Medical and toxicological aspects of occupational nickel exposure in the Federal Republic of Germany--clinical results (carcinogenicity, sensitization) and preventive measures (biological monitoring).

In recent years reports on nickel-related diseases in the Federal Republic of Germany have been increasingly frequent. As a result, medical scientific institutions were called upon to clarify both the occupational medical and clinical, as well as the toxicological aspects of the situation. The main clinical finding was the increased incidence of malignant neoplasias in the respiratory tracts, in particular after many years of nickel exposure in refineries. Between 1967 and 1981, seven malignant neoplasms were legally recognized as occupation-related. Additionally, in the last two years, the existence of nickel-induced malignant neoplasms has been suspected in 16 cases, and the statutory procedure for the recognition of occupational diseases instituted. Our overview presents occupational-medical and clinical aspects. Among allergic nickel-induced conditions, eczematous skin diseases predominate. In addition, case reports of asthma have been published. Statistical evaluations showed that up to 17% of all occupational allergies may be related to occupational exposure to nickel. In this situation, preventive measure are of particular importance. To estimate exposure levels, both the measurement of the agent at the workplace and the quantitative determination of nickel in biological material can be used. The measurement of nickel excretion by the kidney has proved particularly useful in occupational medicine. In addition to clinical surveillance, it is recommended that this measurement should be performed on exposed persons at regular intervals.