Could you have a metal allergy?

administrator

Just found this fantastic article about metal allergies. It's a very good and informative read.

https://music.byu.edu/students/trumpet-professor-helps-student-identify-metal-allergy/

Vulgano Brother

The Fourth Horn in our symphony was allergic (he found) to both silver and gold. Derlin proved to be the rim material that worked.

Newell Post

Wow. Nickel allergy is somewhat common, but I had never heard of anyone with silver or gold allergy.

tmd

Of the 3, nickel allergies are the most common (around 5% of people), followed by gold (about 1%), and then silver (less than 1%).

The numbers have to be taken in context, since they are often collected from people undergoing allergy testing (meaning, they already have a history of hypersensitivity reactions). So the numbers may be overstated, when compared to the general population.

Also, the allergy may be to the metal in question, or to other added metals used to make a particular alloy.

Mike

Richard III

Quote from several sources:

Nickel allergy signs and symptoms include:

Rash or bumps on the skin
Itching, which may be severe
Redness or changes in skin color
Dry patches of skin that may resemble a burn
Blisters and draining fluid in severe cases

The same sources say that it takes up to 72 hours for symptoms to appear.

I can't seem to find any reference that indicates the instant reaction that has been described when sensitive to a mouthpiece metal. Can anyone point me to that? Further I can't find any reference to pain or other neurological reaction that has been described. I'm curious about the mechanism of this. Thanks.

Dr GO

I have seen this in my practice related more to body piercing and ear rings. The symptoms (as noted above) of chronic exposure (when wearing the metal) are even more impressive. Eliminating the contact is the obvious treatment, and I found substituting the metal (or moving to a higher quality product not including Ni) is still an alternative such that jewelry may still be used.

I try to avoid use of steroid in cartilaginous areas (such as the ear) but in non-cartilaginous areas a steroid cream can be used to heal the blisters faster for the metal change to then be made. For the ear, I find just using mineral oil will help as well without risk of damaging cartilage.

So for most trumpet players that will heal the rash, a topical steroid would work... but if you play by ear... maybe not?

Dr GO

@Richard-III said in Could you have a metal allergy?:
I can't seem to find any reference that indicates the instant reaction that has been described when sensitive to a mouthpiece metal. Can anyone point me to that? Further I can't find any reference to pain or other neurological reaction that has been described. I'm curious about the mechanism of this. Thanks.

Nickle allergy is a "contact dermatitis" and can sometimes appear and confused for poison ivy. This therefore requires a repeat exposure, then sensitization of the immune response. Once sensitization is processed, then the rash goes from gradual to very rapid response.

Richard III

The article linked by the OP in this thread contained this quote:

“I would feel this tingling or stinging when I put the metal mouthpiece up to my face, but I played through it because it always felt like that. It was really during the last two years when I started to feel serious pain, where it hurt to play or even touch my face after I’d been playing.”

Doesn't sound like contact dermatitis to me. I get what a metal allergy is. I have it. A watch or ring worn continuously for weeks will eventually give me a rash. Titanium or surgical steel does not do that. So when I hear players say they are allergic to metal and the symptoms are not rashes or other skin lesions, but actual pain, I'm curious as to the mechanism. I should also point out that no mouthpiece has every given me an issue.

flugelgirl

I have a nickel allergy and maybe more than that - I don’t have any trouble with silver or gold, but have reactions to raw brass. When playing raw brass horns, my hands will smell and develop an itchy rash. It usually takes prolonged contact, but helps if I use a valve guard with extra coverage for practice or gloves for prolonged dent work. I have noticed that I have less of a reaction if I keep patina from developing, which seems strange, but it works so I polish. With jewelry I stick to gold, silver, stainless or titanium. I can wear stainless in my bottom earrings but have fewer reactions if I use titanium in my cartilage piercings.
I’ve know people with mouthpiece allergies, some of which have given up playing because of severe pain. Trent Austin developed his acrylic tops to help with his allergies - maybe he will chime in.

flugelgirl

BTW if I wear earrings with nickel, instant pain, swelling, and puss-filled infections. Gross!

administrator

I would reach out to Dr. Bergman with any questions you might have. He is a personal friend of mine, a fine trumpeter and our next ITG President. I trust his word.

Dr GO

@Richard-III said in Could you have a metal allergy?:

The article linked by the OP in this thread contained this quote:

“I would feel this tingling or stinging when I put the metal mouthpiece up to my face, but I played through it because it always felt like that. It was really during the last two years when I started to feel serious pain, where it hurt to play or even touch my face after I’d been playing.”

Doesn't sound like contact dermatitis to me.

Oh but it does. Tingling, stinging initially leading to serious pain in two years. Here are the symptoms of of contact dermititis as referenced by the Mayo Clinic:

Signs and symptoms of contact dermatitis include:
A red rash.
Itching, which may be severe.
Dry, cracked, scaly skin.
Bumps and blisters, sometimes with oozing and crusting.
Swelling, burning or tenderness.

https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742

From the same site:
*Allergic contact dermatitis occurs when a substance to which you're sensitive (allergen) triggers an immune reaction in your skin. It usually affects only the area that came into contact with the allergen. But it may be triggered by something that enters your body through foods, flavorings, medicine, or medical or dental procedures (systemic contact dermatitis).

You may become sensitized to a strong allergen such as poison ivy after a single exposure. Weaker allergens may require multiple exposures over several years to trigger an allergy. Once you develop an allergy to a substance, even a small amount of it can cause a reaction.*

Common allergens include:
Nickel, which is used in jewelry, buckles and many other items**

I stopped here because Nickel is at the TOP OF THE LIST.

Richard-III it is a contact dermatitis, caused by Nickel and it does present, especially chronically, like the individual in the post.

Dr GO

@Richard-III said in Could you have a metal allergy?:
You said: "A watch or ring worn continuously for weeks will eventually give me a rash."

This is because it takes hours to days to develop nickel contact dermatitis, as opposed to minutes to hours to develop a poison ivy contact dermatitis (as the plant's oils bring the allergen into the lipid layers of the skin much more quickly). So I am betting if you paste a nickle mouthpiece to your lips (disclaimer - I do not recommend this), you would likely develop this rash as well.

The lad in the post is a trumpet student, and I bet did spend hours a day on the horn, making him even more sensitive to developing a lip contact dermatitis to nickel.

Dr GO

@administrator said in Could you have a metal allergy?:

I would reach out to Dr. Bergman with any questions you might have. He is a personal friend of mine, a fine trumpeter and our next ITG President. I trust his word.

I am Board Certified in Internal Medicine, Pediatrics, was the President of the Medicine-Pediatrics Residency Association, have a National Teaching Award named after me (The Gary Onady Award) published Evidence-based Systematic Reviews on allergy reactions AND am a member of the American Federation of Musicians (very proud of that one). So what am I, chopped liver?

I see and have personally cared for and treated nickel allergies (more related to jewelry) for over 30 years in my medical practice. The case you posted is a clear presentation of long duration, repeat exposure to nickel which is commonly seen in a medical practice. So any individual can additionally reach out to me through this thread, as a member of TrumpetBoards. But I ask you to judge for yourselves if you feel my above discussions are on point.

Please do read our disclaimer. I do ask that you first reach out personally to your own physician and then have that physician contact me if they have additional questions. I will provide the background and medical recommendations that physicians' will need. I serve as a consultant to United Healthcare and the American College of Physicians to produce such educational materials for physicians and patients.

Richard III

Thanks for all the info.

Dr GO

@Richard-III said in Could you have a metal allergy?:

Thanks for all the info.

Richard-III you are so welcome. Hope all does work out for your current mouthpiece. If you do notice any of the symptoms starting, one option is gold plating. Gold chops does this for $35. I think it would be worth the try as gold has a great feel and less of a chance of developing a contact dermatitis. Plastic mouthpieces would be an alternative.

administrator

@Dr-GO said in Could you have a metal allergy?:

@administrator said in Could you have a metal allergy?:

I would reach out to Dr. Bergman with any questions you might have. He is a personal friend of mine, a fine trumpeter and our next ITG President. I trust his word.

I am Board Certified in Internal Medicine, Pediatrics, was the President of the Medicine-Pediatrics Residency Association, have a National Teaching Award named after me (The Gary Onady Award) published Evidence-based Systematic Reviews on allergy reactions AND am a member of the American Federation of Musicians (very proud of that one). So what am I, chopped liver?

I see and have personally cared for and treated nickel allergies (more related to jewelry) for over 30 years in my medical practice. The case you posted is a clear presentation of long duration, repeat exposure to nickel which is commonly seen in a medical practice. So any individual can additionally reach out to me through this thread, as a member of TrumpetBoards. But I ask you to judge for yourselves if you feel my above discussions are on point.

Please do read our disclaimer. I do ask that you first reach out personally to your own physician and then have that physician contact me if they have additional questions. I will provide the background and medical recommendations that physicians' will need. I serve as a consultant to United Healthcare and the American College of Physicians to produce such educational materials for physicians and patients.

Didn't mean to discredit your credentials, only that I personally know Dr. Bergman and he's an empathetic and qualified trumpet pedagogue.

Richard III

@Dr-GO said in Could you have a metal allergy?:

@Richard-III said in Could you have a metal allergy?:

Thanks for all the info.

Richard-III you are so welcome. Hope all does work out for your current mouthpiece. If you do notice any of the symptoms starting, one option is gold plating. Gold chops does this for $35. I think it would be worth the try as gold has a great feel and less of a chance of developing a contact dermatitis. Plastic mouthpieces would be an alternative.

Thanks. I was just asking for others and out of curiosity. I've never had an issue or allergic reaction with any mouthpiece. I don't know why as I've had reactions to metal everywhere else on my body. I've also played really old mouthpieces that were quite worn and the plating very thin with no problems. And I'm talking about many hours a day, every day for years and no reaction. I also play on horns with the lacquer removed with no problems. True that wearing a ring or watch for 16 hours a day is not the same as playing 2-5 hours a day. Exposure level is obviously different. The people who are reactive must be extremely reactive. I would ask them if they have the same issues with rings, watches and piercings.