Flare-up of dermatitis following patch testing is more common in polysensitized patients

Background: To estimate the prevalence of nickel allergy, self‐reports are sometimes used in epidemiological studies. Self‐reports are practical and may facilitate estimation of prevalence provided that the questions are validated. Objectives: To investigate the validity of self‐reported nickel allergy. Methods: Three hundred and sixty‐nine women, aged 30–40 years, from the general population participated in the study. The participants answered a questionnaire before a clinical examination and patch testing. The two questions being validated were ‘Are you sensitive/hypersensitive/allergic to nickel?’ and ‘Do you get a rash from metal buttons, jewellery or other metal items that come in direct contact with your skin?’ Results: Patch test showed nickel‐positive reaction in 30% of the subjects. Self‐reported prevalence of nickel allergy as indicated by the two respective questions was 40% and 35%. Positive predictive values for the two questions were 59% (95% CI 50–67) and 60% (95% CI 51–69). History of childhood eczema was over‐represented among women with ‘false‐positive’ self‐reported nickel allergy (P = 0.008). Self‐reported hand eczema or ‘high wet exposure’ did not influence the validity. Conclusions: The validity of self‐reported nickel allergy is low. The questions regarding nickel allergy overestimate the true prevalence of nickel allergy.