Ingela Rystedt

False-positive, follicular and irritant patch teat reactions to metal salts

853 hard metal workers were patch tested with nicked nickel sulphate 5%, potassium dichromate 0.5% and cobalt chloride 1% each in petrolatum. Non‐allergic reactions appeared in 6.5% of the nickel tests, 13% of the chromium tests and 18.3% of the cobalt tests. Most of the individuals with positive, poral or pustular reactions were retested with serial dilutions of metal salts in pet, and in water. The accuracy of a positive initial nickel reaction was 83%, a chromium reaction 40% and a cobalt reaction 62%. The nonallergic reactions were partly reproducible and correlated with both the type of patch test material and with individual factors. Weak and moderately strong positive patch test reactions to metal salts may be irritant and should be checked with serial dilution tests ot at least be tested. A reduction of the cobalt chloride concentration from 1% to 0.5% in the standard test material is discussed.

Relationship between nickel and cobalt sensitization in hard metal workers

853 hard metal workers were examined and patch tested with 20 substances from their environment, including nickel and cobalt. Nickel sensitivity was found in 2 men and 38 women. 88% of the nickel‐sensitive individuals had developed a jewellery dermatitis prior to employment in the hard metal industry or before the appearance of hand eczema. 29% of the hard metal workers gave a history of slight irrifant dermatitis. In the nickel sensitized group, 40% had had severe hand eczema which generally appeared 6–12 months after starting employment. In 25% of the cases, nickel sensitive individuals developed cobalt allergy, compared with 5% in the total population investigated. Most facts indicate that nickel sensitivity and irritant hand eczema precede cobalt sensitization. Hard metal workers with simultaneous nickel and cobalt sensitivity had a more severe hand eczema than those with isolated cobalt or nickel sensitivity or only irritant dermatitis. 64% of the female population had pierced ear lobes. Among the nickel allergic women, 95% had pierced ear lobes. The use of earrings containing nickel after piercing is strongly suspected of being the major cause of nickel sensitivity. Piercing at an early age seems to increase the risk of incurring nickel sensitivity.

Cobalt allergy in hard metal workers

Hard metal contains about 10% cobalt. 853 hard metal workers were examined and patch tested with substances from their environment. Initial patch tests with 1% cobalt chloride showed 62 positive reactions. By means of secondary serial dilution tests, allergic reactions to cobalt were reproduced in 9 men and 30 women, Weak reactions could not normally be reproduced. A history of hand eczema was found in 3d of the 39 individuals with reproducible positive test reactions La cobalt, while 21 of 23 with a positive initial patch test but negative serial dilution test had never had any skin problems. Hand etching and hand grinding, mainly female activities and traumatic to lire hands, were found to involve the greatest risk of cobalt sensitization. 24 individuals had an isolated cobalt allergy. They had probably been sensitized by hard metal work, white the individuals, all women, who had simultaneous nickel allergy had probably been sensitized to nickel before their employment and then became sensitized to cobalt by hard metal work. A traumatic occupation, which causes irritant contact dermatitis and/or a previous contact allergy or atopy is probably a prerequisite for the development of cobalt allergy.

Atopic background in patients with occupational hand eczema

Of 368 patients with hand eczema examined during the years 1978–79, at a Department of Occupational Dermatology, 39% had a history of atopic disease (dermatitis, asthma, or rhinitis). 28% of the patients had or had had atopic dermatitis. The % of atopics in the patient material was highest in the age range 20–24 years, in which 57% of the patients had a history of atopic dermatitis, compared with only 11% in the age range above 35 years. Of all patients with a history of atopy, 22% had developed allergic contact dermatitis, while the corresponding figure for non‐atopics was 45% (p < =0.001). Positive patch test reactions occurred in a significantly smaller number of individuals with past or present atopic disease than in non‐atopics. Atopics had not changed jobs because of hand eczema to a greater extent, but had healed to a lesser extent after change of occupation than non‐atopics (p < 0.01).

Nickel release from ear piercing kits and earrings

Ear piercing with nickel‐alloyed studs/clasps involves considerable risk of nickel sensitisation. Stainless steel studs/clasps for ear piercing and different types of earring were stored in synthetic sweat for 1 week. The nickel release was determined. One “hypoallergenic” stud/clasp released 0.005 μg Ni; 21 unused studs/clasps and earrings released 0.05–3 μg Ni, and 11 unused studs/clasps and earrings released 6–25 μg Ni. 6 earrings which caused dermatitis released 14–442 μg Ni. Thus, all studs/clasps and earrings released nickel. Neither gold nor silver plating prevented the nickel release. Nickel‐sensitive women were asked to wear studs/clasps releasing various amounts of nickel. The most sensitive of them showed eczematous reactions to studs/clasps releasing nickel down to 0.05 μg. The dimethylglyoxime test was positive only when more than 10 μg Ni was released.

Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood

A series of 955 persons aged 24–44 years, with atopic dermatitis in childhood, were interviewed in order to identify factors which increase the risk of developing hand eczema in adult life, or aggravate, already existing hand eczema. Endogenous (constitutional) factors were in general of greater importance than exogenous factors, viz. chemicals, water, soil and wear (friction). Eczematous involvement of the hands in childhood was of predominant importance. In individuals without such involvement, severe (widespread) dermatitis in childhood was a dominant factor. Other factors, each of them significantly more important than the exogenous ones, were persistent eczema on other parts of the body and dry/itchy skin. The factors female sex, family history of atopic dermatitis and simultaneous bronchial asthma/allergic rhinitis were associated with increased risk of developing hand eczema in adult life, but were of limited importance compared with the other endogenous and the exogenous factors.

Work-related hand eczema in atopics

549 individuals with severe (group I). 406 with moderate (group 2)atopic dermatitis in childhood. 222 with respiratory allergy hut no a topic dermatitis in childhood (group 3), and 199 without personal of family atopy (group 4) were studied as to occupational health symptoms due to hand eczema. In groups 1, 2 and 4, there was a slightly significant difference (p < 0.05) between the frequency of hand eczema in individual with and without Occupational exposure in chemicals, water, soil or wear (friction). Despite no such work. 55% in group 1 and 44% in group 2 had developed hand eczema About 1/4 of the atopics in extreme risk occupations, such is ladies hairdressers and nursing assistants, had dot developed band eczema.

Evaluation and relevance of isolated test reactions to cobalt.

During a 5‐year period, 286 of 4,034 (7.1 %) standard tested eczema patients reacted to cobalt. Fifty (1.2 %) showed “isolated” cobalt reactions (i.e. without simultaneous reaction to chromium and/or nickel). A follow‐up study of 36 of these patients included a serial dilution test (SDT). Eleven of 15 patients with negative reactions in the SDT had demonstrated weak reactions in the previous standard test, whereas stronger initial reactions had been noted in 19 of 21 patients who reacted positively. Sixteen SDT‐positive and six SDT‐negative patients were definitely or probably exposed to cobalt in their working or home environments. The majority of patients with “isolated” cobalt sensitivity also had other contact sensitivities (especially to rubber chemicals) or atopic dermatitis. Therefore in some cases of “isolated” cobalt reactions another contact sensitivity or skin disease may be a prerequisite for the development of cobalt allergy. It is however possible that the simultaneous presence of reactivities to different test substances is only a reflection of general skin vulnerability. An uncertainty in testing methodology must also be considered when evaluating test reactions to cobalt. Finally, present results show that cobalt allergy unassociated with contact sensitivity to other substances or other skin diseases is rare.

Contact sensitivity in adults with atopic dermatitis in childhood

2 groups of patients were patch tested with a standard series of allergens. 1 group of 159 individuals aged 24 44 years had a history of severe atopic dermatitis, and the other group of 159 individuals in the same age range, hail had moderate atopic dermatitis in childhood. In group I, positive reactions were recorded in 17% and in group 2 in 23%. A significant difference in the % of individuals with positive reactions was found between those who had healed (9%) and those who had not healed (22%) before 15 years of age (P<0.05). The frequency of individuals‐with hand eczema in adult life was higher, but not significantly. among sensitized than non‐sensitized, individuals. Altogether K.H) positive reactions were found in groups I and 2. The average number of positive reactions per person was significantly higher in individuals with than without hand eczema in adult life (P < 0.05). The most frequent contact allergens were fragrance‐mix, balsam of Peru and nickel, which had sensitized 8.0%. 4.5% and 4.1% of the individuals, respectively.

The scandinavian multicenter photopatch study. Preliminary results

The Scandinavian photopatch test procedure has been applied to 745 patients with suspected photodermatoses during the years 1980‐1981. Our experience has been encouraging with the recording of several relevant reactions. A total of 132 positive photocontact reactions and 120 ordinary contact reactions Were seen. Photocontact reactions to musk ambrette (19 cases) and PABA (19 cases) were surprisingly frequent. The next most common photocontact reactions were to promethazine (24). chlorpromazine (22 cases and fentichlor (12). Ordinary contact reactions were observed to balsam of Peru (30). PABA (23), lichen mix (21), wood mix (14) and to perfume mix (10).