What is Nickel Allergy?
Allergic contact dermatitis (ACD) is a condition that develops when your skin is exposed repeatedly to something that irritates it or to which it is allergic. It’s the most common skin condition people get from their jobs. This skin reaction is known as a delayed-hypersensitivity reaction, and it can be caused by contact with metals, especially nickel.
Metals causing these skin reactions are found in many common things we use daily like kitchen utensils, watches, earrings, bracelets and also in medical equipment and industrial uses.
What Causes Nickel Allergy?
A nickel allergy is a kind of skin allergy that happens upon contact with the metal. It’s commonly seen with items like jewelry, kitchen utensils, and cutlery. For people who are sensitive to nickel, eating certain foods like chocolate, nuts, oats, green beans, and peas might cause a more severe reaction called systemic nickel allergy syndrome (SNAS) or lead to long-term skin inflammation.
Devices that are implanted into the body can also raise the risk of triggering a system-wide reaction. There’s a belief that having certain existing inflammation conditions, like ulcerative colitis (a type of bowel disease), can make a person more likely to develop a nickel allergy.
Risk Factors and Frequency for Nickel Allergy
A review of over 44,000 patients who had allergy skin tests conducted by the North American Contact Dermatitis Group between 1994 and 2014 found a common sensitivity to Nickel. Of these, 17.5 percent had a sensitivity to nickel, and 55.5 percent of these reactions were deemed clinically significant. Another study of 20,000 individuals from the general population also tested for allergies found that 20.1 percent expressed contact allergies. The most commonly identified allergen was nickel.
- Nickel Sensitivity was observed in 17.5 percent of tested individuals.
- 55.5 percent of these reactions were considered relevant from a clinical perspective.
- In a separate study, 20.1 percent of individuals exhibited contact allergies.
- Nickel was the most common cause of these allergies.
- Allergy to nickel is more common in females.
- The more a person is exposed to nickel through body piercings, the higher the risk of developing an allergy.
Signs and Symptoms of Nickel Allergy
Identifying allergic contact dermatitis, a type of skin inflammation, relies heavily on the patient’s history. Understanding the patient’s past activities, including their job and hobbies, can help pinpoint the cause of their reaction. It’s also important to note anything they use frequently such as make-up, hair dyes, perfumes, glasses, clothes, and jewelry. Allergic contact dermatitis can affect anyone but is more common as people get older. One common type of this condition is a nickel allergy, which can often require several doctor’s appointments to diagnose. During a physical examination, the doctor might find red patches, swelling, scaly skin, blisters, or a hardening of the skin if the condition is in its early stages. If the condition has been around for a while, the skin can become dry, scaly, thick, darker, thick and leathery, or develop cracks.
- Long-term personal history
- Activities, jobs, hobbies
- Products used regularly (cosmetics, hair dyes, fragrances)
- Personal items (eyeglasses, clothes, jewelry)
- Nickel allergy (often requires multiple doctor’s visits)
- Physical examination findings (early stages: red patches, swelling, scaly skin, blisters, skin hardening; later stages: dryness, scaling, thick skin, dark skin, leathery skin, cracks)
Testing for Nickel Allergy
The process of diagnosing allergic contact dermatitis (a skin allergy), mostly relies on your doctor performing a comprehensive check-up and asking you about your health history. If you’ve been in contact with nickel, a common allergen, and your doctor’s physical exam findings align with a nickel allergy, they typically can confirm the diagnosis of allergic contact dermatitis. Medically, there is usually no need for tests like blood tests or imaging scans, as they might not contribute much to the diagnosis.
However, some specific situations might require further investigation. Your doctor would determine this based on your individual case, and would probably involve a specialist, such as an immunologist (a doctor specialized in immune system disorders) or a dermatologist (a skin specialist). Your doctor might use patch testing, a procedure where small amounts of different substances are applied to your skin to identify what’s causing your reaction, to confirm the diagnosis, or to detect any other substances that you might be allergic to.
Treatment Options for Nickel Allergy
Treating a nickel allergy, which can cause a skin condition known as allergic contact dermatitis, begins with figuring out what’s causing the reaction and then keeping away from that item. It might take several doctor visits and a detailed record of everything you’ve touched in a day, given that it’s required to find the nickel source. Some items in your household that you might not suspect could contain nickel, and your doctor might provide you with a list to help you identify them. You can also use commercially available nickel test kits to identify potential sources.
When you figure out that you’re allergic to nickel, the best way to manage it is to avoid contact with it. Scratching the affected areas of your skin can result in excoriation (damage to the skin’s surface), increasing the risk of infection. You might also want to avoid foods that typically contain a lot of nickel like cocoa, chocolate, oatmeal, various nuts, and legumes.
If you’re unable to completely avoid nickel or if avoidance isn’t effective in your case, consider protective measures such as applying skin-care creams, using gloves and moisturizing to prevent skin cracks. Washing frequently could also help. If these self-care measures do not bring desired relief, medication might be required. The first choice would typically be creams or ointments containing corticosteroids, starting with milder formulas and progressing to stronger ones as required. Tacrolimus, a topical calcineurin inhibitor, could serve as another option. Oral corticosteroids could be considered in extreme cases, but they are not usually necessary. Disulfiram, another type of medicine, has been found to improve symptoms in some people, but it has a number of side effects that limits its widespread use.
If these treatments don’t work well, you might need to see a skin specialist (dermatologist). Also, if you experience upset stomach from your nickel allergy, some studies suggest that probiotics might be helpful. Always remember to discuss these treatment options with your healthcare provider to find the one that suits you best.
What else can Nickel Allergy be?
First and foremost, it’s crucial to rule out serious medical conditions like severe allergic reactions and anaphylaxis. After making sure the patient is stable, we can then start looking into other potential causes of allergic contact dermatitis, around which the allergy is linked to nickel. Some possibilities include:
- Exposure to plants
- Use of cosmetics
- Use of skin lotions
- Use of soaps
- Use of detergents
It’s also necessary to check for skin and soft tissue infections. Fungal infections could be at play too, and these are typically diagnosed by preparing a sample of skin scrapings in a solution of potassium hydroxide. Additionally, we should consider underlying inflammatory diseases like psoriasis, lupus, or ulcerative colitis, which can not only mimic but also increase the risks for allergic contact dermatitis due to nickel allergy.
What to expect with Nickel Allergy
The overall outlook for a nickel allergy is typically very good.
Possible Complications When Diagnosed with Nickel Allergy
Allergies to nickel generally don’t cause significant problems, unless the source of irritation remains in contact with the skin continuously. This can result in the skin becoming raw and damaged, which raises the risk of infection. If the skin breaks and gets infected, this can result in a condition called cellulitis, a more serious skin infection. Cellulitis can complicate treatments and the use of topical corticosteroids might hinder the body’s local immune response to fight off the infection. It is vital to treat the skin infection alongside removing the cause of the allergy to ensure the skin heals correctly.
Possible Complications of Nickel Allergy:
- Damaged and raw skin
- Risk of skin infections
- Development of cellulitis
- Complications in treatment plans
- Limited immune response due to topical corticosteroid use
Preventing Nickel Allergy
Patients should learn about avoiding exposure to nickel, which includes identifying potential sources and making necessary lifestyle changes. Staying away from nickel is the most effective way to prevent allergic reactions on the skin due to this metal. It’s also essential to learn about proper skin care and how to heal wounds. For any existing skin problems, they need to know how to take care of them. It’s also really important not to scratch these areas. Scratching can cause more harm and increase the chances of getting an infection.
