Metal Allergy pp 551-561 | Cite as

Systemic Nickel Allergy Syndrome

  • Mario Di Gioacchino
  • Alessia Gatta
  • Loredana Della Valle
  • Anila Farinelli
  • Riccardo Caruso
  • Cinzia Pini
  • Alice Malandra
  • Rocco Mangifesta
  • Enrico Cavallucci
  • Claudia Petrarca


Nickel is one of the most common skin sensitizers, usually responsible for allergic contact dermatitis (ACD). The ingestion of nickel-rich foods is also able to elicit cutaneous (in the absence of physical contact with nickel) and gastrointestinal symptoms in some subjects with nickel ACD, a condition referred to as systemic nickel allergy syndrome (SNAS). The pathogenesis of this disease involves both Th1 and Th2 cells and cytokines, with involvement of both CD8- and CD4-positive T lymphocytes. Clinical aspects include flares of previous ACD lesions and/or positive nickel patch test reactions, widespread eczema, and gastrointestinal disturbance essentially characterized by meteorism and colic. This diagnosis may be suspected in patients with nickel ACD whose gut and skin symptoms disappear or improve after a low nickel diet. Essential for the diagnosis is to confirm that symptoms reappear after a double-blind placebo-controlled oral nickel challenge. In such cases, the low nickel diet can be used as treatment. Of note, to maintain a nickel-free diet for a long time may strongly impact a patient’s quality of life. Therefore, a desensitization treatment should be considered in these patients. Nickel hyposensitization is effective in patients suffering from SNAS. The majority of such patients can safely ingest nickel-containing foods after 1 year of treatment. Clinical experience in patients with ACD alone, although positive and encouraging, is scarce in terms of the number of patients treated and length of the hyposensitization course, which is usually followed, after a relatively short period of time, by a relapse of cutaneous symptoms. In any case, nickel hyposensitization is able to modulate immune responses to nickel by restoring a state of tolerance that seems to be mediated by T regulatory lymphocytes.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mario Di Gioacchino
    • 1
    • 2
  • Alessia Gatta
    • 1
  • Loredana Della Valle
    • 1
  • Anila Farinelli
    • 1
  • Riccardo Caruso
    • 1
  • Cinzia Pini
    • 1
  • Alice Malandra
    • 1
  • Rocco Mangifesta
    • 2
  • Enrico Cavallucci
    • 1
  • Claudia Petrarca
    • 2
  1. 1.Allergy and Clinical ImmunologyG. d’Annunzio UniversityChietiItaly
  2. 2.Immunotoxicology and Allergy Unit, CeSI-METG. d’Annunzio UniversityChietiItaly

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