title: Body piercing and metal allergic contact sensitivity: North American contact dermatitis group data from 2007 to 2010.
abstract: OBJECTIVE
  This study aimed to examine the association between piercing and patch test sensitivity to metals (nickel, cobalt, and chromium) in North America.
  
  
  METHODS
  A retrospective analysis of 9334 patients tested by the North American Contact Dermatitis Group from 2007 to 2010 was conducted.
  
  
  RESULTS
  Nickel sensitivity was statistically associated with at least 1 piercing (risk ratio [RR], 2.52; 95% confidence interval [CI], 2.26-2.81; P < 0.0001) and nickel sensitivity rates increased with the number of piercings (16% for 1 piercing to 32% for ≥ 5 piercings). Prevalence of nickel sensitivity was higher in females (23.2%) than in males (7.1%), but the association with piercing was stronger in males (RR, 2.38; 95% CI, 1.72-3.30; P < 0.0001) than in females (RR, 1.30; CI, 1.13-1.49; P = 0.0002). Crude analysis indicated that cobalt sensitivity was statistically associated with piercing (RR, 1.63; 95% CI, 1.40-1.91; P < 0.0001); however, stratified analysis showed that this relationship was confounded by nickel. After adjusting for nickel sensitivity, the adjusted risk ratio for piercing and cobalt was 0.78 (not significant). Chromium sensitivity was negatively associated with piercing (RR, 0.60; 95% CI, 0.48-0.75; P < 0.0001).
  
  
  CONCLUSIONS
  Piercing was statistically associated with sensitivity to nickel. This relationship was dose dependent and stronger in males. Cobalt sensitivity was not associated with piercing when adjusted for nickel. Chromium sensitivity was negatively associated with piercing.
authors.affiliation: From the *Department of Dermatology, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN; †Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; ‡Department of Dermatology, Columbia University, New York, NY; §Dartmouth-Hitchcock Medical Center, Lebanon, NH; ∥Department of Dermatology, University of California, San Francisco, San Francisco, CA; ¶Department of Dermatology, Cleveland Clinic, Cleveland, OH; #Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; **University of Louisville, Louisville, KY; ††Department of Dermatology, University of Cincinnati, Cincinnati, OH; ‡‡Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada; §§Department of Dermatology, Pennsylvania State University, Hershey, PA; ∥∥Associates in Dermatology, Fort Myers, FL.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Kingsley-Loso
authors.forename: Joel G
authors.initials: JG
authors.lastname: DeKoven
authors.forename: Donald V
authors.initials: DV
authors.lastname: Belsito
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Zug
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Zirwas
authors.forename: Howard I
authors.initials: HI
authors.lastname: Maibach
authors.forename: James S
authors.initials: JS
authors.lastname: Taylor
authors.forename: Denis
authors.initials: D
authors.lastname: Sasseville
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fowler
authors.forename: Charles Gordon Toby
authors.initials: CG
authors.lastname: Mathias
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeLeo
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Pratt
authors.forename: James G
authors.initials: JG
authors.lastname: Marks
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Fransway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046288:Body Piercing / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002857:Chromium / Q000009:adverse effects*; D003035:Cobalt / Q000009:adverse effects*; D016208:Databases, Factual; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects*; D009656:North America / Q000453:epidemiology; D010328:Patch Tests; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt; D009532:Nickel