Epidemiology of Sensitivity to Nickel, Cobalt and Chromium in Israel: A Retrospective Cohort Study.

Background: Nickel, cobalt and chromium are three common allergens included in the European baseline series (EBS). It was shown that sensitivity to nickel and cobalt is more frequent among young women, most commonly due to contact with inexpensive jewellery, while sensitivity to chromium is more common among older men. Israel is located in West Asia and hosts the largest Jewish population in the world. There is limited data regarding the epidemiology of these metals in Israel or in the Mediterranean region.

Objective: To investigate the epidemiology of sensitivity to nickel, cobalt and chromium in the EBS in a single center in Israel between 2009 and 2023.

Methods: Retrospective cohort study that included all patients who underwent patch testing with the EBS in a tertiary center in Israel between 2009 and 2023.

Results: Of 5234 consecutive patients (1679 males [32.1%]) 2158 (41%) were sensitive to nickel, 541 (10.3%) to cobalt and 383 (7.3%) to chromium. During the study period, nickel sensitivity was stable and was associated with female sex and age 18-40 years. Among both sexes, cobalt sensitivity decreased significantly from 11.7% in 2009-2011 to 7.9% in 2020-2023 and was associated with female sex and age < 18 years. Chromium sensitivity decreased significantly from 11.1% in 2009-2011 to 5% in 2020-2023 and was associated with male sex and older age (> 60 years). Among both sexes, cobalt strongly co-reacted with nickel (OR = 1.69, 95% CI 1.38-2.06, p < 0.001) and chromium (OR = 3.57, 95% CI 2.67-4.55, p < 0.001). Nickel-cobalt co-sensitization was significantly more common among patients with strong (++) or very strong (+++) nickel sensitivity compared to patients with weak (+) sensitivity. Males, but not females, with nickel sensitivity positively co-reacted with chromium. Among patients with nickel sensitivity, the strong (++) or very strong (+++) reaction (36.3%) was significantly more common compared to patients with cobalt or chromium sensitivity.

Conclusion: In this retrospective Israeli study, the prevalence of sensitivity to nickel was stable but much higher compared to European and North American studies, highlighting the necessity for multicenter and general population studies and possibly a legislation regarding nickel restriction of items with prolonged contact with the skin. Cobalt and chromium sensitivities decreased and were in line with previous studies.