{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:05:20Z","timestamp":1787504720870,"version":"build-2736575974"},"reference-count":90,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:p>Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics).<\/jats:p>\n                  <jats:p>To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population.<\/jats:p>\n                  <jats:p>This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high\u2013nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel-avoidance strategies on both individual and global levels.<\/jats:p>","DOI":"10.1542\/peds.2020-0628","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T12:53:39Z","timestamp":1587992019000},"source":"Crossref","is-referenced-by-count":54,"title":["Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention"],"prefix":"10.1542","volume":"145","author":[{"given":"Nanette B.","family":"Silverberg","sequence":"first","affiliation":[{"name":"Departments of Dermatology and Pediatrics, Mt Sinai Hospital and Icahn School of Medicine at Mt Sinai, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice L.","family":"Pelletier","sequence":"additional","affiliation":[{"name":"Northern Light Health, Bangor, Maine;"},{"name":"College of Medicine, University of New England, Biddeford, Maine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E.","family":"Jacob","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Loma Linda University, Loma Linda, California;"},{"name":"Departments of Medicine and Pediatrics, University of California, Riverside, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda C.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SECTION ON DERMATOLOGY, SECTION ON ALLERGY AND IMMUNOLOGY","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Horii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Kristal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheilagh M.","family":"Maguiness","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha Mathakia","family":"Tollefson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam G.","family":"Weinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa S.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert C.","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Matsui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Bird","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla McGuire","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian Pilar","family":"Hernandez-Trujillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan S.","family":"Orange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pistiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,5,1]]},"reference":[{"issue":"1","key":"2021121013093442100_B1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.2310\/6620.2008.06062","article-title":"Detection of nickel sensitivity has increased in North American patch-test patients","volume":"19","author":"Rietschel","year":"2008","journal-title":"Dermatitis"},{"issue":"6","key":"2021121013093442100_B2","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.jaad.2008.11.893","article-title":"Nickel allergy in the United States: a public health issue in need of a \u201cnickel directive\u201d","volume":"60","author":"Jacob","year":"2009","journal-title":"J Am Acad Dermatol"},{"key":"2021121013093442100_B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1600-0536.2011.01957.x","article-title":"Nickel and cobalt allergy before and after nickel regulation\u2013evaluation of a public health intervention","volume":"65","author":"Thyssen","year":"2011","journal-title":"Contact Dermatitis"},{"issue":"3","key":"2021121013093442100_B4","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.clindermatol.2014.12.008","article-title":"Nickel contact dermatitis in children","volume":"33","author":"Tuchman","year":"2015","journal-title":"Clin Dermatol"},{"issue":"5","key":"2021121013093442100_B5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.2310\/6620.2009.08118","article-title":"Contact sensitization by age group in adults: patch-test data from the Massachusetts General Hospital, 1996 to 2006","volume":"20","author":"Landeck","year":"2009","journal-title":"Dermatitis"},{"issue":"6","key":"2021121013093442100_B6","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.clindermatol.2015.09.003","article-title":"Allergic contact dermatitis: kids are not just little people","volume":"33","author":"Brod","year":"2015","journal-title":"Clin Dermatol"},{"key":"2021121013093442100_B7","unstructured":"Nickel Institute. 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