Deposition of nickel, chromium, and cobalt on the skin in some occupations – assessment by acid wipe sampling

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.

OBJECTIVES

To investigate alloy use, coin composition and nickel and cobalt release for a worldwide selection of currently circulating coins.

MATERIALS AND METHODS

Eight hundred and fifty coins of 361 different denominations or issues from 52 countries were collected and analysed with X-ray fluorescence spectrometry and nickel and cobalt spot tests.

RESULTS

Copper-nickel was the most frequently identified coin alloy, being observed in 100 denominations (28%), followed by aluminium-bronze (62, 17%). In total, 239 denominations released nickel (28%). Coins from Bolivia, Brazil and Costa Rica did not release nickel. Fewer than one-third of the denominations or issues from China, India, the euro area and Indonesia released nickel. In the United States, the Russian Federation, Japan, and Mexico, one-third or more of the denominations released nickel.

CONCLUSIONS

This worldwide selection of circulating coins covered countries with 75% of the world population, and shows that the majority of the world population lives in countries where coins release nickel. Pertinently, ∼ 40% of circulating coin denominations do not release nickel.

Coin exposure may cause allergic nickel dermatitis: a review

Nickel is used in coins because the metal has beneficial properties, including price, colour, weight, and corrosion resistance, and also because it is easy to stamp. It has often been claimed that the duration of skin contact with coins is too short to cause nickel release and dermatitis. However, it is well known by dermatologists specialized in occupational skin diseases, and by their nickel-allergic patients, that hand eczema in cashiers and other professionals who handle coins may be caused or aggravated by nickel release from coins. In this review, we present evidence from past studies showing that nickel-containing coins can indeed pose a risk for those who handle them. For protection of the health of consumers, cashiers, and other workers who handle coins, it is suggested that coins without nickel release should be used as a substitute for the high nickel-releasing coins currently in widespread use. The key risk factor in this situation is the ability of metal alloys in coins to release nickel and contaminate the skin after repeated contact from coin handling.

Concurrent sensitization to metals and occupation

BACKGROUND

Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups.

OBJECTIVES

To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors.

PATIENTS/METHODS

Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis.

RESULTS

Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26).

CONCLUSIONS

Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.

Assessment of nickel and cobalt release from 200 unused hand-held work tools for sale in Denmark - Sources of occupational metal contact dermatitis?

INTRODUCTION

Nickel and cobalt allergy remain frequent in dermatitis patients. It is important to determine possible nickel and cobalt exposures at work as these may offer important information to regulators and physicians who perform patch testing. Clinical relevance of metal exposure is usually assessed by the treating physician via the medical history and by presentation of allergic contact dermatitis.

OBJECTIVES

To screen unused non-powered hand-held work tools for nickel and cobalt release by using colorimetric spot tests.

MATERIALS & METHODS

A random selection of 200 non-powered hand-held work tools for sale in 2 retailers of home improvement and construction products were analyzed qualitatively for metal release using the colorimetric nickel and cobalt spot tests.

RESULTS

Nickel release was identified from 5% of 200 work tools using the dimethylglyoxime (DMG) test. In 8 of 10, positive results were located to the metal ring that acts like a cuff and is located at the end of the grip. The positive DMG test results were not related to specific categories of work tools. The cobalt spot test gave no positive test reactions.

CONCLUSIONS

It appears that the proportion of work tools that release nickel, in amounts that may result in allergic nickel dermatitis, has decreased markedly, when results were compared with a Swedish study performed more than a decade ago. No cobalt release was detected but it should be underscored that hard-metal tools were not examined. Other sources of cobalt may explain the relatively high levels of cobalt allergy in dermatitis patients.

Allergic contact dermatitis: epidemiology, molecular mechanisms, in vitro methods and regulatory aspects. Current knowledge assembled at an international workshop at BfR, Germany

Contact allergies are complex diseases, and one of the important challenges for public health and immunology. The German ‘Federal Institute for Risk Assessment’ hosted an ‘International Workshop on Contact Dermatitis’. The scope of the workshop was to discuss new discoveries and developments in the field of contact dermatitis. This included the epidemiology and molecular biology of contact allergy, as well as the development of new in vitro methods. Furthermore, it considered regulatory aspects aiming to reduce exposure to contact sensitisers. An estimated 15–20% of the general population suffers from contact allergy. Workplace exposure, age, sex, use of consumer products and genetic predispositions were identified as the most important risk factors. Research highlights included: advances in understanding of immune responses to contact sensitisers, the importance of autoxidation or enzyme-mediated oxidation for the activation of chemicals, the mechanisms through which hapten-protein conjugates are formed and the development of novel in vitro strategies for the identification of skin-sensitising chemicals. Dendritic cell cultures and structure-activity relationships are being developed to identify potential contact allergens. However, the local lymph node assay (LLNA) presently remains the validated method of choice for hazard identification and characterisation. At the workshop the use of the LLNA for regulatory purposes and for quantitative risk assessment was also discussed.

Contact allergy and human biomonitoring--an overview with a focus on metals

Humans are widely exposed to chemicals. Today, there is an increased acknowledgement of the importance of measuring human and environmental exposures to man-made or refined chemicals. Different approaches have been applied over time, but during the past 25 years, there has been a general trend towards the use of human biomonitoring. A few studies have used human biomonitoring methodology to track contact allergens together with information on patch test reactivity. Hypothetically, the internal load of reactive chemicals might modify the immune response to haptens and the propensity to sensitize and elicit allergic contact dermatitis or develop tolerance. This review offers a general overview of human biomonitoring, including information about its typical application and methodology. Furthermore, studies that have attempted to perform simultaneous biomonitoring and patch testing are reviewed. It is concluded that all studies conducted until the present have focused on one or two routes of exposure (typically skin and oral exposure, but also skin and airway exposure), whereas no studies have investigated all routes at the same time. Also, there is a need for prospective studies, as all epidemiological studies so far have been cross-sectional.

Metal allergy--a review on exposures, penetration, genetics, prevalence, and clinical implications

The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1-3% are allergic to cobalt and chromium. Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.

Skin deposition of nickel, cobalt, and chromium in production of gas turbines and space propulsion components

Skin exposure to nickel, cobalt, and chromium may cause sensitization and allergic contact dermatitis and it is known that many alloys and platings may release significant amounts of the metals upon contact with skin. Occupational exposure to these sensitizing metals has been studied in different settings with regards to airborne dust and different biological end points, but little is known about deposition on skin from airborne dust and direct contact with materials containing the metals. In this study, skin deposition was studied in 24 workers in an industry for development and manufacturing of gas turbines and space propulsion components. The workers were employed in three departments, representing different exposure scenarios: tools sharpening of hard metal items, production of space propulsion structures, and thermal application of different metal-containing powders. A novel acid wipe sampling technique was used to sample metals from specific skin surfaces on the hands and the forehead of the workers. Total amounts of nickel, cobalt, and chromium were measured by inductively coupled plasma mass spectrometry. The result showed that nickel, cobalt, and chromium could be detected on all skin surfaces sampled. The highest level of nickel was 15 microg cm(-2) h(-1), the highest for cobalt was 4.5 microg cm(-2) h(-1), and for chromium 0.6 microg cm(-2) h(-1). The three departments had different exposures regarding the metals. The highest levels of nickel on the skin of the workers were found in the thermal applications department, cobalt in the tools sharpening department, and chromium in the space propulsion components department. In conclusion, the workers' exposure to the metals was more likely to come from direct skin contact with items, rather than from airborne dust, based on the fact that the levels of metals were much higher on the fingers than on the back side of the hands and the forehead. The skin exposure levels of nickel and cobalt detected are judged capable to induce sensitization and elicit allergic contact dermatitis.

Nickel allergy in patch-tested female hairdressers and assessment of nickel release from hairdressers' scissors and crochet hooks

BACKGROUND

Hand eczema as well as nickel contact allergy is prevalent among hairdressers. Recently, two female hairdressers were diagnosed with nickel contact allergy-related hand eczema following prolonged skin contact with scissors and crochet hooks used during work.

OBJECTIVES

To determine the proportion of hairdressers' scissors and crochet hooks that released an excessive amount of nickel and to determine the prevalence of nickel allergy among patch-tested female hairdressers.

MATERIALS

Random hairdressers' stores in Copenhagen were visited. The dimethylglyoxime (DMG) test was used to assess excessive nickel release. The prevalence of nickel allergy among female hairdressers from the database at Gentofte Hospital was compared with the prevalence of nickel allergy among other consecutively patch-tested dermatitis patients.

RESULTS

DMG testing showed that 1 (0.5%; 95% CI = 0 - 2.0) of 200 pairs of scissors and 7 (53.8%; 95% CI = 26.0 - 82.0) of 13 crochet hooks released an excessive amount of nickel. The prevalence of nickel allergy was higher among middle-aged and older female hairdressers than among young female hairdressers.

CONCLUSIONS

The prevalence of nickel allergy was lower among young hairdressers in comparison to older hairdressers. This may possibly be a result of the European Union (EU) Nickel Directive or a consequence of a decreased use of nickel-releasing work tools in salons. When nickel allergic hairdressers present with hand eczema, their work tools should be investigated for nickel release.

Release of nickel from coins and deposition onto skin from coin handling--comparing euro coins and SEK

BACKGROUND

Nickel exposure is the most common cause of contact allergy. The role of contact with nickel-containing coins has been controversial.

OBJECTIVES

To compare the release of nickel from 1 and 2 EUR coins (both composed of two alloys: Cu 75%, Zn 20%, Ni 5% and Cu 75%, Ni 25%) and Swedish 1 SEK coin (alloy: Cu 75%, Ni 25%) and to assess the deposition of nickel onto skin by coin handling.

METHODS

Nickel release was determined by immersion in artificial sweat (2 min, 1 hr, 24 hr, and 1 week). Deposition of nickel onto the skin was assessed in three subjects after 1-hr handling of 2 EUR and 1 SEK coins. Samples (n = 48) were taken from fingers and palms by acid wipe sampling and analysed by inductively coupled plasma mass spectrometry.

RESULTS

Amounts of nickel released by 1 week from 1 SEK, 1 EUR, and 2 EUR coins were 121, 86, and 99 microg/cm(2), respectively. Corresponding 2 min values were 0.11, 0.25, and 0.22 microg/cm(2). Nickel was deposited onto the skin by 1 hr coin handling (range 0.09-4.1 microg/cm(2)), the largest amounts were on fingers; similar amounts of nickel were deposited from 1 SEK and 2 EUR coins.

CONCLUSIONS

Nickel is released from 1 and 2 EUR and 1 SEK coins at similar amounts. Nickel is deposited onto skin at substantial and similar amounts by coin handling. Acid wipe sampling is suitable for studies of skin exposure to nickel and in risk assessment.