Premium
Assessing the validity of self‐reported history of rash caused by metal or jewellery
Author(s) -
Ko Lauren N.,
Kroshinsky Daniela,
Schalock Peter C.
Publication year - 2018
Publication title -
contact dermatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.524
H-Index - 96
eISSN - 1600-0536
pISSN - 0105-1873
DOI - 10.1111/cod.12928
Subject(s) - medicine , rash , patch testing , dermatology , predictive value , allergy , contact allergy , patch test , contact dermatitis , allergic contact dermatitis , skin reaction , nickel allergy , surgery , immunology
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.