European Journal of Dermatology

, Volume 28, Issue 5, pp 668–676 | Cite as

Variation and covariation in patch test reactivity to palladium and nickel salts

  • Lisbeth Rosholm Comstedt
  • Malin Engfeldt
  • Cecilia Svedman
  • Anna Åkesson
  • Monica Hindsén
  • Magnus Bruze
Clinical report



Concomitant reactions to palladium chloride (PdCl2), sodium tetrachloropalladate (Na2PdCl4), and nickel hexahydrate sulphate (NiSO4·6H2O) are very common during patch testing and have mainly been explained by cross-sensitisation. Whether there is variation in reactivity to palladium or covariation to nickel and palladium is not known.


The aim of this study was to investigate the variation in patch test reactivity to PdCl2 and Na2PdCl4 over time and compare this to variation in patch test reactivity to NiSO4·6H2O.

Materials & methods

Fifteen females known to be sensitised to nickel and palladium were patch tested four times with 12-week intervals using a dilution series of NiSO4·6H2O, PdCl2 or Na2PdCl4.


Patch test reactivity to Na2PdCl4 was less variable compared to that for NiSO4·6H2O or PdCl2. All test salts showed higher patch test reactivity during wintertime. No significant correlation was observed between the variation in patch test reactivity to Na2PdCl4 and PdCl2 and the variation in patch test reactivity to NiSO4·6H2O during the entire test period.


Patch test reactivity to Na2PdCl4 is less variable over time compared to that for PdCl2 or NiSO4·6H2O. No clear covariation was identified between tests for palladium salts and NiSO4·6H2O. The variation in patch test reactivity found in this study could be due to seasonal changes.

Key words

contact allergy delayed hypersensitivity equimolar falsenegative metal salts seasonal influence 


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  1. 1.
    Muris J, Goossens A, Goncalo M, et al. Sensitization to palladium in Europe. Contact Dermatitis 2015; 72: 11–9.CrossRefGoogle Scholar
  2. 2.
    Finch TM, Prais L, Foulds IS. Palladium allergy in a British patch test clinic population. Contact Dermatitis 1999; 41: 351–2.CrossRefGoogle Scholar
  3. 3.
    van Joost T, Roesyanto–Mahadi ID. Combined sensitization to palladium and nickel. Contact Dermatitis 1990; 22: 227–8.CrossRefGoogle Scholar
  4. 4.
    Faurschou A, Menne T, Johansen JD, Thyssen JP. Metal allergen of the 21st century–a review on exposure, epidemiology and clinical manifestations of palladium allergy. Contact Dermatitis 2011; 64: 185–95.CrossRefGoogle Scholar
  5. 5.
    Wahlberg JE, Boman AS. Cross–reactivity to palladium and nickel studied in the guinea pig. Acta Derm Venereol 1992; 72: 95–7.Google Scholar
  6. 6.
    Hindsén M, Spiren A, Bruze M. Cross–reactivity between nickel and palladium demonstrated by systemic administration of nickel. Contact Dermatitis 2005; 53: 2–8.CrossRefGoogle Scholar
  7. 7.
    Pistoor FH, Kapsenberg ML, Bos JD, Meinardi MM, von Blomberg ME, Scheper RJ. Cross–reactivity of human nickel–reactive T–lymphocyte clones with copper and palladium. J Invest Dermatol 1995; 105: 92–5.CrossRefGoogle Scholar
  8. 8.
    Moulon C, Vollmer J, Weltzien HU. Characterization of processing requirements and metal cross–reactivities in T cell clones from patients with allergic contact dermatitis to nickel. Eur J Immunol 1995; 25: 3308–15.CrossRefGoogle Scholar
  9. 9.
    Bordignon V, Palamara F, Cordiali–Fei P, et al. Nickel, palladium and rhodium induced IFN–gamma and IL–10 production as assessed by in vitro ELISpot–analysis in contact dermatitis patients. BMC Immunol 2008; 9: 19.CrossRefGoogle Scholar
  10. 10.
    Muris J, Kleverlaan CJ, Feilzer AJ, Rustemeyer T. Sodium tetrachloropalladate (Na2[PdCl4]) as an improved test salt for palladium allergy patch testing. Contact Dermatitis 2008; 58: 42–6.CrossRefGoogle Scholar
  11. 11.
    Hindsén M, Bruze M, Christensen OB. Individual variation in nickel patch test reactivity. Am J Contact Dermat 1999; 10: 62–7.CrossRefGoogle Scholar
  12. 12.
    Masjedi K, Bruze M, Hindsén M, Minang J, Ahlborg N. Is the variability of nickel patch test reactivity over time associated with fluctuations in the systemic T–cell reactivity to nickel? Br J Dermatol 2009; 161: 102–9.CrossRefGoogle Scholar
  13. 13.
    Tillman C, Engfeldt M, Hindsén M, Bruze M. Usage test with palladium–coated earrings in patients with contact allergy to palladium and nickel. Contact Dermatitis 2013; 69: 288–95.Google Scholar
  14. 14.
    Engfeldt M, Tillman C, Hindsén M, Bruze M. Variability in patch test reactivity over time, falsely indicating patch test sensitization, in a patient tested with palladium salts. Contact Dermatitis 2012; 67: 109–11.CrossRefGoogle Scholar
  15. 15.
    Bruze M, Isaksson M, Gruvberger B, Frick–Engfeldt M. Recommendation of appropriate amounts of petrolatum preparation to be applied at patch testing. Contact Dermatitis 2007; 56: 281–5.CrossRefGoogle Scholar
  16. 16.
    Johansen JD, Aalto–Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing–recommendations on best practice. Contact Dermatitis 2015; 73: 195–221.CrossRefGoogle Scholar
  17. 17.
    Fregert S. Manual of contact dermatitis, 2nd ed. Copenhagen: Munksgaard, 1981.Google Scholar
  18. 18.
    Bruze M, Frick–Engfeldt M, Gruvberger B, Isaksson M. Variation in the amount of petrolatum preparation applied at patch testing. Contact Dermatitis 2007; 56: 38–42.CrossRefGoogle Scholar
  19. 19.
    van Strien GA, Korstanje MJ. Site variations in patch test responses on the back. Contact Dermatitis 1994; 31: 95–6.CrossRefGoogle Scholar
  20. 20.
    Kranke B, Aberer W. Seasonal influence on patch test results in central Europe. Contact Dermatitis 1996; 34: 215–6.CrossRefGoogle Scholar
  21. 21.
    Agner T, Serup J. Seasonal variation of skin resistance to irritants. Br J Dermatol 1989; 121: 323–8.CrossRefGoogle Scholar
  22. 22.
    Proksch E, Brasch J. Influence of epidermal permeability barrier disruption and Langerhans’ cell density on allergic contact dermatitis. Acta Derm Venereol 1997; 77: 102–4.Google Scholar
  23. 23.
    Uter W, Geier J, Land M, Pfahlberg A, Gefeller O, Schnuch A. Another look at seasonal variation in patch test results. A multifactorial analysis of surveillance data of the IVDK. Information Network of Departments of Dermatology. Contact Dermatitis 2001; 44: 146–52.Google Scholar
  24. 24.
    Agner T, Damm P, Skouby SO. Menstrual cycle and skin reactivity. J Am Acad Dermatol 1991; 24: 566–70.CrossRefGoogle Scholar
  25. 25.
    Bonamonte D, Foti C, Antelmi AR, et al. Nickel contact allergy and menstrual cycle. Contact Dermatitis 2005; 52: 309–13.CrossRefGoogle Scholar
  26. 26.
    Rohold AE, Halkier–Sorensen L, Andersen KE, Thestrup–Pedersen K. Nickel patch test reactivity and the menstrual cycle. Acta Derm Venereol 1994; 74: 383–5.Google Scholar
  27. 27.
    Hindsén M, Bruze M, Christensen OB. Flare–up reactions after oral challenge with nickel in relation to challenge dose and intensity and time of previous patch test reactions. J Am Acad Dermatol 2001; 44: 616–23.CrossRefGoogle Scholar
  28. 28.
    Larsen EH, Andersen NL, Moller A, Petersen A, Mortensen GK, Petersen J. Monitoring the content and intake of trace elements from food in Denmark. Food Addit Contam 2002; 19: 33–46.CrossRefGoogle Scholar
  29. 29.
    Kielhorn J, Melber C, Keller D, Mangelsdorf I. Palladium–a review of exposure and effects to human health. Int J Hyg Environ Health 2002; 205: 417–32.CrossRefGoogle Scholar

Copyright information

© John Libbey Eurotext 2018

Authors and Affiliations

  • Lisbeth Rosholm Comstedt
    • 1
  • Malin Engfeldt
    • 1
  • Cecilia Svedman
    • 1
  • Anna Åkesson
    • 2
  • Monica Hindsén
    • 1
  • Magnus Bruze
    • 1
  1. 1.Department of Occupational and Environmental DermatologyLund University, Skåne University HospitalMalmöSweden
  2. 2.Clinical Studies Sweden – Forum SouthSkåne University HospitalLundSweden

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