Experimental systemic contact dermatitis from nickel: a dose–response study

Abstract

Systemic contact dermatitis is usually seen as flare-up of previous dermatitis or de novo dermatitis similar to allergic contact dermatitis. Although systemic contact dermatitis from medicaments is a well-established entity, the existence of clinically relevant systemic reactions to oral nickel exposure, in particular systemic reactions to nickel in the daily diet, remains controversial. Several studies have shown that oral exposure to nickel can induce systemic contact dermatitis in nickel-sensitive individuals. In most of these studies, however, the exposure dose of nickel used has been considerably higher than the nickel content in the normal daily diet. The aim of the current investigation was to study dose-response dependency of oral exposure to nickel. In a double-blind, placebo-controlled oral exposure trial, 40 nickel-sensitive persons and 20 healthy (non-nickel-sensitive) controls were given nickel sulfate hexahydrate in doses similar to and greater than the amount of nickel ingested in the normal Danish daily diet. The nickel content in urine and serum before and after oral exposure was measured to determine nickel uptake and excretion. The influence of the amount of nickel ingested on the clinical reactions to oral exposure and on nickel concentrations in serum and urine was evaluated. Among nickel-sensitive individuals, a definite dose-response dependency was seen, following oral exposure to nickel. 7 of 10 nickel-sensitive individuals had cutaneous reactions to oral exposure to 4.0 mg nickel, an amount approximately 10 times greater than the estimated normal daily dietary intake of nickel. 4 of 10 nickel-sensitive individuals had cutaneous reactions to 1.0 mg nickel, a dose which is close to the estimated maximum amount of nickel contained in the daily diet. 4 of 10 nickel-sensitive individuals reacted to 0.3 mg nickel or to the amount equivalent to that contained in a normal daily diet, and 1 of 10 reacted to a placebo. None of the 20 healthy controls had cutaneous reactions to 4.0 mg nickel or to a placebo. Prior to oral exposure, there was no measurable difference in the amount of nickel in the urine or serum of nickel-sensitive persons and healthy controls. Following the oral challenge, the nickel content in the urine and serum of both nickel-sensitive and healthy control individuals was directly related to the dose of nickel ingested.

Systemic Nickel Allergy Syndrome: Epidemiological Data from Four Italian Allergy Units

“…Although some data concerning the correlation between the ingestion of foods containing nickel and the onset of cutaneous and gastrointestinal symptoms have been previously reported (11)(12)(13)(14), the available information is insufficient to draw definitive conclusions about the epidemiology of SNAS. For this reason we conducted a crosssectional study aimed at determining the prevalence of SNAS among the population of patients afferent to four allergy units in Sicily, also reporting the most common symptoms of SNAS presentation and the most common triggering foods.…”

Contact hypersensitivity to nickel in patients with atopic dermatitis

“…When a patient sensitive to nickel becomes exposed to this hapten via the gastrointestinal tract [27], the appearance of new skin lesions or exacerbation of the previous ones may be reported. Dyshidrotic eczema, maculopapular rash and vasculitis have also been described in these patients.…”

“…Dyshidrotic eczema, maculopapular rash and vasculitis have also been described in these patients. Additionally, pruritus aggravation and concomitant nausea, headache and malaise have been reported [27]. Some products containing large amounts of nickel are nuts, chocolate, cocoa, sunflower seeds, whole meal products, red beans, legumes, licorice and dried fruit [28,29].…”

“…Gdy pacjent zostanie poddany działaniu haptenu drogą pokarmową [27], można zaobserwować nasilenie istniejących zmian wypryskowych lub powstanie nowych ognisk zapalnych. Opisano także u tych chorych rozwój wyprysku dyshydrotycznego, osutki plamisto-grudkowej i zapalenia naczyń.…”

“…Opisano także u tych chorych rozwój wyprysku dyshydrotycznego, osutki plamisto-grudkowej i zapalenia naczyń. Dodatkowo obserwowano nasilenie świądu z towarzyszącymi nudnościami, bólami głowy i osłabieniem [27]. Do pokarmów o dużej zawartości niklu zalicza się: orzechy, czekoladę, kakao, nasiona słonecznika, produkty pełnoziarniste, czerwoną fasolę, warzywa strączkowe, lukrecję i suszone owoce [28,29].…”