Internal Medicine

The nickel allergy

definition

The nickel allergy is one of the most common allergies that exist and belongs to the group of contact allergies (so-called. Contact dermatitis, allergic contact eczema). Here, only direct contact with the allergenic substance (allergen), i.e. in this case nickel, leads to an inflammatory reaction that is limited to exactly the point that came into contact with the substance. The symptoms of nickel allergy consisting of Rash, itching, and redness, usually regress after a few days.

Nickel (Ni) is a white or shiny silver, water-soluble chemical element that contributes to the ferromagnetic Heavy metals counts. It is part of many metal alloys, but can also be found in some foods. Nickel is important for humans because it is necessary for certain enzymes to function.

Nickel allergy can be diagnosed with the help of an allergy test and is usually easy to get under control by avoiding objects containing nickel and treating the skin of the affected areas with special creams or ointments.

Read more on this topic at: Contact dermatitis

Symptoms of a nickel allergy

itching

Itching (Urticaria) is a typical symptom of allergic reactions: The allergen, i.e. the substance that causes allergies, releases certain messenger substances in the body. An important representative of these substances is histamine, which in turn is used for Release of inflammatory substances leads. These in turn cause widening and increased permeability of the blood vessels. As a result, all kinds of components enter the surrounding tissue and cause itching in the corresponding area.

Rash and pustules

Pustules, wheals or eczema are all typical skin reactions of a contact allergy, but strictly speaking they describe different skin symptoms.

Pustules are small blisters on the skin that are filled with pus. These can be caused by a wide variety of inflammatory reactions and skin diseases, or by allergies.

Wheals occur when fluid is deposited in the subcutaneous tissue, for example when the permeability of blood vessels is increased by an allergic reaction. They then show up as flat, raised and reddened areas on the skin.

Eczema, on the other hand, is a collective term for a wide variety of subspecies, of which allergic contact eczema is relevant here. This consists of the joint appearance of pustules, nodules and scales on the reddened and swollen area.

Read more about the topic here: Rash from an allergy

Reddening of the skin

Reddened and itchy skin is a typical symptom of a contact allergy that can be caused by nickel. The reason for the reddening of the skin is the expansion of the blood vessels, or medically "Vascular dilatation". This is conveyed by certain messenger substances, which also ensure the corresponding body reaction in the event of inflammation. The purpose of this vasodilation is actually to bring more blood to the corresponding part of the body and thus to ensure that immune cells get into the tissue that is supposedly attacked by harmful foreign bodies. The reddened skin results from the improved blood circulation.

Read also: Symptoms of a nickel allergy

Pain

The painfulness and excessive sensitivity of areas of the skin that are affected by an allergic reaction can also be attributed to the above-mentioned messenger substances that are released during such a reaction. In addition to vasodilation and increased vascular permeability, the pain receptors are also sensitized. The same mechanism takes effect when there is inflammation in the body: pain, swelling and reddening therefore match both processes.

Diagnosis of a nickel allergy

A doctor usually suspects a nickel allergy based on the skin symptoms and the patient's history, who is asked in detail when and where the rash existed and whether this is related, for example, to certain items of clothing or jewelry.

An allergy test is then performed to confirm the diagnosis of nickel allergy. In this case, a patch test (also Patch test) is used in which the doctor sticks plasters treated with test substances to the patient's upper arms or back.

In addition to nickel, other allergens such as fragrances or other metals are usually tested. These patches must stay on for at least 48 hours and must not come into contact with water during this time. After this period of time, the doctor will remove the patches and inspect the skin underneath. If the skin shows a reaction to the nickel-containing plaster, there is an allergy.

If this confirms the allergy, it is recommended that this be noted in an allergy passport.

A blood test, which is also possible, only plays a subordinate role in diagnostics.

How can you test a nickel allergy?

In order to test or rule out an allergy to nickel, skin contact with nickel is usually brought about over a longer period of time. Specifically, this means that several platelets containing the allergy-causing nickel ion are stuck onto the body, i.e. usually onto the back. A scratching of the skin, as is usually the case with allergy tests ("Prick test“) Is carried out often, is rather unusual here. The platelets usually stay on the skin for at least a day.

If a skin reaction occurs during this time, a nickel allergy can be assumed. If there is no reddening or eczema, however, an allergy to nickel is very unlikely. The doctor may also sometimes prescribe a low-nickel diet to check for a possible link between skin reactions and dietary nickel intake. This is then maintained for a few days and can suggest a nickel allergy if the symptoms improve. However, nickel allergy sufferers can also tolerate foods containing nickel.

Therapy of nickel allergy

The nickel allergy is not curable. So the therapy consists primarily of the Avoid contact with allergenic substances as much as possible. Since cigarettes also contain small amounts of nickel, those affected should not smoke.
In severe cases of nickel allergy, it can also help to change your diet and omit foods that are high in nickel. However, this diet is difficult to adhere to and is also controversial among experts. It should definitely be discontinued if it does not show any effect after one or two months.

The treatment of contact eczema of nickel allergy is done with anti-inflammatory agents such as Glucocorticoids (here the most important representative is the cortisol). Antihistamines are also used in the form of ointments and creams, which also curb the body's allergic reaction. This will reduce itching and speed up the healing of the rash.

Even if the itching can become very severe, scratching should be avoided if possible, as it delays the healing process and encourages the development of infections.

If there is an allergic reaction to an implant or a prosthesis, these must be replaced immediately with an appropriate nickel-free preparation.

Further information is available here: The therapy of an allergy

When do I need cortisone / cortisone cream?

Cortisone is an extremely versatile active ingredient that is used to control a disproportionately strong immune response. It is therefore very often used for allergies, and here again especially for acute allergic reactions. Cortisone can therefore also be used in the event of an acute reaction in the case of a nickel allergy, for example a reaction of the skin to contact with nickel. As soon as the rash, redness and itching of the allergic reaction have subsided, the use of the cortisone should also be stopped. Regular use for the prophylaxis of allergic reactions is not common because of the side effects of cortisone.

Which home remedies can help?

In addition to avoiding foods containing nickel and metallic objects that contain or could contain nickel, another helpful measure to prevent an allergic reaction is skin care. Dry skin quickly tends to crack, which can also be so small that they are invisible to the naked eye. If nickel penetrates these cracks, a stronger allergic reaction usually occurs quickly. A sufficiently good skin barrier also serves to protect the body here.

If the contact dermatitis has already occurred due to the allergy, you can try to alleviate it with oils containing vitamin E or active plant ingredients such as evening primrose oil. These active ingredients can be applied topically at the appropriate location. The anti-inflammatory effects of omega-3 fatty acids have also been known for many years. These are taken with food and are in particularly high concentrations fatty fish and vegetable oils such as linseed oil and avocado contain. The consumption of such foods can serve to support healing as well as prevention.

homeopathy

Those who want to treat nickel allergy with homeopathic substances can rely on the remedies Niccolum metallicum or Niccolum sulfatum To fall back on. Both are in their original substance compounds that contain nickel. Since “like with like” is supposed to be treated in homeopathic teaching, these compounds are used to treat an allergic reaction caused by nickel. Niccolum metallicum is preferably used when the acute reaction to nickel manifests itself in a skin reaction and itching. Niccolum sulfuricum is indicated when the allergic reaction causes profuse sweating. In such acute cases a low C-potency such as C4 should be given, three globules are usually sufficient. In order to establish a long-term therapy for nickel allergy, however, higher potencies should be selected.

What are foods containing nickel?

Nickel occurs as a trace element in many different foods. If you want to eat as nickel-free as possible, for example to determine the influence on symptoms that may be allergic, you can do without foods that contain a lot of nickel. The limit value for when a food contains “a lot” of nickel is over 100 micrograms per 100 grams.

Foods that are above this limit are for example:

Soy products
nuts
dried foods
Chocolate (especially dark chocolate)
alcoholic drinks of all kinds (but especially beer)
Coffee.
"Older" grains such as millet, amaranth and oats (contain a relatively large amount of nickel compared to wheat)
Offal such as liver or corresponding products (liver or blood sausage)
Shellfish

Which cross allergies are there?

A Cross allergy is caused when the molecules of a certain substance are so similar to those of the allergen that the immune system also reacts to them. The similarity comes from biochemical characteristics, the so-called Epitopes by which the immune cells recognize the corresponding molecules. Often the substances that cause such a cross allergy are also externally similar to the actual allergens.

Allergies to certain plant pollen or fruits therefore often trigger cross-allergies to other pollen or fruits. It is the same with nickel: Known cross allergies contain reactions to other metals such as cobalt or chromium. Other metallic substances can also trigger a cross allergy, but this is usually difficult to analyze as these are usually used together with other metals or with nickel.

Allergy to chromium and nickel

As described above on the subject of cross allergies, molecules that have a similar biochemical structure, such as a certain allergen, can be fought as such by the immune system. Nickel allergy sufferers can therefore sometimes react to certain other metals. These metallic substances include chromium. An allergy to chromium is not necessarily uncommon in nickel allergy sufferers, but it is still rare. In addition, the treatment of a chromium allergy is basically no different from that of a nickel allergy: Here too, skin reactions are treated by avoiding contact and, if necessary, with a cream containing cortisone.

Can i get a tattoo?

Anyone who suffers from a nickel allergy and would like to get a tattoo may come across various alarming articles while researching, which report a questionable nickel content in the tattoo inks. If such a color is used for the tattoo, even very small amounts of nickel can lead to an allergic reaction, after all the color is brought under the body's natural protective barrier, the skin.

The nickel contamination does not affect all colors, the composition varies depending on the manufacturer. If a nickel-free ink is used, the allergy should not stand in the way of a tattoo. It is advisable to carefully check the quality of the studio in question and to consult with the tattoo artist about this.

Can i wear braces?

Using a metal containing nickel for the wires of braces has now become uncommon. Metallic components that could trigger a cross allergy are usually no longer used. A person with a nickel allergy can therefore generally wear braces. Nevertheless, it is advisable to speak to the treating dentist or orthodontist about this issue in order to be on the safe side, if they have not already brought up the subject of allergies.

What do I do if I have a nickel allergy and need a prosthetic knee?

So-called Endoprostheses, i.e. prostheses that are placed in the body, are mostly made of metal. It is therefore justified to ask whether, in the case of a nickel allergy, difficulties can be expected from the insertion of a prosthesis, for example in the knee. For allergy sufferers, however, there is good news here:

Prostheses are always nickel-free, as they are made of material that does not trigger allergic reactions. Since nickel is a metal that many people are allergic to, particular attention is paid to avoiding the manufacture of prostheses at this point. The same applies to the instruments that are used for insertion during the operation. A nickel allergy is therefore not a cause for concern in an upcoming operation of any kind.

Nickel allergy prophylaxis

As far as possible, contact with nickel should be avoided, i.e. one should definitely refrain from wearing jewelry containing nickel. In addition, those affected should not choose occupations in which it is inevitable that they will come into contact with nickel, such as as Cashier, hairdresser, jeweler or dental assistant.

In addition, it makes sense to protect the skin at every opportunity (with protective gloves or protective skin ointments) and to maintain it at all times, as small cracks and injuries to the skin encourage the development of a hypersensitivity reaction.

Preventive measures against a nickel allergy should also be taken by people who are not yet known to have an allergy, but who generally tend to have sensitive skin.

What is the course of a nickel allergy?

The nickel allergy itself, like other allergies, usually lasts for life. The symptoms, such as contact eczema after prolonged contact with nickel, can be treated well and usually do not even occur if nickel contact is avoided.

In rare cases, recurring eczema can occur even without nickel contact, which must then be treated accordingly. The most important piece of advice is generally to avoid prolonged contact with nickel and nickel-containing material, i.e. to pay attention to compatibility, especially with jewelry or implants.

Nickel allergy prognosis

The course of the nickel allergy is usually favorable. Contact eczemas that have developed once respond very well to therapy with the appropriate creams and ointments and then quickly disappear again. If those affected consistently avoid contact with nickel, then eczema can also be completely avoided.

In whole rare cases In the case of nickel allergy, chronic eczema develops, which requires ongoing therapy with special skin care products or, under certain circumstances, UV therapy.

Serious complications can only arise if the nickel-containing substance is inside the body, as is the case with, for example Prostheses, implants or dentures the case is.

Epidemiology

Exact numbers for the presence of a nickel allergy are difficult to determine, but it is estimated that up to 10% of women and around 1% of men in Germany are hypersensitive to nickel. However, these have been falling for a number of years. This is due to the fact that since 1994 jewelry containing nickel has had to guarantee that within two years of normal use of the jewelry a certain limit value for the nickel released is not exceeded.

People with atopic dermatitis have an increased risk of developing a nickel allergy.

Summary

Nickel allergy is a contact allergy that causes reddening, itching and a rash several hours after direct contact with a substance containing nickel on the skin. If the presence of this allergy has been confirmed by an allergy test, you should avoid coming into contact with nickel as much as possible, paying attention to both metallic objects and food. Existing eczema can be treated well with creams and ointments and then usually heal completely within a few days.