Our embrace of wireless gadgets and modern medical implants is exposing us to nickel, the highly sensitizing metal, as never before. As this investigation for Allergic Living found: the result is a surge in nickel allergy. [Article updated: May 2019.]
Our love affair with modern technology seems to know no bounds. But amid the flood of consumer items new and digital, an unforeseen health effect surfaced. Many of the shiny devices contain nickel, and the increasing number of hours during which hands sweep over laptops or faces brush against phones is leading to nickel sensitization – and the development of mild or even severe cases of allergic contact dermatitis or ACD.
This condition, more commonly called eczema, manifests as a red, bumpy, itchy and uncomfortable rash, which becomes blistered, widespread and even raw in more severe cases. Allergic contact dermatitis’s relationship to nickel allergy has long been familiar to dermatologists. The allergy is one of the most common – estimated to affect more an 30 million and perhaps as many as 55 million Americans. (In Canada, it affects 3 to 7 million people.) Nickel is also everywhere – it’s used in countless ordinary items, including eyeglasses, belt buckles, coins, keys and even underwire bras.
But the emerging scourge ties directly to 21st century technology. The first alarm bell sounded with mobile phones, and dermatologist case reports of telltale rashes on faces where the phones rubbed against skin.
By 2009, reports began surfacing in Europe of ACD resulting from lengthy exposures to laptops. In March 2014, Fitbit, the maker of popular activity-training wristbands, issued a recall of one million devices as many consumers complained of skin reactions – attributed largely to nickel and also adhesives in the device’s band. In response, the company later released a new model, with reduced nickel content. However, nickel reaction reports still surface with other brands of wearable devices.
In 2014, a published case report about a California boy gained widespread attention. The then 11-year-old developed a rash that experts linked to his first-generation iPad tablet or, more specifically, its nickel-containing case. “The rash began on his wrists when the family got a metallic laptop for Christmas,” explains dermatologist Dr. Sharon Jacob, an associate professor in Loma Linda University’s Dermatology Department, who counseled the boy and his family. As “he started using the iPad more, and the rash progressed,” she told Allergic Living. After testing confirmed the boy’s nickel allergy, he was instructed to avoid the metal. In their report for the journal Pediatrics, Jacob and her co-author noted that a plastic case covering the iPad prevented continued exposure, and the boy’s irritating rash swiftly receded.
If you know one of your digital devices contains nickel and you have the allergy, Jacob recommends a full plastic case. You might prefer to find a smartphone with a nickel-free exterior, though some phone covers will give adequate coverage and a wireless earpiece can significantly reduce face time with nickel.
In North America, nickel ACD now afflicts up to 17 percent of women (thanks in part to jewelry like pierced earrings) and at least 3 percent of men. However, the highest rate of nickel dermatitis in North America today is among young people; studies put the prevalence in children and teens in a range between 17 and 33 percent.
Where is the Oversight?
Given the massive popularity of digital devices, you might think that strict regulatory oversight would be in place. But that’s not the case. In contrast to the European Union, which specifies how much nickel a consumer item can release, North America has no rules. Some of the giant electronics manufacturers still deem nickel content a “proprietary” matter and won’t reveal it.
But others are changing with the sensitizing times. “We do not use nickel for the exterior of our mobile phones, tablets or laptops at all,” Samsung’s spokesperson said in an email. Likewise, Sony has stopped using the metal on phone and tablet surfaces.
Apple’s spokesperson Chris Gaither, meantime, said that Apple has moved to “meet the same strict standards set for jewellery by both the U.S. Consumer Safety Product Commission and their counterparts in Europe.” He called incidents of iPad dermatitis “extremely rare”.
Safe Levels Hard to Quantify
Yet Dr. Jacob Thyssen, a leading dermatology researcher who has closely studied ACD from mobile phones, isn’t assured. “The problem definitely requires our full attention, especially regarding children and adolescents,” he told Allergic Living from his office in Copenhagen’s National Allergy Research Center. While research including his own has led to regulation in Europe, he still sees too much nickel exposure in the digital marketplace, and suggests it can be difficult to quantify precise “safe” levels.
“Industry may follow the regulations, but still market items that put consumers at risk,” Thyssen says. “They have the choice to avoid nickel use in their products, as there are many good alternatives.”
The researcher is also concerned about adults since they “widely use computers and mobile phones at work, and typically have prolonged contact with these devices.” The term “prolonged contact” is key, because sweat accelerates nickel’s release by corroding the metal, allowing it to be absorbed into the skin. In some products, nickel (or another allergenic metal like cobalt and chromium) is wrapped in an alloy, such as stainless steel, to inhibit corrosion and seepage.
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. A 2018 study from Brazil found an even higher rate of nickel content among 20 models on phones. “It is alarming, and as consumers we need to be protected from a risk of getting sick,” says Thyssen.
FDA Responding to Concern over Medical Implants
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 on behalf of 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.
The FDA has issued updated guidance for implant device manufacturers on the risks of certain components. In April 2019, it outlined testing and other information it wants manufacturers to provide when submitting products for approval that use nitinol, the nickel-titanium alloy. The federal agency announced an advisory panel meeting into medical device implants and nitinol, but a date has not yet been set. The meeting is to be followed by further research on nickel in these devices and a review of the medical literature on the topic.
A research team from National Jewish Health (NJH) in Denver presented at an annual allergists’ conference in 2014 on 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 their abstract. (While it will depend on the individual situation, orthopedic surgeons will in some cases recommend replacing an implant with an alternative 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. However, the medical literature recommends that the patient with no history of metal reactions does not need preoperative testing for such an allergy. “Few, if any, have a positive reaction to metal patch testing,” Pacheco says, a finding supported in the NJH study.
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 developed a simple and effective blood test that screens for the presence of nickel. It’s called the NiLPT test, and physicians can order it through the NationalJewish.org website.
The FDA may be paying heed to medical implants, but with so many millions of Americans having issues with nickel in electronics and everyday items from metal fasteners to eyewear, you might expect a strong push for broad industry regulations. But that’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 updated its longstanding Nickel Directive, which regulates the release of nickel in consumer products, in 2013. Way back 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, due to other pressing health topics, such as lead in toys.
In 2009, dermatologist Jacob co-wrote an article in the Journal of the American Academy of Dermatology making the case for a U.S. directive, and citing reasons that one would reduce sensitization, especially in a growing patient population under age 18. “The importance of implementing an EU-like ‘Nickel Directive’ in the United States is paramount; only then will there be recognition of this public health problem,” the article said. Yet, still there is no such directive.
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.”
Related: Testing Devices and Blocking Nickel
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.
‚Ä¢ 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).
‚Ä¢ For a mobile phone, consider one with a nickel-free exterior. If a phone change isn’t feasible, some phone covers will give adequate coverage. Also, a wireless earpiece prevents face exposure in case a phone is releasing nickel.
‚Ä¢ If you do have a lengthy exposure to a nickel item, Jacob says to wash your hands with soap as soon as possible. Once the rash has broken out, hydrocortisone creams are also helpful.