The role of nickel allergy in hand dermatitis and its impact on handling cupronickel currency coins.
A comparative cohort study from Kuwait

Introduction

Contact allergy is an important public health problem with a significant personal, social and economic impact on the affected individuals, and the society at large. Nickel exposure is the most common cause of contact allergy in the general population. Also, nickel allergy is a well-known risk factor for developing hand eczema [1, 2]. Common sources of nickel allergy are jewelry and other metal items coming in contact with the skin such as belt buckles, watches, clothing metal items such as buttons, clips, hooks, buckles, clippers, etc. Skin contact with any item that releases nickel in sufficient amounts may cause contact allergy and dermatitis, as shown recently by the increasing use of metallic mobile phones and laptop computers [3]. One study from Sweden showed that the prevalence of nickel allergy in students aged 15–23 years was 13% in females and 2.5% in males [4], and that 24% of female and 7.4% of male dermatitis patients were allergic to nickel [5]. However, a more recent study from Sweden shows a decreasing prevalence of nickel allergy especially in young women [6]. And, a reduction in prevalence of nickel allergy has also been seen in other EU states like in Denmark, Germany and Italy [7]. The decrease in prevalence has been largely due to stricter EU norms for regulation of nickel content in REACH items. Wherein, the items intended for prolonged contact with the skin are not allowed to release nickel at a rate > 0.5 µg/cm2/week. Allergic nickel dermatitis still remains a problem in EU nations. This might be attributable to lack of restrictions on many short and frequent contacts with everyday items and products containing nickel, such as coins and tools [8]. Some of those items in the work tools and materials may release nickel in high amounts [9]. Occupations requiring short and repeated contact with nickel and involving tools and objects such as cashiers, sales assistants, hairdressers, health care workers, dental assistants etc. are at risk of nickel allergy [10]. This may result in hand eczema, a chronic condition that can result in poor quality of life, reduced ability to work, and large costs to individuals and the society [11]. Handling of nickel containing coins may be a potential contributor to occurrence or aggravation of signs and symptoms of dermatitis in nickel sensitized individuals [12].

Aim

Many studies have been reported, mainly from Europe, on the risk of allergic dermatitis from handling...


View full text...