Nickel Allergy: A Rash on the Digital Age

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in Indoor Allergies, Skin Allergy
Published: January 29, 2016

Thyssen acknowledges efforts by some manufacturers to reduce nickel in devices. But having co-authored a study that found about 20 percent of cellphone brands releasing nickel, he sees the need for more transparency and oversight. “It is alarming, and as consumers we need to be protected from a risk of getting sick.”

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NICKEL allergy is distressing enough as a skin ailment. But when you become sensitive to nickel that’s inside your body, serious complications can ensue. Consider that the modern quick fix for an aging-but-active population has become knee and hip replacements. Between 2000 and 2009, a study conducted for the American Academy of Orthopaedic Surgeons found that total knee replacement surgery alone in the United States increased a remarkable 120 percent, and at an even higher rate in those under age 65.

The good news is that only 10 percent of these surgeries result in complications. But when failure happens, sensitivity to metal – mainly nickel – turns out to be the culprit.

In February 2014, a research team from National Jewish Health (NJH) in Denver presented an abstract at an annual allergists’ conference concerning a study of 311 patients who either had an implant failure or were being evaluated for suspected metal allergy. “Sensitization to nickel, cobalt, chromium and/or bone cement was found in 50 percent of implant failure patients and 59 percent of preoperative patients,” said the abstract. (While it will depend on the individual situation, orthopedic surgeons will in some cases recommend replacing an implant with an alternate artificial joint.)

Candidates for implants who have a history of reacting to metal, which would commonly present as a skin rash to metal jewellery, do need to undergo a risk-assessment before proceeding with surgery, advises Dr. Karin Pacheco, co-author of the NJH study. “Their rates of positive patch tests to metals are very high – close to 70 percent,” she says.

When it comes to joint replacements, however, the medical literature recommends that the patient with no history of reactions does not need preoperative testing for metal allergy. “Few, if any, have a positive reaction to metal patch testing,” she says, a finding supported by the NJH study. As well, Pacheco says that when patients at NJH are discovered to be allergic to a component of their implant and undergo surgery to replace with safe components, “they have much better outcomes.”

For patients who must avoid nickel or other metals, there are other alloys available, such as titanium/aluminum/vanadium or zirconium/niobium. The implant patients who face a real problem, she says, are those who are also allergic to the bone cement, which is an issue she wishes manufacturers would address.

While the usual test for nickel allergy entails wearing a patch for several days on the back or shoulder, Pacheco and colleague Dr. Vijaya Knight have this good news: They’ve recently developed a simple and effective blood test that screens for the presence of nickel. Called the NiLPT test, it can be easily ordered through the NationalJewish.org website. A physician simply draws the blood, fills out a form and, for a small fee, the bloodwork is couriered to NJH for testing. A similar blood test for cobalt allergies is also in the works.

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THE RASH and itch of allergic contact dermatitis from nickel can take up to 48 hours to emerge. If you or your child appear to have the condition, it’s time to see a dermatologist for patch testing. If the skin diagnosis is confirmed, avoidance is the only way to dodge symptoms. But that doesn’t have to mean giving up your laptop or your beloved mobile phone. What it means is becoming aware of the items in your life that contain nickel.

Fortunately, there is a chemical solution called DMG (dimethylglyoxime), which can be swabbed onto items to test for the presence of nickel ions. If the swab turns pink, you’ve found nickel. The DMG test is widely available online (as is Nickel Guard, a clear solution that can be painted onto objects such as belt buckles and eyeglass frames to block the release of nickel particles).

If you know one of your digital devices contains nickel and you have the allergy, Jacob recommends a full plastic case, such as the boy with the iPad purchased. You might prefer to find a smartphone with a nickel-free exterior, though some phone covers will give adequate coverage, and an earpiece can also significantly reduce face time with nickel. If you do have a lengthy exposure to a nickel item, wash your hands with soap as soon as possible. Once the rash has broken out, hydrocortisone creams are also helpful.

With so many millions of North Americans having to patrol and protect against the metal, you might expect a strong push for stricter industry regulations. But it’s nowhere in sight. “There’s still not a lot of awareness in North America about nickel allergy unless someone is nickel-allergic, so there is not the same kind of pressure as there is in Europe,” says Dr. Katherine Heim, a toxicologist with NiPERA, the North Carolina-based Nickel Producers Environmental Research Association, which is the Nickel Institute’s scientific division. (The Nickel Institute works closely with nickel producers, who sell their products to companies like the big phone and laptop makers.)

The European Union enacted the Nickel Directive back in 2001, which regulates the release of nickel in consumer products. Then in 2013, it updated the standard, strengthening the test methods that are used to show compliance.

In 2005, NiPERA staff visited the Consumer Product Safety Commission in Washington, D.C. to discuss the possible regulation of nickel release in the United States. The talks were unproductive. “Our presentation was well-received,” Heim says. “But due to other priorities at the time with more severe health effects – lead in toys was specifically noted – they said they were unable to devote the time to nickel allergy.”

What’s clear is that for children, the ever-growing role of technology in the classroom means the nickel issue is not about to vanish, and absent any regulatory oversight, sensitization rates seem likely to increase. Back in Copenhagen, Thyssen believes nickel awareness needs to be on the front burner. “There is a need for media to maintain a public focus on this issue so that manufacturers are forced to do something about it.”

Have you had a nickel reaction to a digital gadget? Let us know at editor@allergicliving.com.

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