Systemic contact dermatitis (SCD), a cutaneous reaction that is a direct manifestation of systemic exposure to a known allergen in a sensitized individual, has been increasingly recognized as a cause of persistent cutaneous contact dermatitis that is refractory to conventional therapies. While SCD in response to drugs has been described well in the literature, SCD to allergens in common foodstuffs is a less well-articulated phenomenon. Several foods that are universally consumed throughout the world contain potent allergens including nickel, balsam of Peru, trace metals, urushiol, and sesquiterpene lactones as well as a host of others that may cause a distinctive clinical picture. In this review article, the authors review the typical presentation and prevalence of SCD to foods, pathophysiology, the most common offensive ingestible food allergens, several appropriate diets, and effectiveness of dietary avoidance for situations in which SCD is suspected.
This is a preview of subscription content,to check access.
Access this article
Similar content being viewed by others
Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance
Bajaj AJ, Saraswat A. Systemic contact dermatitis. Int J Derm Venerol Leprol. 2006;72(2):99–102.
Kaaber K, Sjolin KE, Menne T. Elbow eruptions in nickel and chromate dermatitis. Contact Dermatitis. 1983;9(3):213–6.
Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Derm. 2004;51(5–6):297–310.
Schiavino D. Systemic nickel allergy syndrome. Int J Immunopathol Pharmacol. 2005;18(4S):7–10.
Falagiani P, Gioacchino MD, Ricciardi L, et al. Systemic nickel allergy syndrome: a review. Rev Port Imunol. 2008;16(2):135–47.
Jensen CS, Lisby S, Larsen JK, et al. Characterization of lymphocyte subpopulations and cytokine profiles in peripheral blood of nickel-sensitive individuals with systemic contact dermatitis after oral nickel exposure. Contact Dermatitis. 2004;50(1):31–8.
Niyama S, Tamauchi H, Amoh Y, et al. Th2 immune response plays a critical role in the development of nickel-induced allergic contact dermatitis. Int Arch Allerg Immunol. 2010;153(3):303–14.
Petrucci F et al. Role of diet in nickel dermatitis. The Open Chem Biomed Methods. 2009;2:55–7.
Sharma AD. Low nickel diet in dermatology. Indian J Dermatol. 2013;58:240.
Jensen CS, Menné T, Lisby S, et al. Contact Dermatitis. 2003;49(3):124–32. Experimental systemic contact dermatitis from nickel: a dose-response study.
Anke M, Angelow L, Glei M, et al. The biological importance of nickel in the food chain. Fresenius J Anal Chem. 1995;352:92–6.
Veien NK, Hattel T, Laurberg G. Low nickel diet: an open, prospective trial. J Am Acad Dermatol. 1993;29(6):1002–7.
Veien NK. Systemic contact dermatitis. Int J Dermatol. 2011;50:1445–56. Comprehensive review of endogenous and exogenous causes of systemic contact dermatitis with pertinent overview of possible cutaneous manifestations.
Matiz C, Jacob SE. Systemic contact dermatitis in children: how an avoidance diet can make a difference. Ped Dermatol. 2011;28:368–74.
Mislankar M, Zirwas MJ. Low-nickel diet scoring system for systemic nickel allergy. Dermatitis. 2013;24(4):190–5.
Kaaber K, Menné T, Veien N, et al. Treatment of nickel dermatitis with Antabuse; a double blind study. Contact Dermatitis. 1983;9(4):297–9.
Christensen OB, Kristensen M. Treatment with disulfiram in chronic nickel hand dermatitis. Contact Dermatitis. 1982;8:59–63.
Mario CA. Systemic nickel allergy syndrome. Biological monitoring of dietary nickel intake and induction of immunotolerance. Clin Transl Allergy. 2011;S1:P108.
Krecisz B, Chomiczewska D, Kiec-Swierczynska M, Kaszuba A. Systemic contact dermatitis to nickel present in cocoa in 14-year-old boy. Pediatr Dermatol. 2011;28(3):335–6.
Fowler JF, Kentucky L. Systemic contact dermatitis caused by oral chromium picolinate. Cutis. 2000;65:116.
Stuckert J, Nedorost S. Low cobalt diet for dyshidrotic eczema patients. Contact Dermatitis. 2008;59(6):361–5.
Yoshihisa Y, Shimizu T. Metal allergy and systemic contact dermatitis: an overview. Dermatol Res Pract. 2012. doi:10.1155/2012/749561. Discusses clinical presentations of common metal allergies known to cause systemic contact dermatitis such as nickel and reviews proposed pathophysiological mechanisms.
Asano Y, Makino T, Norisugi O, Shimizu T. Occupational cobalt induced systemic contact dermatitis. Eur J Dermatol. 2009;19(2):166–8.
Belsito DV. Surviving on a balsam-restricted diet: cruel and unusual punishment or medically necessary therapy? J Am Acad Dermatol. 2001;45(3):470–2.
Brancaccio G, Ronald R, Alvarez MS. Contact allergy to food. Dermatol Ther. 2004;17:302–13.
Lowther A, McCormick T, Nedorost S. Systemic contact dermatitis from propylene glycol. Dermatitis. 2006;19(2):105–8.
Fisher AA. Systemic contact dermatitis caused by ingestion of certain foods in propylene glycol-sensitive patients. Dermatitis. 1996;7(4):259.
Scheman A, Cha C, Jacob SE, Nedorost S. Food avoidance diets for systemic, lip, and oral contact allergy: an American contact alternatives group article. Dermatitis. 2012;23(6):248–57. Comprehensive list of food elimination diets to food ingredients described in this review that was created by using widely available nutritional data.
Rodriguez SM, Sanchez-Motilla JM, Ramon R, et al. Allergic and systemic contact dermatitis from Matricaria chamomilla tea. Contact Dermatitis. 1998;39(4):192–3.
Kulberg A, Schliemann S, Elsner P. Contact dermatitis as a systemic disease. Clin Dermatol. 2014;32(3):414–9. Brief review of known agents that are causative of systemic contact dermatitis as well as new potential treatment mechanisms such as oral hyposensitization.
Hill AM, Belsito DV. Systemic contact dermatitis of the eyelids caused by formaldehyde derived from aspartame. Contact Dermatitis. 2003;49:258–9.
Hamilton TK, Zug KA. Systemic contact dermatitis to raw cashew nuts in a pesto sauce. Dermatitis. 1998;9(1):51–4.
Park SD, Lee SW, Chun JH, et al. Clinical features of 31 patients with systemic contact dermatitis due to the ingestion of Rhus (lacquer). Br J Dermatol. 2000;142(5):937–42.
Burden AD, Wilkinson SM, Beck MH, et al. Garlic-induced systemic contact dermatitis. Contact Dermatitis. 1994;30(5):299–300.
Veien NK. Ingested food in systemic allergic contact dermatitis. Clin Dermatol. 1997;15(4):547–55.
DL Silvestri (2014) Systemic contact dermatitis: the dermatologist www.the-dermatologist.com/content/systemic-contact-dermatitis. Accessed 9 June 2014.
Rietschel RL, Fowler Jr JF. Systemic contact-type dermatitis. In: Rietschel RL, Fowler Jr JF, editors. Fisher’s contact dermatitis. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 89–101.
Ricciardi L, Arena A, Arena E, et al. Systemic nickel allergy syndrome: epidemiological data from four Italian allergy units. Int J Immunopathol Pharmacol. 2014;27(1):131–6.
Veien NK, Christiansen AH, Svejgaard E, et al. Anti-bodies against nickel-albumin in rabbits and man. Contact Dermatitis. 1979;5:378–82.
Thyssen JP. Drug-elicited systemic allergic (contact) dermatitis—update and possible pathomechanisms. Contact Dermatitis. 2008;4:195.
Sharma AD. Low chromate diet in dermatology. Ind J Dermatol. 2008;54(3):293–5.
Dejobert Y, Delaporte E, Piette F, et al. Vesicular eczema and systemic contact dermatitis from sorbic acid. Contact Dermatitis. 2001;45(5):291.
Giordano-Labadie F, Pech-Ormieres C, Bazex J. Systemic contact dermatitis from sorbic acid. Contact Dermatitis. 2001;34(1):61–2.
Walgrave SE, Warshaw EM, Glesne LA. Allergic contact dermatitis from propolis. Dermatitis. 2005;16(4):209–15.
Cho E, Lee JD, Cho SH. Systemic contact dermatitis from propolis ingestion. Ann Dermatol. 2001;23(1):85–8.
Warshaw EM, Botto NC, Zug KA, et al. Contact dermatitis associated with food: retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 2001–2004. Dermatitis. 2008;19(5):252–60.
Compliance with Ethics Guidelines
Conflict of Interest
Matthew J. Zirwas declares the receipt of consulting fees from Smart Practice, outside of the submitted work.
Stephanie K. Fabbro declares no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the authors.
This article is part of the Topical Collection on Allergic Skin Diseases
About this article
Cite this article
Fabbro, S.K., Zirwas, M.J. Systemic Contact Dermatitis to Foods: Nickel, BOP, and More. Curr Allergy Asthma Rep 14, 463 (2014). https://doi.org/10.1007/s11882-014-0463-3