Prevalence of contact allergy in the general population: Sensitization to metals with a focus on nickel sulfate, the EDEN Fragrance Study Group

M.-L. Schuttelaar, R. Ofenloch, M. Bruze, S. Cazzaniga, P. Elsner, M. Gonçalo, L. Naldi, Å. Svensson, T. Diepgen

Research output: Contribution to journalMeeting AbstractAcademic


Sensitization to metals is assessed mostly in clinical populations. Studies in the general population are scarce. Our objective was to determine the prevalence of metal sensitization in the general population and to determine risk factors for nickel sensitization. In five European countries (the Netherlands, Germany, Italy, Portugal and Sweden) a random sample (n=3119) from the general population aged 18-74 years was patch tested with the TRUE Test. Different risk factors for contact allergy to nickel sulfate were investigated in terms of odds ratios (ORs). Overall, the age-standardized prevalences of sensitization to nickel, cobalt and chromate were 14.5%, 2.1% and 0.8%, respectively. The prevalence of nickel sensitization showed a variation among different countries; the highest prevalences were seen in Portugal (18.5%) and Italy (16.4%), while the lowest prevalence (8.3%) was seen in Sweden. The prevalence of cobalt sensitization varied between 3.8% (the Netherlands) and 0.9% (Italy), and the prevalence of chromate sensitization varied between 1.3% (Portugal) and 0.4% (Italy and the Netherlands). The highest crude prevalences of strongly positive (++) andextreme (+++) reactions to nickel were observed in Italy (14.7%) and Portugal (14.2%). These countries showed the lowest prevalences of irritant/doubtful reactions: 0.5% and 1.1%, respectively. The prevalence of sensitization to nickel increases in younger age groups from 12.1% (18-30 years) to 20.6% (31-45 years), then decreases to 16.1% (46-60 years) and 7.4% (61-74 years) in higher age groups. Stratification for sex showed a higher crude prevalence of nickel sensitization in women (22.2%) than in men (5.2%). The highest prevalence in women (31.8%) was seen in the age group 31-45 years, while in men the highest prevalence (7.9%) was found in the age group 46-60 years. Estimates from univariate logistic regression models showed strongly significant associations between sensitization to nickel and female sex [OR 5.19, 95% confidence interval (CI) 3.99-6.74], piercing use ever (OR, 4.24, 95% CI 3.33-5.40) and three or more current piercings (OR5.58,95%CI, 4.02-7.76). For age the OR was 0.89(95% CI 0.81-0.97). No significant association was observed for atopic dermatitis (OR 1.17, 95% CI 0.79-1.72). The above-mentioned associations were still significant in a multiple regression model. In conclusion, the prevalence of contact allergy to nickel in the general population was high. Sensitization to nickel decreased in older age groups. There were differences in the prevalence between countries, with the highest prevalence of nickel sensitization in Portugal and Italy. The lowest prevalence in Sweden supports the effectiveness of long-standing adequate regulation.
Original languageEnglish
Pages (from-to)50-51
Number of pages2
Issue numberS1
Publication statusPublished - 1-Sep-2016
Event13th congress of the European Society of Contact Dermatitis (ESCD) - Manchester, United Kingdom
Duration: 14-Sep-201617-Sep-2016


  • chromic acid
  • cobalt
  • fragrance
  • irritant agent
  • nickel
  • nickel sulfate
  • adult
  • atopic dermatitis
  • confidence interval
  • contact allergy
  • controlled study
  • female
  • Germany
  • human
  • Italy
  • logistic regression analysis
  • major clinical study
  • male
  • middle aged
  • model
  • multiple regression
  • Netherlands
  • odds ratio
  • population
  • Portugal
  • prevalence
  • random sample
  • risk factor
  • sensitization
  • stratification
  • Sweden
  • young adult

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