A spot test for detection of cobalt release - early experience and findings

Recognizing and Managing Allergic Contact Dermatitis: Focus on Major Allergens

Patch testing is the reference standard for the diagnosis of allergic contact dermatitis. Identification and avoidance of culprit allergens are essential in the treatment of this disease. Each year, new allergens are identified as emerging or important. The authors discuss allergens that are common, enduring, emergent, incompletely recognized, and controversial for the practicing allergist and dermatologist. This Clinical Management Review will encompass a review of fragrances, preservatives, rubber, acrylates, metals, and medications; their common sources of exposure; controversies in diagnosis and patch testing; management and how to avoid those allergens. This review will also include practical aspects of diagnosis and management and will provide resources that can be used as guidance for physicians and patients on nickel, methylchloroisothiazolinone/methylisothiazolinone, and fragrance, the most common allergens positive on patch testing.

Skin and respiratory exposure to soluble lead, cobalt, nickel, copper, arsenic and silver at two South African precious metals refineries

OBJECTIVES

Precious metals refinery workers are exposed to soluble platinum group metals (PGMs) during PGM-refining but may also be exposed to hazardous non-PGMs (Pb, Co, Ni, Cu, As and Ag) still present in the matte following base metals refining. The aim of this article was to report the skin and respiratory exposure of workers to soluble non-PGMs during PGM-refining.

METHODS

Skin and respiratory exposure (of 40 workers at two precious metals refineries) were measured simultaneously over two consecutive shifts. Skin exposure was measured on the palm, wrist, neck and forehead using Ghostwipes™ and respiratory exposure was measured using the MDHS method 46/2 during which soluble metals were extracted using 0.07 M HCl and mechanical agitation, followed by ICP-MS analysis.

RESULTS

The geometric means (GM) of average skin exposure to individual soluble metals on all anatomical areas was found in the order Cu (0.018 µg/cm²) > Ni (0.016 µg/cm²) > Pb (0.008 µg/cm²) > Ag (0.006 µg/cm²) > As (0.004 µg/cm²) > Co (0.0008 µg/cm²) with the palm being the highest exposed anatomical area. The order of the GM respiratory exposure was Pb (0.224 µg/m³) > Ag (0.201 µg/m³) > Cu (0.159 µg/m³) > As (0.079 µg/m³) > Ni (0.034 µg/m³) > Co (0.016 µg/m³) with exposure to As exceeding the South African occupational exposure limit (20 µg/m³) during concentrate handling (max 66.174 µg/m³).

CONCLUSIONS

Workers were exposed to a mixture of toxic PGM and non-PGMs via the skin and inhalation. Exposure to these metals could lead to the development of diseases, such as contact dermatitis, occupational allergy, or occupational cancer. Non-PGMs must be included in hazardous chemical risk assessments and control strategies implemented at precious metals refineries.

Nickel and cobalt release from beauty tools: a field study in the German cosmetics trade

BACKGROUND

Relevant nickel and cobalt release from hairdressing tools has recently been evidenced. Comparable data are not available for tools used in beauty salons.

OBJECTIVES

Screening of beauty tools for nickel and cobalt release.

METHODS/MATERIALS

Three hundred eight beauty tools were tested in seven beauty salons located in two North-German states. A nickel spot test and a cobalt spot test were used to test the tools for nickel release and cobalt release, respectively.

RESULTS

143 of 308 beauty tools overall (46.4%; 95%CI: 40.8-52.2%) released nickel and 18 of 308 beauty tools overall (5.8%; 95%CI: 3.5-9.1%) released cobalt. Nickel release was found in 22 of 99 metal tools (22.2%; 95%CI: 14.5-31.7%) and 121 of 209 tools with metallic parts (57.9%; 95%CI: 50.9-64.7%); cobalt release was detected in 3 of 99 metal tools (3.0%; 95%CI: 0.63-8.6%) and 15 of 209 tools with metallic parts (7.2%; 95%CI: 4.1-11.6%).

CONCLUSIONS

Nickel and cobalt are emitted at allergologically relevant levels by a wide range of beauty tools (i.e., metal tools and tools with metallic parts) utilized in the German cosmetics trade. Beauty tools should thus be considered occupational sources of nickel and cobalt exposure. This article is protected by copyright. All rights reserved.

Identifying Safe Alternatives for Contact Allergy Patients

Allergen avoidance is the most effective treatment of contact allergy. Patient improvement ultimately relies on identification of safe alternative products, which can be used by the patient. Safe personal care product options typically can be found using ingredient database programs. Avoidance of allergens in other products (eg, shoes, clothing, and dental care) often is challenging. This article discusses specific safe alternatives for the 80 allergens on the 2017 American Contact Dermatitis Society core allergen series.

Chromium and cobalt release from metallic earrings from the Danish market

BACKGROUND

Chromium and cobalt are important skin sensitizers. It has, however, been difficult to identify causative exposures. Studies on nickel allergy have demonstrated piercing as critical for both sensitization and elicitation. It may be speculated that the same applies for chromium and cobalt.

OBJECTIVE

To examine the content and release of chromium and cobalt from earrings randomly purchased in Denmark.

METHODS

Three hundred four earrings were examined with x-ray fluorescence (XRF) spectrometry. Earrings with measured content of chromium or cobalt were spot tested with diphenylcarbazide spot test (n = 166) or Nitroso-R spot-test (n = 99), respectively. Chromium and cobalt release were quantified in a selected subsample (n = 100) with the artificial sweat test (EN 1811).

RESULTS

Chromium was present in 54.6% (166/304) of earrings and cobalt was present in 72.0% (219/304),- measured by XRF. All chromium spot tests for chromium VI were negative. The cobalt spot test was positive for one component. Chromium release was found from 59/100 (median concentration = -0.06 μg/cm² /week) and cobalt release from 29/100 (median concentration = -0.06 μg/cm² /week) of earrings in tested subsample.

CONCLUSION

Earrings for piercing release chromium and cobalt and may on a case basis be a source of chromium and cobalt allergy.

Chemical Identification and Confirmation of Contact Allergens

Identification of the etiological chemical agent(s) associated with a case(s) of allergic contact dermatitis (ACD) is important for both patient management and public health surveillance. Traditional patch testing can identify chemical allergens to which the patient is allergic. Confirmation of allergen presence in the causative ACD-associated material is presently dependent on labeling information, which may not list the allergenic chemical on the product label or safety data sheet. Dermatologists have expressed concern over the lack of laboratory support for chemical allergen identification and possibly quantification from patients' ACD-associated products. The aim of this review was to provide the clinician a primer to better understand the analytical chemistry of contact allergen confirmation and unknown identification, including types of analyses, required instrumentation, identification levels of confidence decision tree, limitations, and costs.

Experimental evaluation of nickel and cobalt release from tools and self-reported prevalence of nickel and cobalt allergy in the German hairdressing trade

BACKGROUND

Nickel release from some metal tools in the hairdressing trade has been sporadically evidenced, whereas data about cobalt release from metal tools in the hairdressing trade are lacking.

OBJECTIVES

To screen metal tools for nickel and cobalt release and to estimate the prevalence of nickel allergy and cobalt allergy in the German hairdressing trade.

METHODS

Four hundred seventy-five metal tools in the hairdressing trade were tested in three North German states with a nickel spot test for nickel release and with a cobalt spot test for cobalt release. Seventy hairdressers were surveyed with a standardized questionnaire to collect data about the tested metal tools as well as the prevalence of nickel allergy and cobalt allergy.

RESULTS

One hundred thirty-one of 475 metal tools (27.6%) - 60 of 60 hair clips (100%), five of five crochet hooks (100%), 24 of 40 tweezers (60.0%), 33 of 75 sectioning clips (44.0%), five of 32 straight razors (15.6%), and four of 45 tail combs (8.9%) - released nickel and 10 of 475 metal tools (2.1%) - three of 40 tweezers (7.5%), four of 60 hair clips (6.7%), one of 32 straight razors (3.1%), and two of 75 sectioning clips (2.7%) - released cobalt. Eight of 63 female hairdressers (12.7%) suffered from nickel allergy and two of 63 female hairdressers (3.2%) suffered from cobalt allergy.

CONCLUSIONS

Metal tools in the German hairdressing trade - with which a prolonged skin contact is intended - release nickel and cobalt in allergologically relevant amounts and thus should be taken into account as occupational sources of exposure to nickel and cobalt.

Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children

Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.

Electrochemical Screening Spot Test Method for Detection of Nickel and Cobalt Ion Release From Metal Surfaces

BACKGROUND

Present screening methods to rapidly detect release of nickel and cobalt ions from metallic surfaces involve colorimetric dimethylglyoxime (DMG)- and disodium-1-nitroso-2-naphthol-3,6-disulfonate-based spot tests with a cotton bud. There is a risk of false-negative test reactions because test outcomes are dependent on the pressure, area, and duration of surface wiping.

OBJECTIVE

The aim of the study was to develop a miniaturized electrochemical device that uses a voltage to accelerate nickel and cobalt release from the tested item and perform an initial validation.

METHODS AND RESULTS

A device was built in plastic, and its performance was investigated using 0.5 mL of test solutions of, respectively, DMG and disodium-1-nitroso-2-naphthol-3,6-disulfonate. Cotton buds that had been wetted in test solution were pressed against different metal surfaces at various voltages (0-9 V) and a range of test durations (0-120 seconds). Duplicate testing for nickel and cobalt release was also performed on a sample of 163 jewelry items.

CONCLUSIONS

This novel electrochemical device makes it possible to perform nickel and cobalt ion release testing without rubbing, thereby reducing interindividual differences in testing technique. The nickel testing with the device seemed to be superior to conventional DMG spot testing.

A bioluminescent strategy for imaging palladium in living cells and animals with chemoselective probes based on luciferin-luciferase system

To develop a strategy for visualizing palladium species in the biological system, several turn-on bioluminescent probes were designed and synthesized by using a Pd-induced reductive reaction herein. Such probes exhibited high sensitivity (detection limit: 0.5 μM) and excellent selectivity toward Pd²⁺in vitro. In particular, probe 2 was identified as a viable molecule with the capability of visualizing the fluctuations of level and distribution of Pd²⁺ in living cells and animals, which provides a valuable tool for tracing Pd²⁺ in biological system.

Contamination of skin and surfaces by cobalt in the hard metal industry

BACKGROUND

It is well known that hard metal workers have historically been affected by contact allergy to cobalt. Knowledge is sparse about occupational skin exposure to cobalt, in terms of skin doses and sources of exposure, which could be used to improve protection of workers.

OBJECTIVES

To improve knowledge about skin doses and sources of skin exposure to cobalt within hard metal production, thereby facilitating better protection of workers.

METHODS

Forty workers were sampled on the index finger by acid wipe sampling after 2 hours of work. The samples were analysed with inductively coupled plasma mass spectrometry. Cobalt spot testing was performed in the work environment.

RESULTS

The highest skin doses were found among raw material workers. Skin doses among other production workers were also significant. Most office workers had low, but measurable, levels of cobalt on the skin. Glove use varied between workers. Cobalt was found on production equipment, on items in the canteen area, and on handles and buttons throughout the company.

CONCLUSIONS

Cobalt skin doses were prominent, and originated from contact with raw materials, sintered materials, and contaminated surfaces. Cobalt was present on surfaces outside production areas. Companies need to identify and reduce skin exposure for protection of workers.

Cobalt release and complications resulting from the use of dental prostheses

BACKGROUND

Cobalt release from dental prostheses has been shown to elicit allergic reactions in cobalt-allergic patients. It is therefore important to investigate whether these prostheses are possible sources of sensitization.

OBJECTIVES

To assess (i) cobalt release from dental prostheses and (ii) allergic reactions to components of dental prostheses, and (iii) to investigate the oral mucosa for inflammation 1-5 years after insertion of the prostheses.

METHOD

Clinical oral examination was conducted in 66 patients with 84 dental prostheses. Cobalt release from 84 functional (used) and 32 non-functional (new) prostheses was investigated with the cobalt spot test. Contact allergy was assessed by patch testing. Smear tests for Candida spp. were performed in patients showing signs of inflammation of the oral mucosa. The prostheses were assessed for biological and technical complications.

RESULTS

None of the functional prostheses released cobalt, whereas this was observed in 24 of 32 non-functional prostheses. None of the patients had contact allergy to cobalt. Of the 66 patients, 11 showed signs of inflammation of the oral mucosa, 2 had oral candidiasis, 16 had ill-fitting prostheses, and all had insufficient oral hygiene.

CONCLUSIONS

Dental prostheses released cobalt during the fabrication stages, but not 1-5 years after insertion. No allergic reactions were observed. Signs of inflammation were related to candidiasis, insufficient oral hygiene, and ill-fitting prostheses.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Assessment of nickel and cobalt release from jewelry from a non-nickel directive country

BACKGROUND

A directive restricting nickel release from jewelry and other skin-contact products has not been initiated in Thailand or in the United States. The prevalence of nickel and cobalt allergies is increasing, and the main cause of sensitization seems to be jewelry.

OBJECTIVES

We aimed to investigate nickel and cobalt release from jewelry available in Thai marketplaces and to study the factors associated with nickel and cobalt release.

METHODS

Used costume jewelry items were collected from volunteers. They were tested with the dimethylglyoxime and cobalt tests.

RESULTS

Five hundred fifty-one items, including belt buckles, bracelets, earrings, necklaces, rings, and watches, were tested; 216 (39.2%) gave positive dimethylglyoxime tests, and 206 (37.4%) gave positive cobalt tests. The factors that determined nickel or cobalt release were shopping location and jewelry price. Cobalt-containing jewelry could be identified by its dark color.

CONCLUSIONS

A large proportion of the jewelry sold in Thai markets release nickel or cobalt.

European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

Failure of total hip implants: metals and metal release in 52 cases

BACKGROUND

The pathogenesis of total joint replacement failure is multifactorial. One hypothesis suggests that corrosion and wear of alloys result in metal ion release, which may then cause sensitization and even implant failure, owing to the acquired immune reactivity.

OBJECTIVES

To assess cobalt, nickel and chromium(VI) release from, and the metal composition of, failed metal-on-ethylene total hip replacements.

MATERIALS/METHODS

Implant components from 52 revision cases were evaluated with spot tests for free nickel, cobalt, and chromium (VI) ions. Implant composition was determined with X-ray fluorescence spectroscopy, and information on the reason for revision and complications in relation to surgery was collected from the medical charts when possible (72%). For 10 implants, corrosion was further characterized with scanning electron microscopy.

RESULTS

We detected cobalt release from three of 38 removed femoral heads and from one of 24 femoral stems. Nickel release was detected from one of 24 femoral stems. No chromium(VI) release was detected.

CONCLUSIONS

We found that cobalt and nickel were released from some failed total hip arthroplasties, and corrosion was frequently observed. Metal ions and particles corroded from metal-on-polyethylene may play a role in the complex aetiopathology of implant failure.

Cobalt skin dose resulting from short and repetitive contact with hard metals

BACKGROUND

Many daily contacts with metallic items are short and repetitive, and result in metal release; material, sweat, friction and wear may all be important.

OBJECTIVES

To study cobalt release and skin deposition as a result of many short and repetitive contacts with two cobalt-containing materials.

MATERIALS/METHODS

Study participants (n = 5) handled two types of hard metal disc (Co 6% and Co 15% Cr 0.6%) for 30 min. Deposited cobalt skin doses were measured with acid wipe sampling and chemical analysis. Cobalt release from the hard metal discs in artificial sweat was measured under conditions simulating those present during the handling of discs.

RESULTS

Average cobalt skin doses from discs containing 6% Co and 15% Co 0.6% Cr were 1.1 µg/cm(2) [standard deviation (SD) 0.4 µg/cm(2) ] and 0.7 µg/cm(2) (SD 0.5 µg/cm(2) ), respectively. More cobalt was released from hard metal discs containing 6% Co [11.4 µg/cm(2) (SD 1.2 µg/cm(2) )] than from discs containing 15% Co 0.6% Cr [4.8 µg/cm(2) (SD 0.6 µg/cm(2) )]. 10% to 15% of the potentially available cobalt was deposited on the skin during handling.

CONCLUSIONS

It is likely that the cobalt deposited as a result of short and repetitive contact with hard metals may cause harm. Research regarding cobalt exposure, metal release and the deposition of skin-sensitizing metals resulting from short and repetitive contact is needed for a better understanding of the allergy risk.

Mobile Phones: Potential Sources of Nickel and Cobalt Exposure for Metal Allergic Patients

The use of cellular phones has risen exponentially with over 300 million subscribers. Nickel has been detected in cell phones and reports of contact dermatitis attributable to metals are present in the literature. We determined nickel and cobalt content in popular cell phones in the United States. Adults (>18 years) who owned a flip phone, Blackberry^®, or iPhone^® were eligible. Seventy-two cell phones were tested using SmartPractice's^® commercially available nickel and cobalt spot tests. Test areas included buttons, keypad, speakers, camera, and metal panels. Of the 72 cell phones tested, no iPhones or Droids^® tested positive for nickel or cobalt. About 29.4% of Blackberrys [95% confidence interval (CI), 13%-53%] tested positive for nickel; none were positive for cobalt. About 90.5% of flip phones (95% CI, 70%-99%) tested positive for nickel and 52.4% of flip phones (95% CI, 32%-72%) tested positive for cobalt. Our study indicates that nickel and cobalt are present in popular cell phones. Patients with known nickel or cobalt allergy may consider their cellular phones as a potential source of exposure. Further studies are needed to examine whether there is a direct association with metal content in cell phones and the manifestation of metal allergy.