Blogs related to nickel allergic contact dermatitis

Nickel in Cocoa – speciation

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Food Chem. 2017 Sep 1;230:327-335. doi: 10.1016/j.foodchem.2017.03.050. Epub 2017 Mar 10.

Nickel speciation in cocoa infusions using monolithic chromatography – Post-column ID-ICP-MS and Q-TOF-MS.

Peeters K1, Zuliani T2, Žigon D3, Milačič R4, Ščančar J5.

Author information

Abstract

Nickel (Ni) is considered to be a potentially harmful element for humans. Its levels in foodstuffs are normally low (below 0.2mgkg-1), but sensitive individuals may develop allergy to Ni as a result of dietary consumption. Cocoa contains relatively high Ni concentrations (around 3mgkg-1). Ni bioavailability, its role in the flavour of food and its potential impact on human health depends primarily on its chemical species. However, there is a lack of information about Ni speciation in cocoa. In this work Ni species were separated on a weak convective interaction media diethylamine (CIM DEAE) monolithic chromatographic column and quantified by the post-column isotope dilution inductively coupled plasma mass spectrometry (ID-ICP-MS). The Ni binding ligands in the separated fractions were identified “off line” by quadrupole time-of-flight mass spectrometry (Q-TOF MS). Ni was found to be present in the cocoa infusions as Ni2+ and Ni-gluconate and Ni-citrate complexes.

Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Triggers of ACD – allergens and the jewelry addict

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Discussion of Triggers of Allergic Contact Dermatitis in Accessories – the Jewelry addict

Original article: Nanette B. Silverberg. (2016). The “Jewelry Addict”: Allergic contact dermatitis from repetitive multiple children’s jewelry exposures. Pediatric Dermatology 33: e103-e105

Reviewed by Lauren A. Ivey, MS. MSI & Brittanya A. Limone, MA, BS. MSIII Loma Linda University

  • Nickel Allergic Contact Dermatitis (Ni-ACD) can be a distressing problem, especially for young girls with pierced ears and a love for costume jewelry.
  • Nickel is the most commonly confirmed contact allergen in both children and adults.
  • Confirmed Ni-ACD has increased 3 to 4-fold since 1986.
    • Common sources of nickel exposure in children include jewelry and adornments, electronics, and school chairs.
    • Girls are especially at risk to early nickel exposure through earrings and daily us of costume jewelry (aka “jewelry addict”)
    • Electronics, eg cell phones, laptops, and tablets have increased the frequency of nickel exposure.
  • Silverberg presents a case study of a 9-year-old girl “addicted to costume jewelry” who developed ACD after exposure to different metal- and rubber-containing accessories.
    • Confirmed sources of the allergen exposure included rubber bracelets, cheaper metal jewelry, lip balm case and belt buckles.
    • Physical examination: classic involvement of the antecubital fossa (crease of arms) consistent with a diagnosis of atopic dermatitis, and lichenified plaques on the fingertips and dorsal hands.
    • Notable plaques were seen on the lips and perioral region associated with application of lip balm kept in the metal case.
    • Patch testing revealed a 3+ reaction to nickel (papular variant), 2+ to gold thiosulfate, and 3+ to thiuram, all of which were deemed clinically relevant considering the child’s history with jewelry containing these allergens and her  presentation.
  • Parents and caregivers must remain cognizant of important allergens in jewelry.
  • Because virtually any type of jewelry can be a source of allergy, children who exhibit persistent dermatitis should be tested for suspected allergens based on history and exposure.

Free article on Suspender Nickel dermatitis – prevention is the key

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Review of: ‘ Suspender ’ Dermatitis and Nickel Sensitivity

Original article:  D. Calnan and G. C. Wells. (1956). Suspender Dermatitis and Nickel Sensitivity. British Medical Journal, 1(4978), p. 1265-1268.

Reviewed by Brittanya Limone, BS, MA, MSIII, Loma Linda University.

  • Historically, nickel allergy contact dermatitis was primarily associated with women working in industrial processes.
    • Calnan and Wells use a case of suspender dermatitis, one of the most common causes of nickel allergic contact dermatitis c. 1956, to highlight the prevalence of this condition amongst women regardless of their employment.
  • A dermatitis reaction is thought to occur after friction and sweat wear on nickel-containing products. These mediums gradually remove the nickel coatings and allow for nickel ion absorption across one’s skin.
    • In addition to suspenders, other everyday nickel-containing products that may induce an allergic contact dermatitis include watches, bra clasps, and earrings.
  • Typically, the first reaction site occurs in direct contact with the metal, also known as the primary site. This region appears as excoriated, superficial papules or a confluent patch.
    • Of note, pierced earrings were noted to cause earlobe dermatitis with crusts and exudates that might be mistaken for impetigo (infection).
  • Eruptions at sites distant to the metal’s direct contact are secondary sites. These occur in a symmetric fashion on the eyelids, sides of the neck, inner thighs, and elbow flexures.
    • Secondary reactions develop as papules or vesicles overlying an erythematous, edematous background with or without crusts and exudates.
  • A secondary flare-up is a more important clinical feature for diagnosis and treatment.
    • In terms of diagnosis, patients might not typically seek medical care until a secondary eruption. Therefore, recognition of these lesions, more commonly, leads to the diagnosis of nickel sensitivity.
    • However, conditions with secondary flare-up reactions are more difficult to treat. Patients with a primary lesion respond quickly to therapy, but once a secondary eruption occurs, clearing the condition is difficult and recurrences are more common.
  • Patch testing is used to confirm the diagnosis of nickel allergic contact dermatitis. However, waiting for the alleviation of an acute exacerbation is important as false positives from local reactions to patch testing may occur.

 

  • Prevention is key to this condition’s treatment and reduces recurrences.
    • The first step is the removal of all jewelry, metal clips or fasteners.
    • If nickel-containing products must be worn, then they should be covered with a protective coating of fabric, plastic, or enamel.
    • Alternatively, replacement products may be used such as items made of 100% plastic or nylon.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1979680/

Role of low Nickel Diet in Nickel Allergy

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What Role Does the low nickel diet Play in the Management of Nickel Allergy?

Original article:

Eleese Cunningham. What Role Does Diet Play in the Management of Nickel Allergy? Journal of the Academy of Nutrition and Dietetics, 2017; Vol. 117: p. 500.

Reviewed by Brittanya Limone, BS, MA. MSIII, Loma Linda University

  • Nickel is a common cause of allergic contact dermatitis (ACD) in the United States with rising detected prevalence. ACD reactions typically involve an ‘itchy rash’ following contact with nickel-containing compounds and are able to be confirmed using the diagnostic patch test.
  • Patients may present with widespread dermatitis, in the absence of contact with known allergens, raising the suspicion for dietary sources of nickel.
  • Notably, nickel amounts differ amongst plant types and also vary based on the levels of nickel present in the soil during growth. In the case of seafood, the water nickel content is a major contributing factor.
  • Eleese Cunningham reported that “In most studies, the richest sources of dietary nickel are found in nuts, dried peas and beans, whole grains, and chocolate.” Of note, the use of stainless-steel cookware and metal machinery may increase the nickel content in home-cooked meals and processed foods, respectively.
  • The pervasiveness of nickel across food groups makes a ‘nickel-free’ avoidance diet challenging. A diet high in iron-rich foods may be beneficial for patients with nickel sensitivities:
    • Iron and nickel compete for the same transport pathway during intestinal absorption. Consequently, if more iron is shuttled across intestinal mucosa, then less nickel will be transported.
    • In contrast, while normally only a small percentage of nickel is absorbed, this amount increases in patients with iron deficiencies. Additional processes that may lead to increased absorption of nickel include lactation or a disruption of the gastrointestinal barrier, such as in irritable bowel syndrome.1
  • Evidence suggests that nickel sensitive patients may benefit from reducing high nickel-containing foods from their diet.   Eleese Cunningham notes that the low-nickel diet should be followed for 4-6 weeks and then evaluate for improvement patient symptoms.

Additional Reference:

  1. 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):101-108.

Nickel allergy and wheat sensitivity – Free access article

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Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non-Celiac Wheat Sensitivity 

Original article:

Alberto D’ Alcamo, Pasquale Mansueto, Maurizio Soresi, Rosario Iacobucci, Francesco La Blasca, Girolamo Geraci, Francesca Cavataio, Francesca Fayer, Andrea Arini, Laura Di Stefano, Giuseppe Iacono, Liana Bosco & Antonio Carrocio. Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non-Celiac Wheat Sensitivity.Nutrients, 2017; Vol. 9(2):103  

Reviewed by Sue Min S. Kwon, BS, MSI and Annelise Rasmussen BS, MSII, Loma Linda University.

  • As gluten allergy becomes more prevalent and widely-knownin society, patients with cutaneous or gastrointestinal symptoms following wheat ingestion may self-report gluten/wheat allergies, though they do not in fact have celiac disease. Almaco et al. suggested the term “non-celiac wheat sensitivity” (NCWS) to describe patients presenting with these symptoms, rather than non-celiac gluten sensitivity (NCGS), as it is not known which component of wheat causes the symptoms.
  • Non-celiac wheat sensitivity (NCWS) is a relatively new clinical finding associated with gluten-related diseases. Wheat contains nickel, a known contact allergen, which may produce systemic nickel allergy syndrome (SNAS) symptoms. Nickel is the most frequent cause of contact allergy in tested populations.
  • NCWS can mimic irritable bowel syndrome (IBS). 
  • Almacoet al. conducted a double-blind placebo-controlled (DBPC) experiment in order to evaluate the frequency of contact dermatitis due to nickel allergy.

o   NCWS patients suffering from nickel allergy were compared with a control group of NCWS patients who did not report nickel allergy.

o   NCWS patients with nickel allergy had a significantly higher percentage of atopic disease manifestations than those with irritable bowel syndrome (IBS) and NCWS patients without nickel allergy.

  • Nickel allergy (diagnosed by a confirmatory epicutaneouspatch test) may manifest with both cutaneous and gastrointestinal symptoms.

o   All NCWS patients with nickel allergy exhibited cutaneous erythema.

o   Less than 10% of NCWS patients without nickel allergy exhibited such symptoms.

  • Causes may include dietary short-chain carbohydrate load, autoimmune disorders, and non-immunoglobulin E – mediated wheat allergies.
  • This study did not allow for evaluation of the frequency of nickel allergy in NCWS; nickel patch testing was only performed on patients who self-reported contact dermatitis. Nickel allergy could have been present in patients who did not report nickel allergy.
  • Selection bias was a result of patients referred to tertiary centers.
  • Alcamo et al. suggest that patients with NCWS who exhibit cutaneous erythema should be tested for nickel allergy.

http://www.mdpi.com/2072-6643/9/2/103

https://www.dermatitisacademy.com/nickel-immediate-reactions/

Nickel reactions within minutes to hours – confirmed by prick testing.

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https://www.dermatitisacademy.com/nickel-immediate-reactions/

OLYMPUS DIGITAL CAMERA

This is a most important work by Dr. Doug Powell’s group, which highlights non-delayed type hypersensitivity immune activation to nickel (nickel immediate reactions).  In our practice we see patients with atopic dermatitis that flare in response to nickel exposure.  This is an area in need of further investigation.  Article will be in print this month!


Saluja SS1, Davis CL, Chong TA, Powell DL.  Contact Urticaria to Nickel: A Series of 11 Patients Who Were Prick Test Positive and Patch Test Negative to Nickel Sulfate 2.5% and 5.0. Dermatitis. 2016 Sep-Oct;27(5):282-7. doi: 10.1097/DER.0000000000000211.

BACKGROUND:
Nickel is the most common allergen found by patch testing; however, not all cases of nickel allergy are type 4 (delayed) allergies. Contact urticaria (CU) to nickel (immediate reaction) has been reported; however, few seem to evaluate it as per a recent published survey of American Contact Dermatitis Society members.
OBJECTIVE:
The aim of the study was to present a series of patients who had clinical histories suggestive of nickel allergy and yet were patch test negative but prick test positive to nickel, thus demonstrating CU.
METHODS:
We reviewed the charts of 11 patients who were patch test negative but prick test positive.
RESULTS:
All 11 patients demonstrated evidence of CU by prick testing (or closed chamber test in 1). None were patch test positive to nickel 2.5% or 5.0%. Four patients’ histories mentioned reactions to various jewelry/earrings within minutes, whereas 2 histories mentioned reacting within a few hours. These histories are consistent with CU. Others (except 1 patient) recalled reacting to jewelry/earrings but did not recall a time frame.
CONCLUSIONS:
Our series suggests that CU to nickel may be far more common than anticipated and should be evaluated with prick testing when patients’ history suggests nickel allergy and yet they are patch test negative.

 

Learn more about nickel immediate reactions this month!!!

SNAS – 700 patients evaluated

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This is important work from the Italians… 700 patients evaluated with the systemic nickel allergy syndrome having both skin and GI symptoms.  Patch testing helped confirm the diagnosis.

Tammaro A1, Romano I1, De Marco G1, Parisella FR2, Pigliacelli F1, D’Arino A1, Persechino F3, Gaspari AA2, Persechino S1.

Effects of TIO NICKEL in patients with ACD and SNAS: experience on 700 patients in Italy.

J Eur Acad Dermatol Venereol. 2016 Aug 12. doi: 10.1111/jdv.13916. [Epub ahead of print]
Abstract
The nickel is causes of allergic contact dermatitis (ACD) and of “systemic nickel allergy syndrome” (SNAS). From 2009 to 2015 a very large number of patients with allergies, presented to our Department of Dermatology and Allergology at Sant’Andrea Hospital in Rome; 700 of these showed an allergic reaction to nickel with a double clinical manifestation, skin and gastrointestinal symptoms, between 25 and 60 years old. Regarding the skin manifestation, the diagnosis was confirmed by Patch Test SIDAPA standard series. The results were positive for nickel sulphate with +2 to +3, using the ICDRG scoring system, and also to others allergens (Table 1). This article is protected by copyright. All rights reserved.

 

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13916/pdf

Fibroblasts and oral-induced tolerance against nickel…

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‘Differences in human gingival and dermal fibroblasts may contribute to oral-induced tolerance against nickel’…

present results unveil new aspects of oral-induced tolerance and provide additional information for current knowledge, which indicates that oral Ni2 challenge before piercings may prevent Ni hypersensitivity…

Read more here:http://www.ncbi.nlm.nih.gov/pubmed/27264456

 

 

DMG sensitivity

DMG sensitivity

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The DMG has modest sensitivity:

“The sensitivity of the DMG test was 59.3% and the specificity was 97.5% based on DMG-test results and nickel release concentrations determined by the EN 1811 reference method. …  The EN 1811, a European standard reference method developed by the European Committee for Standardization (CEN), is fine-tuned to estimate nickel release around the limit value of the EU Nickel Directive from products intended to come into direct and prolonged skin contact.”

Direct and prolonged contact with FREE RELEASED nickel is what leads to sensitization and skin rashes (allergic contact dermatitis).  Because of the DMG sensitivity issue (not always detecting) – consumers should not rely on this 100% but rather use if for screening.

Past exposure studies may have underestimated nickel release from consumer items.”

Read more here:

http://www.ncbi.nlm.nih.gov/pubmed/20536475

 

From a clinical impact standpoint, if the object turns pink with the DMG test – best to avoid it – but be aware that it is not 100%… DMG sensitivity is only 59.3%

learn about DMG testing here:

https://www.dermatitisacademy.com/nickel-sources/

 

low nickel diet

Low Nickel Diet article

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Low Nickel Diet: A Patient-Centered Review

‘ A meta review by Jensen specifically assessed elicitation of SCD due to nickel ingestion, and found that 1% of those sensitized to nickel react to the nickel content of a “normal” diet, defined as 0.22 mg, 0.35 mg, or 0.53 mg [12]. Furthermore, a dose-response relationship was revealed showing 10% of nickel sensitized patients responding to exposures between 0.55 mg and 0.89 mg. Such low exposures can be easily attained by consuming foods high in nickel content.  …many patients sensitized to nickel are unaware that dietary exposure may play a role in their morbidity.’  A low nickel diet may help them get their rashes better.

To read more about the Low Nickel Diet: A Patient-Centered Review click here:

http://www.omicsonline.org/open-access/low-nickel-diet-a-patientcentered-review-2155-9554-1000355.php?aid=73356