Nickel Allergy: Epidemiology, Pathomechanism, Clinical Patterns, Treatment and Prevention Programs.

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.

Metodologias formativas: contribuição para o desenvolvimento colaborativo da cadeia de semijoias de Limeira / Formative methodologies contribution to the collaborative development of the costume jewelry productive chain in Limeira

Introdução - A cadeia de produção de semijoias e bijuterias em Limeira é responsável por um processo produtivo complexo que, chega ao domicílio residencial e, gera trabalho infantil e adolescente. Graves problemas de saúde podem surgir para as famílias que produzem semijoias e bijuterias dentro de casa, além dos riscos ocupacionais e de acidentes. Objetivo - Compreender o aprendizado expansivo coletivo de modo a possibilitar a colaboração e a integração entre os diferentes atores da rede de sistemas de atividades da COMETIL - Comissão Municipal de Erradicação do Trabalho Infantil e Adolescente de Limeira. Método - Coleta de dados utilizando entrevistas, reuniões, oficinas de apresentação, observações da atividade. Posteriormente, utiliza-se o método Laboratório de Mudanças (LM), que se apoia na Teoria da Atividade Histórico Cultural e na Aprendizagem Expansiva, para a compreensão das atividades interinstitucionais da COMETIL, com gravação e filmagem das sessões para análise. Resultados - Divididos em 2 artigos e 1 capítulo de livro. No primeiro artigo, as hipóteses são de que contradições existentes no sistema de atividades da cadeia produtiva não permitem transpor o desafio de sustentabilidade da cadeia, aumentando a precarização do trabalho e os riscos à saúde e segurança das famílias que, por não encontrarem outra alternativa, produzem semijoias e bijuterias em casa. No segundo, apresenta-se uma análise dos resultados do LM que permitiu elevar o nível de agência transformativa entre os participantes da COMETIL, além de fornecer visualização das ações com a elaboração de novos instrumentos de trabalho. No terceiro, evidencia-se que a agência transformativa efetiva-se através da compreensão de que há necessidade de atuação coletiva e integrada, entre instituições públicas e privadas, confirmando o processo de aprendizagem expansiva desencadeado pelo método. Conclusão - O LM permitiu visualizar que a COMETIL pode ser entendida como uma plataforma ou um macro sistema de atividades e que possibilita novos processos organizacionais de ações das instituições públicas de erradicação e controle do trabalho infantojuvenil junto a este setor produtivo de semijoias e bijuterias

The costume jewelry production chain in Limeira is responsible for a complex production process that gets the residential homes and creates child and adolescent labor. Consequently, severe health problems can emerge for families that produce costume jewelry inside their houses, besides the occupational risks and accidents. Objective - To understand the collective expansive learning towards the collaboration and the integration between the actors of the activity systems of COMETIL - Committee for Eradication of Child Labor and Adolescent Work Protection of Limeira. Methods - Data collection using interviews, meetings, introductory workshops, and observations of activity. Subsequently, the Change Laboratory (CL) method, based on the Cultural-Historical Activity Theory and the Expansive Learning, was carried out to comprehend the interorganizational activities of the COMETIL with video recording for analysis. Results - These are divided into two papers and one book chapter. In the first paper, the hypotheses are that the existing contradictions in the activity systems of the production chain do not allow to meet the sustainability challenge, increasing the precariousness and the health and safety risks for families that are forced to produce costume jewelry at home because of an absence of other choices. The second text presents the analysis of the CL results that promoted the transformative agency among the COMETIL participants and provided the visualization of actions with the elaboration of new work instruments. The third paper supports that the transformative agency becomes effective through the comprehension of the need for a collective and integrated action between public and private institutions, confirming the learning expansive process resulting from the method. Conclusions - The CL allowed visualizing that the COMETIL can be understood as a platform or a macrosystem of activities and it promoted a new organizational process of actions of public institutions of eradication and monitoring the child labor with this costume jewelry production sector

Impact of occupational cadmium exposure on spirometry, sputum leukocyte count, and lung cell DNA damage among Indian goldsmiths.

BACKGROUND: Cadmium is frequently used in manual jewelry industries. Although its toxicity on lung function is well-known, the mechanism is not well-understood. METHODS: Among 26 goldsmiths exposed to cadmium (mean age 35.9 ± 5.0 years) and 17 referent workers without direct exposure (36.6 ± 6.6 years), we measured blood and urinary cadmium concentration and performed spirometry and quantified leukocytes and comet formation in the cells from spontaneously expectorated sputum samples. RESULTS: The goldsmiths had higher cadmium concentration in urine (mean 6.14 ± 1.63 vs. 0.47 ± 0.17 µg/dl) and blood (0.90 ± 0.23 vs. 0.02 ± 0.007 µg/dl) than the referents, which were inversely associated with FEV1 /FVC. Cadmium exposure also resulted in higher neutrophils (%) and lower macrophage (%) prevalence in the sputum and also caused substantial DNA damage in the lung cells among the goldsmiths than the referents (69 vs. 14%). CONCLUSION: Altered lung function among cadmium-exposed goldsmiths was associated with enhanced inflammatory response and increased cellular DNA damage in the lungs.

Metal allergen of the 21st century--a review on exposure, epidemiology and clinical manifestations of palladium allergy.

Consumers are mainly exposed to palladium from jewellery and dental restorations. Palladium contact allergy is nearly always seen together with nickel allergy, as palladium and nickel tend to cross-react. We aimed to analyse the available palladium patch test data and case reports to determine whether the prevalence of palladium mono-sensitization has increased. Based on available patch test data from the period 1986-2008, a total of 10 778 patients were patch tested with palladium chloride. The median prevalence of palladium allergy was 7.8% (range <1.0-19.0%) in dermatitis patients and 7.4% (range 1.3-13.9%) in dental patients. The median prevalence of palladium mono-sensitization (defined as the presence of palladium allergy and the absence of nickel allergy) was 0.2% (range 0-1.6%) in dermatitis patients and 0.5% (range 0-7.2%) in dental patients. A slight increase in the prevalence of palladium mono-sensitization was observed over the study period. We conclude that clinically relevant palladium allergy should mainly be suspected in patients who present with allergic contact granulomas at sites of piercing, but also in patients who have clinical disease and palladium patch test reactivity without concomitant nickel reactivity. Palladium salts should be included in dental screening patch test series. Palladium use in jewellery should be limited until we know more about the risk of sensitization.

Nickel reactivity and filaggrin null mutations--evaluation of the filaggrin bypass theory in a general population.

BACKGROUND: It was recently shown that filaggrin null mutation carrier status was associated with nickel allergy and self-reported intolerance to costume jewellery. Because of the biochemical characteristics of filaggrin, it may show nickel barrier properties in the stratum corneum. OBJECTIVES: To investigate whether subjects with filaggrin null mutations report nickel dermatitis at an earlier age than wild-type individuals, and to analyse whether null mutation carriers have stronger patch test reactivity to nickel sulfate than do wild-type individuals. MATERIALS: A total of 3471 Danes (18-69 years of age) answered a questionnaire about general health, and underwent patch testing and filaggrin genotyping. RESULTS: The mean number of years at risk of developing nickel dermatitis was significantly lower for the filaggrin null genotype than for the wild-type genotype when ear piercing status was considered. In positive patch test readings, the proportion of null mutants increased with increasing reaction strength. CONCLUSIONS: Filaggrin null mutations may lower the age of onset of nickel dermatitis. The hypothesis that ear piercings obscure the effect of filaggrin null mutations on the development of nickel allergy in statistical analyses was supported. An association between the null genotype and increased nickel sensitivity was indicated by patch test reading and questionnaire data.