An Investigation of Patients with a History of Nickel Allergy but Negative Epicutaneous Patch Tests

Abstract

Patients with a contact allergy to nickel are generally characterised by a good agreement between a history of nickel allergy and the results of epicutaneous patch testing. However, it is reported that 30%–50% of patients who give a positive history of nickel allergy are patch test negative [1–3]. It has been suggested that these patients have a higher than normal incidence of atopy. Moller and Svennson examined 19 such patients for atopic dermatitis, using a constructed score system which they had earlier devised [4], and considered 14 of them to be atopic [5]. Fischer and Rystedt looked at six patients who were nickel history positive but patch test negative and noted that they all had some kind of atopic background, although they did not state their diagnostic criteria for atopy [6]. In contrast, Kieffer found only 4 of 13 such patients to be atopic, using personal and family history as markers [1]. We therefore decided to study the relationship between nickel allergy history with negative patch tests and atopic status more closely.