13.

Greig

, Carson

, Stuckey

, Riley

. Prevalence of delayed hypersensitivity to the European standard series in a self-selected population. Australas J Dermatol, 2000; 41:86-9, doi:10.1046/j.1440-0960.2000.00400.x.

14.

Yiannias

, el-Azhary

, Hand

, et al. Relevant contact sensitivities in patients with the diagnosis of oral lichen planus. J Am Acad Dermatol, 2000; 42(2 Pt 1):177-82.

15.

Torgerson

, Davis

, Bruce

, et al. Contact allergy in oral disease. J Am Acad Dermatol, 2007; 57:315-21. Epub 2007 May 25. doi:10.1016/j.jaad.2007.04.017.

16.

Kuhta

, Pavlin

, Slaj

, et al. Type of archwire and level of acidity: effects on the release of metal ions from orthodontic appliances. Angle Orthod, 2009; 79:102-10, doi:10.2319/083007-401.1.

17.

Petoumenou

, Arndt

, Keilig

, et al. Nickel concentration in the saliva of patients with nickel-titanium orthodontic appliances. Am J Orthod Dentofacial Orthop, 2009; 135:59-65, doi:10.1016/j.ajodo.2006.12.018.

18.

Nogi

. [Electric current around dental metals as a factor producing allergenic metal ions in the oral cavity]. Nippon Hifuka Gakkai Zasshi, 1989; 99:1243-54. Japanese.

19.

Hosoki

, Bando

, Asaoka

, et al. Assessment of allergic hypersensitivity to dental materials. Biomed Mater Eng, 2009; 19: 53-61.

20.

Geurtsen

. Biocompatibility of dental casting alloys. Crit Rev Oral Biol Med, 2002; 13:71-84, doi:10.1177/154411130201300108.

21.

Davis

, Bhate

, Rohlinger

, et al. Delayed patch test reading after 5 days: the Mayo Clinic experience. J Am Acad Dermatol, 2008; 59:225-33. Epub 2008 May 29. doi:10.1016/j.jaad.2008.04.022.

22.

Wohrl

, Hemmer

, Focke

, et al. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns. Pediatr Dermatol, 2003; 20:119-23, doi:10.1046/j.1525-1470. 2003.20204.x.

23.

Larsson-Stymne

, Widstrom

. Ear piercing: a cause of nickel allergy in schoolgirls?. Contact Dermatitis, 1985; 13:289-93, doi:10.1111/j.1600-0536.1985.tb02580.x.

24.

Cronin

Contact dermatitis. Edinburgh, NY: Churchill Livingstone; 1980.

25.

McKenna

, Dolan

, Walsh

, Burrows

. Contact allergy to gold sodium thiosulfate. Contact Dermatitis, 1995; 32:143-6, doi:10. 1111/j.1600-0536.1995.tb00803.x.

26.

Fowler

Jr , Taylor

, Storrs

, et al. Gold allergy in North America. Am J Contact Dermat, 2001; 12:3-5, doi:10.1053/ajcd.2001.21472.

27.

Larese Filon

, Uderzo

, Bagnato

. Sensitization to palladium chloride: a 10-year evaluation. Am J Contact Dermat, 2003; 14:78-81.

28.

Nielsen

, Menne

. Allergic contact sensitization in an unselected Danish population: the Glostrup Allergy Study, Denmark [published erratum appears in Acta Derm Venereol (Stockh) 1993;73:397]. Acta Derm Venereol, 1992; 72:456-60.

29.

Kranke

, Binder

, Derhaschnig

, et al. [Patch testing with the “Austrian standard series„: epidemiologic test values and results]. Wien Klin Wochenschr, 1995; 107:323-30. German.

30.

Walton

, Nayagam

, Keczkes

. Age and sex incidence of allergic contact dermatitis. Contact Dermatitis, 1986; 15:136-9, doi:10.1111/j.1600-0536.1986.tb01313.x.

31.

Estlander

. Occupational skin disease in Finland: observations made during 1974-1988 at the Institute of Occupational Health, Helsinki. Acta Derm Venereol Suppl (Stockh), 1990; 155:1-85.

32.

Nielsen

, Linneberg

, Menne

, et al. Allergic contact sensitization in an adult Danish population: two cross-sectional surveys eight years apart (the Copenhagen Allergy Study). Acta Derm Venereol, 2001; 81:31-4, doi:10.1080/000155501750208155.

33.

Jensen

, Lisby

, Baadsgaard

, et al. Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel-exposure regulation. Br J Dermatol, 2002; 146:636-42, doi:10.1046/j.1365-2133.2002.04666.x.

34.

Prystowsky

, Allen

, Smith

, et al. Allergic contact hypersensitivity to nickel, neomycin, ethylenediamine, and benzocaine: relationships between age, sex, history of exposure, and reactivity to standard patch tests and use tests in a general population. Arch Dermatol, 1979; 115:959-62, doi:10.1001/archderm.115.8.959.

35.

Peltonen

. Nickel sensitivity in the general population. Contact Dermatitis, 1979; 5:27-32, doi:10.1111/j.1600-0536.1979.tb05531.x.

36.

Ahlgren

, Ahnlide

, Bjorkner

, et al. Contact allergy to gold is correlated to dental gold. Acta Derm Venereol, 2002; 82:41-4, doi:10.1080/000155502753600876.

37.

Vamnes

, Morken

, Helland

, Gjerdet

. Dental gold alloys and contact hypersensitivity. Contact Dermatitis, 2000; 42:128-33, doi:10.1034/j.1600-0536.2000.042003128.x.

38.

Nakada

, Iijima

, Nakayama

, Maibach

. Role of ear piercing in metal allergic contact dermatitis. Contact Dermatitis, 1997; 36:233-6, doi:10.1111/j.1600-0536.1997. tb00207.x.

39.

Raap

, Stiesch

, Reh

, et al. Investigation of contact allergy to dental metals in 206 patients. Contact Dermatitis, 2009; 60:339-43, doi:10.1111/j.1600-0536.2009.01524.x.

40.

Oppel

, Schnuch

. [The most frequent allergens in allergic contact dermatitis]. Dtsch Med Wochenschr, 2006; 131:1584-9, doi:10.1055/s-2006-947800. German.

41.

Cheng

, Tseng

, Sun

, Chu

. Contact sensitization to metals in Taiwan. Contact Dermatitis, 2008; 59:353-60, doi:10.1111/j.1600-0536.2008.01468.x.

42.

Bordel-Gomez

, Miranda-Romero

, Castrodeza-Sanz

. Isolated and concurrent prevalence of sensitization to transition metals in a Spanish population. J Eur Acad Dermatol Venereol, 2008; 22:1452-7. Epub 2008 Jul 3. doi:10.1111/j.1468-3083.2008.02892.x.

43.

Hansen

, Menne

, Johansen

. Cr(III) reactivity and foot dermatitis in Cr(VI) positive patients. Contact Dermatitis, 2006; 54: 140-4, doi:10.1111/j.0105-1873.2006.00802.x.

44.

Gebhart

, Geier

. Evaluation of patch test results with denture material series. Contact Dermatitis, 1996; 34:191-5, doi:10.1111/j.1600-0536.1996.tb02172.x.