Topical and Systemic Therapies for Nickel Allergy

Antonella Tammaro; Alessandra Narcisi; Severino Persechino; Cristiano Caperchi; Anthony Gaspari

Disclosures

Dermatitis. 2011;22(05):251-255. 

In This Article

Low-nickel Diet

Patients with diffuse manifestations can reduce clinical cutaneous and gastrointestinal symptoms by following a diet with a low nickel content. Nickel frequently contaminates food, and avoiding it is very difficult. The daily intake of this metal with food is about 300 mg, mainly from oatmeal, nuts, cocoa, chocolate, and soybeans.[16,17] In sensitized patients, nickel ingestion could cause a recurrence of chronic contact dermatitis but could also cause flare-ups of other dermopathies such as those triggered by immunoglobulin E (IgE)–mediated allergy (mainly urticaria). This evidence suggests that nickel allergy may be not only mediated by type I and type IV Gell and Coombs reactions. Activation of T cells by nickel may result in a mixed immune response with only a quantitative difference, potentially causing both IgE antibody production (from type 1 helper T cells) and the development of ACD (from type 2 helper T cells).[7]

The normal daily dietary intake of nickel ranges from 0.02 to 0.48 mg. Many studies have demonstrated the relationship between nickel ingestion and dermatitis flareups. Meta-analysis results of all studies have generally been confirmed.[7] In 2006, Jensen and colleagues reported the results of a meta-analysis of these studies performed to determine the median values of nickel that could elicit allergic reactions. It has been demonstrated that nickel sulfate may provoke chronic eczema when orally administered in the range of 0.6 to 5.6 mg daily as a single dose, and there is much evidence of this relationship (eg, flareup of eczema upon dietary oral nickel challenge, improvement of eczema after starting a low-nickel diet, and management with oral disulfiram or hyposensitization therapy with low-nickel doses).[17]

In 2010, Minelli and colleagues performed a clinical study to determine whether the oral administration of lownickel doses improved clinical conditions and modulated the immunologic aspects of SNAS without significant side effects. By evaluations before and after treatment, they showed that nickel sulphate is effective in reducing symptoms and drug consumption in these patients and is able to modulate inflammatory parameters such as interleukin-1, interleukin-5, and interferon-c released by peripheral blood mononuclear cells.[18]

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