Carsten R. Hamann

p-Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study.

Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers.

Assessment of nickel release from earrings randomly purchased in China and Thailand using the dimethylglyoxime test

Background: China and Thailand produce large amounts of jewellery that are sold domestically and abroad.

Cobalt release from inexpensive earrings from Thailand and China

Conflicts of interest: Carsten Hamann and Dathan Hamann have worked as consultants for SmartPractice (Phoenix, Arizona). Jacob P. Thyssen has sold the cobalt spot test to SmartPractice (Phoenix, Arizona) after its development. Kylin K. Hamann has no conflict to declare. Funding: Funded by a grant from SmartPractice Dermatology distributor of Reveal and ConcealTM Cobalt Spot Test. prevalent. It is interesting to study cobalt exposure from consumer products, as it has previously been debated whether cobalt could substitute for nickel as a component of consumer products following the European regulatory intervention on nickel exposure (5, 6). Using inexpensive earrings recently purchased in five large cities in Thailand and China, we set out to determine the proportion of earrings that gave a positive cobalt spot test reaction (7). This collection of earrings is expected to represent possible cobalt exposure in Chinese and Thai individuals; however, it should be underscored that most inexpensive earrings sold in Europe are produced in China and Thailand.

The cost of nickel allergy: a global investigation of coin composition and nickel and cobalt release

Background. Nickel is widely used in coins; nickel may cause contact allergy and allergic contact dermatitis in those who handle them.

The Sino-American belt study: nickel and cobalt exposure, epidemiology, and clinical considerations.

BackgroundNickel and cobalt are common causes of metal allergy. ObjectiveThe objective of this study was to investigate nickel and cobalt exposure in belt buckles by testing 701 belts purchased in China and the United States and to consider the prevalence of nickel allergy and its relevance among Chinese patients. MethodsSeven hundred one belt buckles purchased in China and the United States were tested for nickel and cobalt release. Six hundred thirty-one Chinese patients with suspected allergic contact dermatitis were patch tested and interviewed to determine clinical relevance of results. The Chinese and American literature was reviewed to investigate trends in nickel prevalence over the past decades. ResultsSixty percent (n = 219) of belts purchased in China (n = 365) released nickel, and 0.5% (n = 2) released cobalt; 55.7% (n = 187) in the United States (n = 336) released nickel, and 0.9% (n = 3) released cobalt. Belt dermatitis was a significant clinical finding in 34.8% of Chinese nickel-allergic patients. Literature review suggests increasing nickel allergy prevalence in the United States and China. ConclusionsMetallic belt buckles are an important source of nickel exposure to consumers. Belts from lowest socioeconomic vendors were more likely to release nickel. Belts with silver color and dark metallic color were more likely to release nickel and cobalt, respectively. Clinical findings show belt dermatitis in China to be a problem.

The impact of common metal allergens in daily devices.

Purpose of reviewWe are widely exposed to metal allergens in our daily doings. As exposures constantly changes because of fashion trends and technological developments, there is a need for a continuous update of patch testers. An overview of consumer metal exposure studies that have been published in 2012 and 2013 is provided as well as lists of common metal exposures. Recent findingsNickel release in concentrations that cause nickel allergy and contact dermatitis is seen from laptop computers. Cobalt is found in leather as a dye and may cause chronic dermatitis. Chromium is used as a dye and for tanning in leather items and is found in nearly all shoes and released from a high proportion. SummaryNew consumer items should continuously be considered and investigated for metal release when patients with positive patch test results to metal allergens are evaluated.

Nickel and cobalt release from children's toys purchased in Denmark and the United States.

BackgroundNickel is the most common allergen detected by patch testing in children. There is an increasing number of cases in children who have not had exposure to piercing. Although the clinical relevance of nickel patch test reactions in children is sometimes uncertain, continued vigilance to identify new sources of nickel exposure in this age group is important. Recent case reports have described allergic nickel contact dermatitis in children following exposure to toys, but the magnitude of this problem is unknown. ObjectiveThe aim of this study was to evaluate nickel and cobalt release from children’s toys. MethodsWe purchased 212 toys in 18 different retail and online stores in the United States and Denmark. Nickel and cobalt release was tested using the dimethylglyoxime and cobalt screening spot tests. ResultsA total of 73 toys (34.4%) released nickel, and none released cobalt. ConclusionsToys are a commonly overlooked source of nickel exposure and sensitization. Therefore, dermatologists, allergists, and pediatricians should consider the role of toys in their evaluation of children with dermatitis, and the parents of children with positive nickel patch test reactions should be told that toys may release nickel and be a potential chemical source in the manifestation of allergic contact dermatitis.

Jewellery: alloy composition and release of nickel, cobalt and lead assessed with the EU synthetic sweat method

Several studies have shown nickel and cobalt release from jewellery by using spot tests, but the metal composition of jewellery is largely unknown.

Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis

Background It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk. Objective To perform a systematic review and meta‐analysis of the association between AD and contact sensitization. Methods The PubMed/Medline, Embase, and Cochrane databases were searched for articles that reported on contact sensitization in individuals with and without AD. Results The literature search yielded 10,083 citations; 417 were selected based on title and abstract screening and 74 met inclusion criteria. In a pooled analysis, no significant difference in contact sensitization between AD and controls was evident (random effects model odds ratio [OR] = 0.891; 95% confidence interval [CI] = 0.771‐1.03). There was a positive correlation in studies that compared AD patients with individuals from the general population (OR 1.50, 95% CI 1.23‐1.93) but an inverse association when comparing with referred populations (OR 0.753, 95% CI 0.63‐0.90). Limitations Included studies used different tools to diagnose AD and did not always provide information on current or past disease. Patch test allergens varied between studies. Conclusion No overall relationship between AD and contact sensitization was found. We recommend that clinicians consider patch testing AD patients when allergic contact dermatitis is suspected. Abbreviations used: ACD: allergic contact dermatitis; AD: atopic dermatitis; CI: confidence interval; CQP: Cochrane Q statistic P value; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta‐analysis; SL: sesquiterpine lactone mix.

A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion

Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.