Metal Allergy pp 211-225 | Cite as

Metals in the Diet

  • Matthew J. Zirwas


A number of metals, primarily nickel, cobalt, and chromium, have been implicated in causing cutaneous reactions when ingested orally. However, there seems to remain some skepticism among practicing dermatologists regarding if this is a real clinical phenomenon.

This chapter focuses on dietary reactions to ingested nickel, for which there is by far the greatest amount of experimental evidence, including numerous placebo-controlled trials confirming that (1) nickel-allergic patients react to oral administration of nickel in a dose-dependent manner, (2) non-nickel-allergic patients do not, and (3) the amount of nickel necessary to cause a flare is within the range of dietary nickel consumption.

Further, a great deal is known about the mechanisms of dietary reactions to nickel, and this will be reviewed as well. Primarily, it has been demonstrated repeatedly that dietary nickel ingestion triggers activation of lymphocytes and release of cytokines, with IL-5 having the greatest role. In addition to the clinically apparent skin inflammation, there is also significant inflammation in the intestinal mucosa.

Finally, a number of useful, specific treatment strategies exist. Most obvious is dietary manipulation to reduce daily nickel intake. In addition, disulfiram, which chelates nickel in the blood, and EDTA, which chelates nickel in the intestinal lumen, are useful adjuncts.

Much less is known about dermatitis triggered by cobalt and chromium, although published reports and clinical experience support that they also trigger flares of dermatitis when ingested in sufficient quantity and that dietary manipulation is useful in management.


Conflict of Interest Statement

Dr. Zirwas has served as a consultant for Anacor, Galderma, Valeant, Sun Laundry, fitbit, Exeltis, Promius, Medimetriks, Novartis, Genentech, and SmartPractice. None of these relationships are relevant to the submitted work.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Ohio Contact Dermatitis CenterColumbusUSA

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