what is systemic nickel allergy?

Nickel is the most common metal allergen in the world. It is used in manufacturing (particularly in stainless steel) and the formation of everyday items such as jewelry, electronics, cookware, and personal care items. It also exists in the water and soil in varying amounts, (it is particularly high in volcanic soil), so it can be taken up by plants, making its way into our bodies through digestion of food or inhalation of plants and toxins like when smoking cigarettes. (1,2) It can also be found in medical implants and dental fillings. (1)

The above are all potential “routes” for nickel to interact with your immune system and cause a “hypersensitivity” to develop. This sensitivity is most common in women, and prevalence has been on the rise in North America, from 14.5% in 1992 to 18.8% in 2004. (3) 

SYSTEMIC NICKEL ALLERGY

Symptoms of: Dyshidrotic Eczema, IBS, Endometriosis, & More

How Does This Allergy Manifest?

Nickel Contact Dermatitis: Skin (cutaneous) reaction at the site of nickel contact.

  • Symptoms: dermatitis, itchiness, eczema where contact was made.

  • Prevalence: It is estimated that up to 19.5% of adults and 25.6% of children have nickel contact dermatitis with 5.7% to be asymptomatic. (4)

Systemic Contact Dermatitis (SCD) or Systemic Nickel Allergy (SNA): Cutaneous reaction due to ingested or implanted nickel.

  • Symptoms: dermatitis, eczema, urticaria, psoriasis occurring commonly on the hands and elbows, and sometimes on the feet, face, and around the mouth.

  • Prevalence: Potentially half nickel-allergic patients experience cutaneous symptoms in places other than nickel contact after taking an oral dose of nickel. (2)

Systemic Nickel Allergy Syndrome (SNAS): Cutaneous and/or extra-cutaneous symptoms due to ingested nickel. The existence and specifics of this syndrome is under debate due to the complexity of identifying causes and effects of the extracutaneous symptoms.

  • Symptoms: The same as systemic nickel allergy plus additional symptoms which include but are not limited to: Irritable Bowel Syndrome (IBS)5,6, chronic fatigue, obesity, endometriosis, GERD, heartburn, nausea, vomiting, asthma, headache, thyroid conditions, burning mouth syndrome, and fibromyalgia. (6-13)

  • Prevalence: 20-30% of Nickel Contact Dermatitis patients. (13)

Common comorbidities: IBS, Celiacs disease, gluten sensitivity, obesity, and metabolic syndrome (1,13-18)

How Does It Develop?

How Does This Allergy Develop?

Though the exact mechanism for each of the above conditions is incredibly complicated and not fully understood, a very simplified version of what happens is that your immune system, which is always looking to eliminate any foreign invaders, is wrongly informed that nickel is something to fear. Wanting to be as effective as possible in fighting off this villain, it builds lots of immune cells whose sole purpose is to find nickel and attack it. This attack can kick off processes meant to help protect your body that unfortunately lead to a variety of uncomfortable symptoms like itchiness, redness, eczema, etc. 

However, research has shown that each nickel-sensitive individual has their own nickel threshold, meaning that if you stay below it, you can potentially avoid those troublesome symptoms. The standard recommendation based on experimental data is to keep your nickel intake below 150 mg a day. (4,19-22)

Therefore, reducing the amount of nickel you contact and consume reduces the amount of nickel you present to your immune system, which reduces symptoms. It may even be possible to lower the number of cells running around looking for nickel, too. The body is always trying to conserve energy, so it is possible for some people that the less nickel that is found by their immune system over time, the more likely it will reduce the production of cells to fight it. This may create a situation where eventually your body becomes less sensitive to nickel, and you can start eating higher-nickel foods without the trouble you had before.

 References

1.         GF CD, Bonamonte. Nickel Hypersensitivity: A General Review on Clinical Aspects and Potential Co-Morbidities. Journal of allergy & therapy. 2016;7(5)doi:10.4172/2155-6121.1000243

2.         Veien N, Menné T. Nickel contact allergy and a nickel-restricted diet. 1990:197-205.

3.         Rietschel RL, Fowler JF, Warshaw EM, et al. Detection of nickel sensitivity has increased in North American patch-test patients. Dermatitis®. 2008;19(1):16-19.

4.         Bergman D, Goldenberg A, Rundle C, Jacob S. Low nickel diet: a patient-centered review. J Clin Exp Dermatol Res. 2016;7(355):2.

5.         Borghini R, Donato G, Alvaro D, Picarelli A. New insights in IBS-like disorders: Pandora's box has been opened; a review. Gastroenterology and Hepatology from bed to bench. 2017;10(2):79.

6.         Rizzi A, Nucera E, Laterza L, et al. Irritable bowel syndrome and nickel allergy: what is the role of the low nickel diet? Journal of Neurogastroenterology and Motility. 2017;23(1):101.

7.         Borghini R, Simoncelli M, Marino M, Casale R, Porpora M, Picarelli A. P. 10.15 RELATIONSHIP BETWEEN NICKEL ALLERGIC CONTACT MUCOSITIS AND NICKEL-RICH DIET IN SYMPTOMATIC WOMEN SUFFERING FROM ENDOMETRIOSIS. Digestive and Liver Disease. 2018;50(2):e234.

8.         Braga M, Quecchia C, Perotta C, et al. Systemic nickel allergy syndrome: nosologic framework and usefulness of diet regimen for diagnosis. International Journal of Immunopathology and Pharmacology. 2013;26(3):707-716.

9.         Gelardi M, Guarino R, Taliente S, Quaranta N, Carpentieri A, Passalacqua G. Allergic and nonallergic rhinitis and skin sensitization to metals: is there a link. Eur Ann Allergy Clin Immunol. 2017;49(3):106-9.

10.       Limone BA, Jacob SE. Insights into the global effect of nickel dermatitis on polysensitization. Annals of Allergy, Asthma & Immunology. 2017;118(6):749.

11.       Takir M, Turkoglu O, Turkoglu Z. Thyroid hormone and ultrasonographical analyses in patients with nickel allergy. European Journal of Medicine and Oncology. 2017;1(3):145-148.

12.       Thyssen JP, Maibach HI. Drug‐elicited systemic allergic (contact) dermatitis–update and possible pathomechanisms. Contact Dermatitis. 2008;59(4):195-202.

13.       Di Gioacchino M RL, De Pità O, et al. Nickel oral hyposensitization in patients with systemic nickel allergy syndrome. Annals of Medicine. 2014;46:31-37.

14.       Lusi EA, Di Ciommo VM, Patrissi T, Guarascio P. High prevalence of nickel allergy in an overweight female population: a pilot observational analysis. PloS one. 2015;10(3):e0123265.

15.       Ahmed M, Gaffen SL. IL-17 in obesity and adipogenesis. Cytokine & growth factor reviews. 2010;21(6):449-453.

16.       Hofmann MA, Kiecker F, Zuberbier T. A systematic review of the role of interleukin-17 and the interleukin-20 family in inflammatory allergic skin diseases. Current Opinion in Allergy and Clinical Immunology. 2016;16(5):451-457.

17.       Regland B, Zachrisson O, Stejskal V, Gottfries CG. Nickel allergy is found in a majority of women with chronic fatigue syndrome and muscle pain—and may be triggered by cigarette smoke and dietary nickel intake. Journal of Chronic Fatigue Syndrome. 2001;8(1):57-65.

18.       D’Alcamo A, Mansueto P, Soresi M, et al. Contact dermatitis due to nickel allergy in patients suffering from non-celiac wheat sensitivity. Nutrients. 2017;9(2):103.

19.       Antico A, Soana R. Nickel sensitization and dietary nickel are a substantial cause of symptoms provocation in patients with chronic allergic-like dermatitis syndromes. Allergy & Rhinology. 2015;6(1):ar. 2015.6. 0109.

20.       Kaaber K, Veien N, Tjell JC. Low nickel diet in the treatment of patients with chronic nickel dermatitis. British Journal of Dermatology. 1978;98(2):197-201.

21.       Mislankar M, Zirwas MJ. Low-nickel diet scoring system for systemic nickel allergy. Dermatitis®. 2013;24(4):190-195.

22.       Da Mata Perez L FA, Zimmerman JR. Systemic nickel allergy syndrome. The World Allergy Organization Journal. 2015;8(Suppl 1)doi:10.1186/1939-4551-8-S1-A89