*********************Allergen of the Millenium**********************
 
As my fond farewell to this ill-conceived treatise, I am awarding an allergen
whose track record speaks for itself. In lacking the typical multi-syllabic
nomenclature, it comes innocently enough. Not an arcane chemical revealed only
to the pantheon of contact allergists, but our familiar childhood friend,
traded in simpler times for gumdrops and lemonade...
 
Our Most Venerated Text of Skin Allergy advises the following rather terse
interaction with the afflicted: "You are allergic to nickel and will probably
remain so indefinitely." What other allergen has a marketed detection assay
(Dimethylglyoxime test) and a systemic medication (disulfiram)? Or another
that flogs 16% of the North American population? Whose victims are almost
comically armed with cellophane tape and nail polish, a sort of band-aid
defense against this ubiquitous evil--suffering wrists and belly buttons and
earlobes (and coronaries? see below) And, of course, add it to the list of
afflictions our beloved hair dresser must agonize.
 
Plainly man and metal, once fast allies, can now only suffer a co-existence;
two Life-Forces immiscible. And to what further commentary does this allergen
lend itself? (None I am certain) That Trade & Industry can itch like hell? 
That whatever precious ores we rob from Mother Earth would best be
returned--lest we inherit the wage of our forefathers’ Faustian bargain? That
our processes lead nowhere, the sting of the metal our remembrance of deistic
abandonment? Are we allergic to the very underpinnings upon which we
stand--Willful inhabitants of Pandemonium?
 
Many of these questions are, of course, impenetrable. It is certainly advisable 
to file this away as rubbish, and proceed with ordering preprinted clobetasol scripts. 
Nickel will likely send at least one of our children through college. And who 
knows?--perhaps this child will enroll in a college of medicine, aspire to the skin, 
and in mad iconoclastic brilliance finally unravel this great cosmic mystery. 
It is my simple hope.
 
REFERENCES:
Koster R et al. Nickel and molybdenum contact allergies in patients with
coronary in-stent restenosis. Lancet. 2000 Dec 2;356(9245):1895-7
 
Fisher’s p 648 
 
Holm JO et al. An epidemiological study of hand eczema. V. Prevalence among
hairdresser trainees, compared with a general population of hairdressers. Acta
Derm Venereol Suppl (Stockh). 1994;187:23-5
 
Marks et al. North American Contact Dermatitis Group patch-test results, 1998
to 2000.
Am J Contact Dermat. 2003 Jun;14(2):59-62.
 
 
Andrew Shors MD MPH
Div of Dermatology
UWMC