Systemic nickel hypersensitivity and diet: myth or reality?

S. Pizzutelli

Nickel is a very common metal contained in many everyday objects and is the leading cause of ACD (Allergic Contact Dermatitis). Nickel is present in most of the constituents of a normal diet, but some food groups are usually considered to be richer. However, the nickel content of specific food can vary widely, depending on many factors. Thus, the daily intake of nickel is also highly variable both among different populations and in a single individual, in different seasons and even in different days. Measuring precisely the daily intake of nickel from food and drinks is extremely difficult, if not impossible. The relationship between ACD and contact with nickel is undisputed and widely confirmed in literature. The situation is different for systemic nickel allergy syndrome (SNAS). The SNAS can have cutaneous signs and symptoms (Systemic Contact Dermatitis or SCD)or extracutaneous signs and symptoms (gastrointestinal, respiratory, neurological, etc.).The occurrence of SCD as a systemic reaction to the nickel normally assumed in the daily diet is very controversial. A rigorous demonstration of the relationship between SCD and nickel is extremely difficult. In particular, further and larger studies are needed to assess the reality and the prevalence of nickel urticaria. With respect to nickel-related gastrointestinal symptoms, as well as chronic fatigue syndrome, fibromyalgia, headache, recurring cold sores and recurrent infections in general, the data available in literature are not conclusive and the studies lack the support of clear, first-hand evidence. With respect to respiratory disorders, the role of food nickel and the effectiveness of a dietary treatment have been assumed but not proven. In fact, the usefulness of a therapeutic low-nickel diet is controversial: rare, if not exceptional, and limited to very sporadic cases of SCD. Additionally, the quantitative and qualitative composition of a low-nickel diet presents few certainties and many uncertainties. The low-nickel diets suggested in literature are highly variable, both in the extension of the restrictions and in their details - and the differences are not marginal. Conclusion: an evaluation of the data presented by medical literature about SNAS and its relationship with oral nickel does not allow to draw final conclusions. In the absence of genuine certainty we can only conclude that further and broader studies, more rigorously conducted, are needed.
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