Internal Medicine

Symptoms of a nickel allergy

introduction

A nickel allergy is a hypersensitivity reaction of the delayed immune reaction (type IV). This type of allergy is also called “Delayed Type Hypersensitivity” (DTH).
This means that after contact with the allergenic nickel, it takes hours to days for the immune cells to release messenger substances. These then lead to inflammation in the affected area.

Typically, the body is first sensitized to the allergen (the allergenic substance, i.e. nickel). The first contact does not result in a rash, only after repeated contact with nickel does allergic contact eczema develop after a few hours.

The symptoms at a glance

Symptoms of a nickel allergy typically appear on the skin that has come into contact with nickel. Nickel is found in costume jewelry, for example, but also in some belt buckles and jeans buttons. The symptoms of a nickel allergy can take years to develop and persist for several days after skin contact with nickel.

The symptoms include:

Redness
itching
swelling
Formation of vesicles or nodules
Scaling
Oozing

What does the rash look like?

The eczema develops in the area that had the closest contact with the nickel. The skin reddens, swells, and begins to itch. In addition, vesicles and small papules may appear.

If the reaction is very strong, the eczema can spread to the skin, but the most severe symptoms develop at the point of direct contact with the nickel. The longer the contact with the nickel and the higher the concentration of nickel in the object, the more severe the rash.

If the nickel-containing item is removed, the rash will usually heal quickly. However, if the contact with the nickel remains (e.g. if a watch with a bracelet containing nickel is still worn), chronic contact eczema can develop. The skin on the affected area thickens, and scales and crusts form.

This eczema (Nickel dermatitis) is accompanied by severe itching and redness. It is characteristic that the rash is pretty much limited to the area where there was direct contact with nickel.

Since nickel is soluble in water, it is increasingly released through perspiration, which is why symptoms of nickel allergy are often more pronounced in summer.

If an allergic reaction occurs to a substance containing nickel that is found inside the body, for example implants or prostheses, it can lead to worse symptoms such as bone destruction, loosening of joints and severe pain.

Nickel-containing foods can make these symptoms worse.

You might also be interested in our next article: Nickel allergy and food

Hives (uriticaria)

The individual wheal is technically referred to as urtika, if many wheals occur, as in hives, one speaks of Urticaria.

Hives can have various causes and, for example, occur as part of an allergic reaction or be triggered by pressure, heat, cold, sunlight or chemical substances.

The wheals usually disappear after a few hours and then reappear in other parts of the body.

A course of over 6 weeks is known as chronic urticaria.

In most cases, no cause of hives can be found. If the trigger is known, contact with the triggering substance / food etc. should be avoided.
Symptomatic therapy uses antihistamines, which inhibit the release of histamine (a tissue hormone that is released in allergic reactions and is responsible for swelling).

Since the nickel allergy is a type IV late allergic reaction and is only triggered by permanent or frequent skin contact and only causes symptoms in these areas, hives generally do not occur with nickel allergy.

Itching with nickel allergy

Contact of nickel with the skin causes an allergic reaction. Histamine, a tissue hormone, causes, among other things, the activation of small skin nerves, which causes itching.

A typical rash in a nickel allergy is severe itching (pruritus) at the inflamed area. The inflammatory reaction releases, among other things, histamine, a tissue hormone, released from mast cells and granulocytes, these are cells that belong to the immune system. Histamine dilates the blood vessels and leads to the characteristic skin changes such as blisters, redness and itching.

Although it is difficult, those affected should refrain from extensive scratching. Scratching damages the skin even more and delays the healing process.

In addition, scratching can cause germs to get into the wound and cause infections.

Weeping blisters with nickel allergy

Frequent or long-term contact with nickel leads to an allergic skin reaction in patients with nickel allergy, which in many cases can look very similar to an inflamed area of skin. Contact eczema develops, consisting of small blisters that can be filled with a clear liquid.

The blisters can burst and a weeping rash develops. Usually the blisters are accompanied by severe itching. The eczema may still be red, very dry and flaky, and itchy.

Swelling with a nickel allergy

At the point of contact with the nickel, the skin becomes inflamed and a non-infectious inflammation develops.
The skin turns red and swells. Doctors refer to the swelling as angioedema, a swelling that occurs suddenly and does not cause pain.

Fluid leaks from the blood vessels into the surrounding tissue, causing the swelling. The skin over the angioedema begins to tighten.

The swelling is harmless and quickly disappears on its own after the nickel has been removed.

node

In addition to vesicles and papules, small nodules (nodules) can also form with a nickel allergy.
These are raised areas of the skin that have a diameter of more than five millimeters.

The lumps can be fairly superficial in the skin and cause itching and burning.

Nickel allergy pain

Contact of nickel with the skin causes an allergic reaction. Histamine, a tissue hormone, is released from mast cells and granulocytes, these are cells that belong to the immune system. In addition, messenger substances are released that are also active in the event of inflammation. These messenger substances trigger pain, among other things.

Scaly skin with nickel allergy

Frequent or long-term contact with nickel leads to an allergic skin reaction in patients with nickel allergy, which in many cases can look very similar to an inflamed area of skin. There is a Contact eczemawhich can be very dry and flaky in the area that was previously in contact with nickel. The eczema may still be red, have weeping blisters, and itchy.

Wheals in a nickel allergy

A wheal is a whitish or reddish swelling of the skin that may be itchy. A wheal is typically a few millimeters to a few centimeters in size. Wheals are a typical symptom of immediate allergic reactions, which include hay fever and food allergies. They can then appear all over the body and keep changing position (see hives). Wheals can also occur in late-stage allergic reactions, including nickel allergy. Long-term contact with nickel results in an allergic reaction, which can become noticeable as wheals at the point of contact with nickel.

Reddening of the skin with nickel allergy

The main characteristic of contact eczema that develops in people with a nickel allergy is reddening of the skin (erythema). The skin reddens or many red spots form at the contact point, which appear after a few hours or days.

The immune cells in the body release messenger substances that lead to inflammation.

Reddening of the skin is a characteristic feature of inflammation and is caused by the vasodilatation and the associated increased blood flow to the tissue

Burn

Burning and mild pain are further signs of a nickel allergy, in addition to swelling and redness.

The allergic reaction causes skin irritation and the immune system releases messenger substances that lead to inflammation.

This leads to itching and a burning sensation on the affected skin areas.

Skin thickening

If the contact with the nickel remains for a long time, the contact eczema turns into a chronic state. The skin thickens and the squamous epithelium becomes keratinized (hyperkeratosis).

The skin thickening is the characteristic of permanent inflammation and can often turn into leather-like changes in the upper layers of the skin.

Changes in the mucous membrane in the mouth and throat in the case of nickel allergy

Nickel is a typical contact allergen. This means that with a nickel allergy, an allergic reaction with the symptoms mentioned above only occurs where the skin or mucous membrane is in contact with nickel. Changes in the mucous membrane in the mouth and throat can occur in patients with nickel allergy if they have a tongue piercing, but not if, for example, earrings containing nickel are worn. If changes in the mucous membrane in the mouth and throat occur in patients with nickel allergy even though they are not wearing a piercing in their mouth, then these changes have a different cause.

When do the symptoms appear?

Nickel allergy is a late-type allergic reaction, which means that the rash does not appear immediately upon first contact.

The skin changes are mediated by the cells of the immune system and usually appear on the skin one to three days after the first contact.

Where do the symptoms appear?

In general, a rash as a reaction to a nickel allergy can occur anywhere the skin comes into contact with the nickel.

Nickel is often used in cheap costume jewelry or watches, so the neck and wrists or earlobes are the most common places where the rash occurs in a nickel allergy.

But belt buckles also often contain nickel, and the rash forms near the navel.

Some glasses frames, zippers, and shoe buckles also contain nickel.

Food allergy to nickel

Some foods contain nickel in not to be despised amounts, of which about 10% is absorbed into the bloodstream.

A lot of nickel can be found in:

Legumes
cocoa
Strawberries
Black tea
coffee
soy
Shellfish
Nuts and
Food that is stored in canned food as the nickel can migrate into it from the canned food.

For some people, even very low concentrations of nickel are sufficient to cause a nickel allergy, for others the threshold is significantly higher.

Causes of food allergy to nickel

The exact cause of a nickel allergy has not yet been clarified. It is partly hereditary, so people with a corresponding hereditary predisposition are more likely to develop hypersensitivity than non-predisposed ones. However, a nickel allergy is an allergy that can develop gradually, so it can only develop if there has been frequent contact with nickel-containing substances over many years. For this reason, many more women suffer from a nickel allergy than men because they wear more jewelry and more often.

Objects that very often contain nickel and can therefore cause an allergic reaction are jewelry (especially earrings and piercings), watches, belts, glasses frames, dentures, buttons, zippers, hair care products and detergents, coins and cutlery.

Nickel allergy is a type IV allergy, also known as late type or delayed type, which is due to the fact that the symptoms do not appear until about 12 hours after exposure. This type of allergy is a special form of hypersensitivity reactions in that it does not run through antibodies. This is where special white blood cells called T cells are responsible for the body's allergic reaction. What happens is that the defense system (immune system) of those affected mistakenly sees the nickel as a dangerous intruder that it is trying to fight. After initial contact with the substance nickel, “sensitization” occurs, which means that some T cells are specialized in recognizing the antigen nickel.
This sensitization phase lasts between 8 and 21 days and the result is so-called memory cells, which are named because they can practically “remember” the contact with nickel. Only after a second contact with nickel does the body really show a reaction to the substance. This happens because the memory cells transform into effector cells, which cause inflammatory cells to migrate. These then release substances such as histamine, which then lead to the typical signs of inflammation such as reddening, water retention or itching.