Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
Endocr Metab Immune Disord Drug Targets. 2020;20(7):992-1002. doi: 10.2174/1871530320666200128141900.
Nickel is the most common cause of contact allergy in the general population and the most frequently detected allergen in patients patch tested for suspected allergic contact dermatitis (ACD). ACD from nickel is a typical type IV hypersensitivity. Nickel allergy is mostly caused by nonoccupational exposure, such as jewelry and clothing decorations, metal tools, medical devices (mainly orthopedic and orthodontic implants, cardiovascular prosthesis), eyeglasses, utensils, keys, pigment for paint, cosmetics, and food (mainly legumes, chocolate, salmon, peanuts). Occupational exposure can involve several workers (mechanics, metalworkers, platers, hairdressers, jewelers, workers in the constructions and electronic industries), classically involving hands and forearms. The classic clinical pattern of ACD caused by nickel is characterized by eczematous dermatitis involving the sites of direct contact with the metal. Non-eczematous-patterns are reported, including lichenoid dermatitis, granuloma annulare, vitiligo-like lesions, dyshidrosiform dermatitis, and vasculitis. In the case of systemic exposure to nickel, sensitized patients could develop systemic contact dermatitis. Patch testing represents the gold standard for the diagnosis of ACD from nickel. Treatment includes avoidance of contact with products containing nickel and the patient's education about the possible use of alternative products. A recent EU nickel directive, regulating the content and release of nickel from products, has caused a decrease of nickel contact allergy in some European countries. Nickel allergy is a relevant issue of public health with significant personal, social, and economic impact. This review summarizes epidemiology, pathomechanism, clinical patterns, treatment, and prevention programs.
镍是普通人群中最常见的接触过敏原，也是怀疑接触性皮炎（ACD）患者斑贴试验中最常检测到的过敏原。镍引起的 ACD 是一种典型的 IV 型超敏反应。镍过敏主要由非职业暴露引起，例如珠宝和服装饰品、金属工具、医疗器械（主要是矫形和正畸植入物、心血管假体）、眼镜、餐具、钥匙、油漆颜料、化妆品和食物（主要是豆类、巧克力、三文鱼、花生）。职业暴露可能涉及到许多工人（机械师、金属工人、电镀工、理发师、珠宝商、建筑和电子行业工人），通常涉及手部和前臂。镍引起的 ACD 的经典临床模式表现为接触金属的部位出现湿疹性皮炎。也有报道称存在非湿疹样模式，包括苔藓样皮炎、环状肉芽肿、白癜风样病变、汗疱疹样皮炎和血管炎。在全身性接触镍的情况下，致敏患者可能会发展为全身性接触性皮炎。斑贴试验是诊断镍引起的 ACD 的金标准。治疗包括避免接触含镍产品和对患者进行有关可能使用替代产品的教育。欧盟最近颁布的一项关于镍的指令，对产品中镍的含量和释放进行了规定，导致一些欧洲国家的镍接触过敏有所减少。镍过敏是一个具有重要个人、社会和经济影响的公共卫生相关问题。这篇综述总结了镍接触过敏的流行病学、发病机制、临床模式、治疗和预防方案。
