Assessing the validity of self‐reported history of rash caused by metal or jewellery. (27th November 2017)

• Record Type: Journal Article
• Authors: Ko, Lauren N.; Kroshinsky, Daniela; Schalock, Peter C.
• Is Part Of: Contact dermatitis. Volume 78:Number 3(2018)
• Page Start: 208
• Page End: 210
• Publication Date: 2017-11-27
• Subjects: chromium -- cobalt -- epidemiology -- jewellery -- metal allergy -- nickel; Contact dermatitis -- Periodicals; 616.51
• DOI: 10.1111/cod.12928
• Languages: English
• ISSNs: 0105-1873

Abstract

Summary: Background: The use of metal‐containing bio‐devices is becoming increasingly common. Self‐reported history of dermatitis with metal exposure is not established as being predictive for metal allergy. Objectives: To assess the validity of two screening questions addressing metal allergy. Methods: At Massachusetts General Hospital Contact Dermatitis Clinic, 2132 consecutive patients were asked either 'Do you get rashes when jewellery touches your skin' (Q1; N = 1816) or 'Do you get rashes when metal touches your skin?' (Q2; N = 316) before being patch tested. Results: Testing showed that 20% of subjects had positive reactions to nickel, 7.4% had positive reactions to cobalt, and 5.8% had positive reactions to chromium. Q1 was 40% sensitive (95%CI: 35–45%). The positive predictive value (PPV) was 51%, and the negative predictive value (NPV) was 82%. Q2 was 77% sensitive (95%CI: 68–84%). The PPV was 71%, and the NPV was 84%. Q2 was 37% more sensitive than Q1 ( p < 0.0001), with a higher relative risk (RR) (4.75, p < 0.001) than Q1 (RR = 3.01, p < 0.001). Conclusions: Patient‐reported metal allergy, although not perfect, is a reasonable method for metal allergy screening to help identify those needing further objective evaluation by patch testing.