Acta Dermato-Venereologica 97-10CompleteContent | Página 28

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Consumer Behaviour Among Nickel-allergic Patients
Malin G. AHLSTRÖM, Jacob P. THYSSEN, Torkil MENNÉ and Jeanne D. JOHANSEN
National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-
2900 Hellerup, Denmark. E-mail: [e-mail]
Accepted Jul 5, 2017; Epub ahead of print Jul 6, 2017
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2751
1
-
40 -
20 -
0
The overall response rate to the questionnaire was 63.2%,
corresponding to 342 patients (318 women and 24 men).
Out of the total of 342 patients 292 (85.4%) gave an af-
RESULTS
Fig. 1. Self-reported consumer actions to avoid nickel among patients
with nickel allergy, stratified by age. Patients often reported more than
one action. χ 2 test was used to test differences between patients aged ≥ 40
years and < 40 years.*p  < 0.05.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2017 Acta Dermato-Venereologica.
-
60 -
80
All patients
<40 years
≥40 years
*
100
A questionnaire was sent to 524 patients who had a positive patch-
test reaction to nickel sulphate 5% pet. (Trolab, Smartpractice-
Almirall Hermal, Reinbek, Germany) within the past 5 years (1
January 2010 to 31 December 2014) at the Department of Derma-
tology and Allergy, Herlev and Gentofte Hospital. The European
baseline series had been used for patch-testing and readings were
performed according to European Society of Contact Dermatitis
(ESCD) guidelines (11) on day (D) 2, D3 or D4 and D7. Further
details of the study methods have been published elsewhere.
The study was reported to the Regional Ethics Committee of
Copenhagen (H-15010935), and approved by the Data Protection
Agency. Questions and possible response options that addressed
the self-reported severity of allergic nickel dermatitis and consu-
mer behaviour regarding purchase and use of metallic items are
shown in Table SI 1 . The visual analogue scale (VAS) (range: 0–10)
was used for questions regarding the severity of dermatitis and the
difficulty of avoiding nickel. Statistical analyses for dichotomous
variables were performed with the χ 2 test. Age-adjusted patch-test
reactivity in groups was tested by logistic regression analysis. We
tested whether self-reported current severity of allergic nickel
dermatitis differed between those who reported that they had tried
to avoid nickel by specific actions and those who had not by Mann-
Whitney test. Age-grouping was performed according to their age
when responding to the questionnaire: < 40 vs. ≥ 40 years. The
level of significance was set at p < 0.05. Statistical analyses were
performed with SAS, Version 9.4 for Windows (SAS Institute Inc.,
Cary, NC, USA) and graphs with GRAPHPAD PRISM version
6.07 for Windows (GraphPad Software, La Jolla, CA, USA).
METHODS
firmative response to the question: “Have you ever had
dermatitis after skin contact with shiny metallic items
such as earrings or ear studs, watches, buttons or metallic
fastenings?” Patient characteristics, shown in Table SII 1 , are
further described elsewhere (12). This population differed
from that of the previous, due to missing values in 2 patients.
Of these 292 patients, 205 (70.7%) stated that they
always tried to avoid metallic it ems to which they were
allergic, and significantly more of these patients were
aged ≥ 40 years (p = 0.03). There were no differences in
the age-adjusted patch-test reactivity between those who
reported always avoiding metallic items compared with
those who stated “not to”, or “not always to” avoid metal-
lic items. On a VAS scale, 167 (58.6%) patients reported
that it was easy to avoid nickel (VAS: 0–3), 66 (23.2%)
moderately difficult (VAS: 4–7) and 52 (18.2%) reported
that it was difficult (VAS: 8–10). There was no evidence
that age affected the difficulty of avoiding metallic items
(p = 0.125). Patients were asked whether they had ever
taken specific actions to avoid nickel in everyday life
(Fig. 1). They reported that: “they had asked the clerk if
a product they wanted to buy contained nickel” (81.7%),
“they had searched for products labelled ‘nickel free’”
(78.6%), “they had used a nickel test set” (42.4%) and
that “they had avoided food containing nickel” (34.0%).
Patients aged ≥ 40 years were more prone than younger
patients to have asked the clerk (p = 0.01).
European Union (EU) regulation regarding the release of
nickel from some metallic items intended for prolonged
contact with the skin have been in place since 2000. De-
spite these regulations, studies from some EU countries
have repeatedly demonstrated high levels of nickel release
from metallic items covered by the EU Directive (1–10).
In Denmark, Sweden and the Netherlands, such items were
frequently found in street markets, but not commonly in
chain stores (6–8). However, it is not known whether the
high proportion of nickel-releasing items found in these
studies is a problem for people with nickel allergy, and
whether these people take prophylactic action to avoid
nickel in everyday living. This paper describes self-
reported consumer behaviour regarding metallic items and
the severity of allergic nickel dermatitis in nickel-allergic
patients from a Danish tertiary dermatology clinic.
SHORT COMMUNICATION
doi: 10.2340/00015555-2751
Acta Derm Venereol 2017; 97: 1247–1248