Low nickel diet: An open, prospective trial

Veien, Niels K.; Hattel, Thais; Laurberg, Grete

doi:10.1016/0190-9622(93)70281-w

Cited by 101 publications

(35 citation statements)

References 15 publications

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“…dermatitis, eczema and urticaria) with a positive patch test to nickel had benefited from a low nickel diet [11, 15]. We hypothesized that in patients affected by RAS with a positive patch test to nickel, if oral nickel challenge is positive, the ingested nickel contained in food can be the cause both of a reactivation of the aphthae and of the subjective symptoms, independently of local contact.…”

Section: Introductionmentioning

confidence: 99%

Results of Double-Blind Placebo-Controlled Challenge with Nickel Salts in Patients Affected by Recurrent Aphthous Stomatitis

Pacor

Lorenzo

Martinelli

et al. 2003

Int Arch Allergy Immunol

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Background: The aetiology of recurrent aphthous stomatitis (RAS) has so far not been completely clarified. Recently, several studies reported that patients affected by cutaneous diseases (i.e. dermatitis, eczema and urticaria) with positive patch test to nickel have a positive oral nickel challenge. Objective: A retrospective data analysis of patch test and oral nickel challenge in 380 patients (204 women and 176 men) affected by RAS was performed. Patients and Methods: We examined 380 consecutive patients affected by RAS during the period 1990–1999. In 28/380 patients the appearance of their oral symptoms coincided with the fitting of orthodontic appliance, while 352/380 reported that their oral symptoms worsened after the fitting of orthodontic appliance. All patients were studied with the series (European standard series and series for dental materials) for patch tests. Results: Seventy out of 380 patients (18.4%) presented a contact sensitization to nickel sulphate (positive patch test). In all of these, the orthodontic appliance was replaced with one made of nickel-free materials. All patients were re-examined by the dentist 6 months after the removal of the orthodontic appliance. The symptoms had completely remitted in 28/70 patients, partially had improved in 31/70 patients and had remained unchanged in 11/70 patients. In all patients (n = 70) with a positive patch test to nickel we performed an oral double-blind placebo-controlled challenge (DBPC) test with nickel sulphate. The DBPC was positive in 32/70 patients, 21 of whom had partially improved and 11 had not, even after the replacement of the orthodontic appliance with material not containing nickel. None of the 28 patients in complete remission showed an adverse reaction to oral nickel challenge. Conclusion: The results of this study demonstrate that, in some patients with a positive patch test to nickel sulphate, the perpetuation of RAS can be related to a hypersensitivity to ingested nickel salts, independently of local contact to nickel.

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Section: Introductionmentioning

confidence: 99%

Results of Double-Blind Placebo-Controlled Challenge with Nickel Salts in Patients Affected by Recurrent Aphthous Stomatitis

Pacor

Lorenzo

Martinelli

et al. 2003

Int Arch Allergy Immunol

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“…However, some studies have shown that an exposure dose equivalent to the maximal nickel exposure through the diet (0.9 mg nickel per day) (21) can induce systemic reactions in some nickel-sensitive individuals (6,8,9,13,20). Additionally, dietary intervention studies (5,(33)(34)(35)(36) indicate that exposure to nickel in diet and drinking water could be a contributing factor to systemic contact dermatitis.…”

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confidence: 99%

Systemic contact dermatitis after oral exposure to nickel: a review with a modified meta‐analysis

2006

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Systemic contact dermatitis can be elicited experimentally in nickel-sensitive individuals by oral nickel exposure. A crucial point interpreting such experiments has been the relevance of nickel exposure from drinking water and diet. The aim of this meta-analysis study on former nickelexposure investigations was to provide the best possible estimation of threshold values of nickel doses that may cause systemic contact dermatitis in nickel-sensitive patients. 17 relevant investigations were identified, and statistical analyses were performed in a stepwise procedure. 9 studies were included in the final dose-response analysis, which divided the studies into a homogenous middle group of 5 studies and 2 groups of 2 studies with a higher and lower response frequency, respectively, described by logistic dose-response curves shifted in parallel. On the basis of these curves, calculations were made of the doses that, theoretically, would cause systemic contact dermatitis in exposed nickel-sensitive patients. The results from the 2 most sensitive groups show that 1% of these individuals may react with systemic contact dermatitis at normal daily nickel exposure from drinking water and diet, i.e. 0.22-0.35 mg nickel.

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“…Moreover, studies on the histological modifications of the gastrointestinal mucosa have shown a marked inflammatory infiltrate, mainly Iymphoplasmacellular, associated with duodenum villus deformation and deepening of the crypta, in some subjects with delayed allergy to nickel sulfate after oral challenge test (21) and after accidental ingestion of a nickel coin (22). When the correlation between nickel allergy and systemic disorders was demonstrated, specific elimination diets were developed to reduce the daily nickel-intake, with significant improvement of symptoms in most patients (23). The etiopathogenetic role of nickel in the genesis of systemic disorders is confirmed by the relapse of previous contact lesions (24)(25)(26), appearance of widespread eczematous (14,27) and urticaria-like general lesions (12,19,28) after oral nickel challenge test.…”

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confidence: 99%

A Clinical Trial of Oral Hyposensitization in Systemic Allergy to Nickel

Schiavino

Nucera

Alonzi

et al. 2006

Int J Immunopathol Pharmacol

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Nickel allergy is the most common contact allergy. Some nickel-sensitive patients present systemic (cutaneous and/or digestive) symptoms related to the ingestion of high nickel-content foods, which significantly improve after a specific low nickel-content diet. The etiopathogenetic role of nickel in the genesis of systemic disorders is, furthermore, demonstrated by the relapse of previous contact lesions, appearance of widespread eczema and generalized urticaria-like lesions after oral nickel challenge test. The aim of this study is to investigate the safety and efficacy of a specific oral hyposensitization to nickel in patients with both local contact disorders and systemic symptoms after the ingestion of nickelcontaining foods. Inclusion criteria for the recruitment of these patients were (other than a positive patch test) a benefit higher than 80% from a low nickel-content diet and a positive oral challenge with nickel. Based on the previous experiences, our group adopted a therapeutic protocol by using increasing oral doses of nickel sulfate associated to an elimination diet. Results have been excellent: this treatment has been effective in inducing clinical tolerance to nickel-containing foods, with a low incidence of side effects (gastric pyrosis, itching erythema).Nickel allergy is the most common contact allergy because nickel is present in various dailyuse accessories and utensils (coins, pots and pans, watches, earrings, etc.) and its widespread use favors sensitization (I). The prevalence of nickel allergy has shown a constant rise in industrialized countries, about 10-15% (with peaks up to 20%) in females, and 4-7% in males (2-4). Female predominance is probably due to a more frequent exposure to metal jewellery and to the higher incidence of allergic diseases in women.Nickel allergy is a delayed, cell-mediated hypersensitivity, presenting with local eczematous lesions after skin contact with nickel and it can be diagnosed by patch tests. Some reports in literature describe how the use of dental and orthopedic prostheses may provoke generalized eczema (5-6) and urticaria (7-8) in nickel-allergic patients.Nickel is an essential element in the diet: its daily intake is about 300 ug, and vegetables are the main source (9-11). Some cases have been described of nickel-sensitized patients with cutaneous systemic disorders correlated to the ingestion of high nickel-content foods: generalized eczema (12-13), recurrent vesicular hand eczema (pompholyx) (14-15), itching erythema with mild

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Low nickel diet: An open, prospective trial

Cited by 101 publications

References 15 publications

Results of Double-Blind Placebo-Controlled Challenge with Nickel Salts in Patients Affected by Recurrent Aphthous Stomatitis

Results of Double-Blind Placebo-Controlled Challenge with Nickel Salts in Patients Affected by Recurrent Aphthous Stomatitis

Systemic contact dermatitis after oral exposure to nickel: a review with a modified meta‐analysis

A Clinical Trial of Oral Hyposensitization in Systemic Allergy to Nickel

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