Nickel and cobalt are common causes of metal allergy.
Objective
The 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.
Methods
Seven 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.
Results
Sixty 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.
Conclusions
Metallic 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.
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References
1.
ThyssenJP, LinnebergA, MennéT, et al..The epidemiology of contact allergy in the general population—prevalence and main findings. Contact Dermatitis, 2007; 57: 287–299.
2.
AgnerT, AndersenKE, BrandaoFM, et al..Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis, 2008; 59: 43–47.
3.
HamannCR, HamannDJ, HamannQJ, et al..Assessment of nickel release from earrings randomly purchased in China and Thailand using the dimethylglyoxime test. Contact Dermatitis, 2010; 62: 232–240.
4.
WarshawEM, BelsitoDV, DeLeoVA, et al..North American Contact Dermatitis Group patch-test results, 2003–2004 study period. Dermatitis, 2008; 19: 129–136.
5.
ZugKA, WarshawEM, FowlerJF, et al..Patch-test results of the North American Contact Dermatitis Group 2005–2006. Dermatitis, 2009; 20: 149–160.
6.
LeePW, ElsaieML, JacobSE. Allergic contact dermatitis in children: common allergens and treatment: a review. Curr Opin Pediatr, 2009; 21: 491–498.
7.
ThyssenJP, MaibachHI. Nickel release from earrings purchased in the United States: the San Francisco earring study. J Am Acad Dermatol, 2008; 58: 1000–1005.
8.
HeimKE, McKeanBA. Children’s clothing fasteners as a potential source of exposure to releasable nickel ions. Contact Dermatitis, 2009; 60: 100–105.
9.
SunejaT, FlanaganKH, GlaserDA. Blue-jean button nickel: prevalence and prevention of its release from buttons. Dermatitis, 2007; 18: 208–211.
10.
ByerTT, MorrellDS. Periumbilical allergic contact dermatitis: blue jeans or belt buckles?. Pediatr Dermatol, 2004; 21: 223–226.
11.
McLeanL, YewchukL, IsraelDM, et al..Acute onset of generalized pruritic rash in a toddler. Diagnosis: systemic allergic (contact) dermatitis to nickel from ingestion of metal coins. Pediatr Dermatol, 2011; 28: 53–54.
12.
CorazzaM, BaldoF, PagnoniA, et al..Measurement of nickel, cobalt and chromium in toy make-up by atomic absorption spectroscopy. Acta Dermatol Venereol, 2009; 89: 130–133.
13.
BercovitchL, LuoJ. Cellphone contact dermatitis with nickel allergy. Can Med Assoc J, 2008; 178: 23.
14.
HsuJW, MatizC, JacobSE. Nickel allergy: localized, id, and systemic manifestations in children. Pediatr Dermatol, 2011; 28: 276–280.
15.
ThyssenJP, JellesenMS, MennéT, et al..Cobalt release from inexpensive jewellery: has the use of cobalt replaced nickel following regulatory intervention?. Contact Dermatitis, 2010; 63: 70–76.
16.
HamannC, HamannD, HamannKK, et al..Cobalt release from inexpensive earrings from Thailand and China. Contact Dermatitis, 2011; 64: 238–240.
17.
ThyssenJP, MennéT, JohansenJD, et al..A spot test for detection of cobalt release - early experience and findings. Contact Dermatitis, 2010; 63: 63–69.
18.
YinR, HuangXY, ZhouXF, et al..A retrospective study of patch tests in Chongqing, China from 2004 to 2009. Contact Dermatitis, 2011; 65: 28–33.
19.
WetterDA, DavisMD, YianniasJA, et al..Patch test results from the Mayo Clinic Contact Dermatitis Group, 1998–2000. J Am Acad Dermatol, 2005; 53: 416–421.
20.
NguyenSH, DangTP, MacPhersonC, et al..Prevalence of patch test results from 1970 to 2002 in a multi-centre population in North America (NACDG). Contact Dermatitis, 2008; 58: 101–106.
21.
MaoH. Analysis of patch test results in 116 patients with suspected allergic contact dermatitis. Chin J Dermatol, 1999; 32: 198.
22.
L. Analysis of patch test results in 326 patients with suspected allergic contact dermatitis. Lingnan Pi Fu Bing Xue Zai Zhi, 1999; 6: 1–3.
23.
WuHu, Yu. Analysis of patch test results in 380 patients with suspected allergic contact dermatitis. Zhejiang Yi Xue, 1999; 21: 235–236.
24.
He Zeng. Analysis of patch test results in 153 patients with suspected allergic contact dermatitis. J Hengyang Med Coll, 2000; 28: 175–176.
25.
ChenJ, KuangX, ZhangJ, et al..Analysis of patch test results in children with suspected allergic contact dermatitis. Chin J Dermatol, 2001; 34: 441.
26.
HanJ, ZhangL. Analysis of patch test results in 348 patients with suspected allergic contact dermatitis in Haining, Qinhai, China. Chin J Microb Immuno, 2001; 21: 99–100.
27.
ZhangY. Analysis of patch test results in 100 patients with suspected allergic contact dermatitis. Liaoning Yao Wu Yu Lin Chuang, 2001; 4: 122–123.
28.
ZhangG, ZhouY, WenH. Analysis of patch test results in 188 patients with suspected allergic contact dermatitis in Changsha, China. Chin Clin Dermatol, 2002; 31: 357.
29.
ZhangR, ZhangP, YinC. Analysis of patch test results in 182 patients with suspected allergic contact dermatitis in Weihai, China. Chin J Lepro Skin Dis, 2003; 19: 274–275.
30.
WangJ, WangY, LiuJ. Analysis of patch test results in 953 patients with suspected allergic contact dermatitis. Chin J Lepro Skin Dis, 2003; 19: 502.
31.
SuY, LiY, XiaoR. Analysis of patch test results in 235 patients with suspected allergic contact dermatitis. China J Mod Med, 2003; 13: 65–66.
32.
LuoP, ChenJ, ZhangJ. Analysis of patch test results in 716 children with suspected allergic contact dermatitis. J Mod Clin Med Bioeng, 2003; 9: 435.
33.
LuD, HuangH, HuX. Analysis of patch test results in patients with suspected allergic contact dermatitis in Zhuhai, Guangdong China. Chin J Lepro Skin Dis, 2004; 20: 545–546.
34.
ZhouS, LiuX, ZhaoZ. Analysis of patch test results in 337 patients with suspected allergic contact dermatitis. Chin J Lepro Skin Dis, 2004; 27: 551–553.
35.
ZhangY, XuT, ZhengL. Analysis of patch test results in 108 patients with suspected allergic contact dermatitis. Beijing Yi Xue, 2005; 27: 633.
36.
JinL, ZhaoY, SunL. Analysis of patch test results in 100 patients with suspected allergic contact dermatitis in Dalian China. Chin J Lepro Skin Dis, 2005; 21: 658.
37.
ZhuX, FuS. Analysis of patch test results in 121 patients with suspected allergic contact dermatitis in Linyi, China. Chin J Dermatovenereol Integr Tradition West Med, 2006; 5: 114–115.
38.
FuL, XieW, YuM. Analysis of patch test results in 530 patients with suspected allergic contact dermatitis. China Prev Med, 2006; 7: 412–414.
39.
LiuY. Analysis of patch test results in 200 patients with suspected allergic contact dermatitis in Linyi, China. Med J Beijing Mil Reg, 2006; 18: 364.
40.
WangD, ZhangW, YuB. Analysis of contact allergen in patients with suspected allergic contact dermatitis. Chin J Dermatovenereol, 2006; 20: 608–609.
41.
ZhaoL, WangL, HongY. Analysis of patch test results in 589 patients with chronic suspected allergic contact dermatitis. Chin J Industrial Med, 2007; 20: 102–104.
42.
MiX, GeP, YuanX, et al..Analysis of patch test results in 1129 patients with suspected allergic contact dermatitis. Acad J PLA Postgrad Med Sch, 2008; 29: 109–111.
43.
ZhangJ, LiuY, YangR. Analysis of patch test results in 400 patients with suspected allergic contact dermatitis. Chin J Misdiagn, 2008; 8: 630–631.
44.
FengH, HaoY, LiuG. Analysis of contact allergen in patients with suspected allergic contact dermatitis. Inner Mongolia Med J, 2008; 40: 1456–1458.
45.
ZhangY, WangX, GaoY. Analysis of contact allergens in 300 patients with suspected allergic dermatitis. J Bin Zhou Med Coll, 2008; 31: 65–66.
46.
WuP, SunJ, YuT. Patch testing in 462 patients with chronic suspected allergic contact dermatitis. Lab Med Clin, 2009; 6: 40–41.
47.
BiesterbosJ, LidénC, van der ValkP. Nickel on the Dutch market: 10 years after entry into force of the EU Nickel Directive. Contact Dermatitis, 2011; 65: 115–117.
48.
KimYY, KimMY, ParkYM, et al..Evaluating the nickel content in metal alloys and the threshold for nickel-induced allergic contact dermatitis. J Korean Med Sci, 2008; 23: 315–319.
49.
MennéT, BrandrupF, Thestrup-PedersenK, et al..Patch test reactivity to nickel alloys. Contact Dermatitis, 1987; 16: 255–259.
50.
ThyssenJP, SkareL, LundgrenL, et al..Sensitivity and specificity of the nickel spot (dimethylglyoxime) test. Contact Dermatitis, 2010; 62: 279–288.
51.
ThyssenJ, MennéT, LidénC, et al.Excessive nickel release from earrings purchased from independent shops and street markets—a field study from Warsaw and London. J Eur Acad Dermatol Venereol, 2010.
52.
ThyssenJP, MennéT, JohansenJD. Nickel release from inexpensive jewelry and hair clasps purchased in an EU country—are consumers sufficiently protected from nickel exposure?. Sci Total Environ, 2009; 407: 5315–5318.
53.
JacobSE, MoennichJN, McKeanBA, et al..Nickel allergy in the United States: a public health issue in need of a “nickel directive”. J Am Acad Dermatol, 2009; 60: 1067–1069.
54.
ThyssenJP, JohansenJD, CarlsenBC, et al..Prevalence of nickel and cobalt allergy among female patients with dermatitis before and after Danish government regulation: a 23-year retrospective study. J Am Acad Dermatol, 2009; 61: 799–805.
55.
SchnuchA, WolterJ, GeierJ, et al..Nickel allergy is still frequent in young German females—probably because of insufficient protection from nickel-releasing objects. Contact Dermatitis, 2011; 64: 142–150.
56.
BiesterbosJ, YazarK, LidénC. Nickel on the Swedish market: follow-up 10 years after entry into force of the EU Nickel Directive. Contact Dermatitis, 2010; 63: 333–339.
57.
ThyssenJP, JohansenJD, MennéT. Nickel allergy in Danish women before and after nickel regulation. N Engl J Med, 2009; 360: 2259–2260.
58.
JulanderA, HindsénM, SkareL, et al..Cobalt-containing alloys and their ability to release cobalt and cause dermatitis. Contact Dermatitis, 2009; 60: 165–170.
59.
ThyssenJP, JensenP, LidénC, et al..Assessment of nickel and cobalt release from 200 unused hand-held work tools for sale in Denmark—sources of occupational metal contact dermatitis?. Sci Total Environ, 2011; 49: 4663–4666.
60.
ThyssenJP, MennéT, LidénC, et al..Cobalt release from implants and consumer items and characteristics of cobalt sensitized patients with dermatitis. Contact Dermatitis, 2011; 66: 113–122.
61.
ThyssenJP. Nickel and cobalt allergy before and after nickel regulation—evaluation of a public health intervention. Contact Dermatitis, 2011; 65 (Suppl 1): 1–68.
62.
WahlbergJE, LidénC. Cross-reactivity patterns of cobalt and nickel studied with repeated open applications (ROATS) to the skin of guinea pigs. Am J Contact Dermatitis, 2000; 11: 42–48.
63.
HindsénM, SpirénA, BruzeM. Cross-reactivity between nickel and palladium demonstrated by systemic administration of nickel. Contact Dermatitis, 2005; 53: 2–8.
64.
ThyssenJP. Nickel and cobalt allergy before and after nickel regulation—evaluation of a public health intervention. Contact Dermatitis, 2011; (Suppl 1): 1–75.
65.
HindsénM, PerssonL, GruvbergerB. Allergic contact dermatitis from cobalt in jewellery. Contact Dermatitis, 2005; 53: 350–351.
