Oral challenge with metal salts. (I). Vesicular patch‐test‐negative hand eczema

Abstract

202 patients, 68 males and 134 females, with patch-test-negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals. 55 patients reacted to the mixture of salts as well as to 1 or 2 of the individual salts. 3 other patients were challenged openly with nickel alone. Male patients reacted primarily to chromate and cobalt, while female patients more commonly reacted to nickel and cobalt. 56 patients were instructed to follow diets planned to reduce the daily intake of the respective metals. The dermatitis of 36 patients cleared or improved markedly after 1 month of dieting. Responses to a questionnaire sent to these 36 patients indicated that 28 of them had followed the prescribed diet rigorously or intermittently for at least a year, because they experienced recurrence of the dermatitis if they stopped dieting. 6 noted no long-term benefit and 2 did not respond.

Stainless Steel Leaches Nickel and Chromium into Foods during Cooking

“…In a similar analysis, the amount of Cr per serving of TS is added to the maximum Adequate Intake Level (as defined by the Institute of Medicine), 45 μg/day (14), then compared to the estimated dose threshold associated with ACD, 2500 μg/day (13). Tomato sauce cooked in the absence of stainless steel would comprise just over half of the maximum adequate level, with about 25μg of Cr per serving; however, well below the estimated threshold associated with ACD.…”

“…Nickel levels are compared with the Tolerable Upper Intake Level (UL) (1000 μg/day) (6) and chromium levels are compared with the lowest dose known to cause ACD, 2500 μg/day (13). …”

Scientific Opinion on the risks to public health related to the presence of nickel in food and drinking water

“…Indeed, ingested Ni may have consequences for the expression of skin conditions in sensitized individuals, such as flare-up of cutaneous reactions in some Ni-allergic patients (Christensen and Möller, 1975;Kaaber et al, 1978;Cronin et al, 1980;Veien et al, 1983;Hindsén et al, 2001;Gangemi et al, 2009). It should also be noted that on the other hand, experimental studies have also shown that repeated oral exposure to Ni may prevent diminish sensitization.…”

The many faces of nickel allergy

“…When prescribing a low nickel diet, the effect is even more disputable. Previous studies have shown that improvement of the dermatitis is seen 4–6 weeks after being on a low nickel diet 60,61 . However, a low‐nickel diet is not helpful in 100% of the cases, and certain patients would not benefit from it.…”

“…Foods rich in nickel include green beans, broccoli, peas, canned vegetables and spaghetti, canned fruit, dried fruit, nuts, cocoa, and chocolate 75 . Only a few patients would react to 0.5 mg nickel given as a single oral dose, while the majority of patients react to a dose of 5 mg or more 60,61,76 …”