Nickel Allergies -Causes, Signs and symptoms

Nickel Allergies

Summary

Nickel allergy is an inappropriate reaction of the immune system to the substance nickel. It is one of the most common forms of allergic contact dermatitis (inflammation that occurs when the skin’s surface comes directly into contact with a substance that triggers an allergic reaction). The allergy usually occurs when skin comes into contact with items containing nickel (e.g., coins, jewelry). People become sensitized (made sensitive) to nickel after having a long period of contact with it. Skin piercing is particularly notorious for allowing nickel to seep into the bloodstream and sensitize an individual.

Traditionally, nickel allergy has primarily affected women because they have worn more jewelry than men. However, an increasing percentage of men now get piercings or wear jewelry. As a result, nickel allergy is occurring in greater numbers of men than ever before.

Preventing symptoms from appearing is difficult once an allergy to nickel has developed. Desensitization techniques, such as allergy shots (treatment in which increasing doses of an allergy-causing substance are injected into a patient over a period of time), are not effective, so avoidance is the only defense. Because nickel is found in so many items, people with this allergy may be advised to buy kits that test products for nickel content.

Experts disagree on whether or not those with nickel allergies need to avoid foods that contain trace amounts of nickel. It is possible that some physicians will recommend a patient abstain from consuming dietary nickel for a period of time to see whether or not this improves symptoms.

About nickel allergy

Nickel allergy is a form of contact dermatitis (inflammation due to the skin’s contact with a allergy-causing substance or irritant). It occurs in some people when their skin makes contact with the silvery-white metal. It often begins after a person undergoes body piercing and wears jewelry with nickel content. Once the individual is sensitized (made sensitive) to the nickel, an allergic reaction (an inappropriate reaction of the immune system to a substance that, in most people, causes no symptoms) occurs and a skin rash forms..

Nickel allergy affects women more often than men. However, the rate of nickel allergy among males is increasing as more men wear jewelry and get piercings.

Those with nickel allergy may find that their skin reacts only on some occasions when it is in contact with nickel. A reaction is most likely when wet or sweaty skin comes into contact with items containing nickel that are not resistant to sweat corrosion. Nickel can also seep into the bloodstream from implants (e.g., surgical clamps, coronary stents) and prostheses.

Certain occupations are more likely to present a risk of sensitizing a person to nickel. These include jobs where a person is in contact with nickel, or does a lot of “wet” work, such as cleaning. Nickel can easily penetrate skin that is cracked and damaged from water exposure. Occupations that present a higher risk of nickel sensitization include:

  • Hairdressers
  • Cleaning crews
  • Hospital staff
  • Cashiers
  • Food service workers, including cooks and catering crews
  • Assembly line workers (particularly in the electronics industry)

Those who work in these industries may take special precautions, such as wearing gloves, to ensure they do not become sensitized to nickel. However, research shows that even intense contact with nickel is unlikely to result in an allergy when metal contacts skin that is dry and in good condition.

Potential causes of nickel allergy

A nickel allergy usually develops from repeated exposure to items containing nickel. It is difficult to find a metal product that does not contain nickel, particularly if the item is silver-colored. The chart below contains just a sampling of potential sources of nickel.

Personal ItemsHome & Office
Belts
Buttons
Chains
Cigarette lighters
Clothes fastenings
Clothing hooks
Earrings
Eyeglasses
Eyelash curlers
Hairpins
Handbag catches
Jeans studs
Keys and key rings
Lipstick holders
Other jewelry
Powder compacts
Razors
Rings
Watches
Zippers
Coins
Cupboard handles
Doorknobs
Filing cabinets
Kitchen utensils
Metal chairs
Metal ornaments
Metal wool scouring pads
Musical instruments
Needles and thimbles
Paper clips
Pens
Pins
Pocket knives
Saucepans
Scissors
Silverware
Toasters
Tools
Vacuum cleaners

Jewelry is frequently a source of nickel allergies. Some jewelry is marketed as being “hypoallergenic,” but consumers should be wary of such advertising. For instance, nickel may not be present in the posts of earrings, but still be present in the earrings themselves.

Nickel is a common alloy metal. The chart below provides an example of when nickel may be added to a metal as well as the potential for reaction. Again, this is only a partial list, and it is up to the consumer to ask the right questions regarding nickel content of jewelry and other products.

MetalPotential for reaction?
Gold – 14 karats or lessYes. Often contains enough nickel to trigger symptoms.
Gold – more than 14 karatsNo.
Gold-plated/rolled-gold jewelryYes. Plating can wear off, exposing nickel underneath.
Pure sterling silverYes. Contains no nickel, but is often coated with it.
White gold alloyYes. Often contains nickel.
Stainless steelNo.


Experts disagree on whether or not those with nickel allergies need to avoid foods that contain nickel. It is possible that some physicians will recommend a patient abstain from consuming dietary nickel for a period of time to see whether or not this improves symptoms.

Sources of dietary nickel include:

Fruits & VegetablesGrains,  Legumes, Meats & Other
Canned fruit
Canned vegetables
Dried fruit
Apricots
Figs
Green beans
Kale
Leeks
Lettuce
Onions
Peas
Pineapple
Prunes
Raspberries
Rhubarb
Tomatoes
Spinach
Sprouts
Baking powder
Buckwheat
Beer
Cocoa and chocolate
Coffee
Legumes
Licorice
Millet
Multigrain breads
Nuts
Oats
Oysters
Salmon
Shellfish
Soy powder
Sunflower seeds
Tea
Wheat bran products

In addition, any high acid foods (e.g., tomato sauce) cooked in stainless steel pots can cause the nickel coating on such pots to seep into the food. This may lead to high enough nickel content in the cooked food to trigger nickel allergies in sensitive people.

Signs and symptoms of nickel allergy

A red, itchy dermatitis (inflammation of the skin) – sometimes called “jewelry dermatitis” – is often the first sign of a nickel allergy. Later, tiny water blisters appear and ooze, and the skin becomes moist and sometimes peels off. If the condition remains over a long period of time, the rash will eventually dry out. The skin then becomes scaly and cracked.

Rashes usually begin at the site of contact, but can appear anywhere on the body. Areas most likely to be affected include:

  • Hands
  • Wrists
  • Ears
  • Stomach

Nickel traces can also be transferred from the fingertips to the eyelids, nose, ear lobes or other areas.

Patients who suspect a nickel allergy should consult with a dermatologist or allergist.

Diagnosis and treatment of nickel allergy

In order to diagnose a nickel allergy, a physician will compile the patient’s medical history and a list of symptoms. A full medical examination will also be conducted.

If an allergy is suspected, the physician will perform a skin patch test. During this procedure, a patch will be soaked with tiny quantities of nickel. The patch is then applied to the patient’s skin for at least 48 hours before the physician removes it and checks for a reaction.

Rashes that result from nickel allergies often clear by themselves if the skin remains free of nickel contact. In some cases, a physician may prescribe a mild corticosteroid cream to clear up the rash and reduce itchiness.  

Skin that is damaged by contact with nickel must be carefully maintained until it heals. Moisturizers can keep the skin from peeling and cracking. Patients should watch carefully for any sign of infection, such as crusting and yellowing, weeping sores or foul-smelling skin.

There is no way to cure a person of a nickel allergy, although some people find they become less sensitive to nickel over time. Desensitization techniques, such as allergy shots (treatment in which increasing doses of an allergy-causing substance are injected into a patient over a period of time), are not effective, so avoidance is the only defense.

Prevention methods for nickel allergy

It is impossible to completely avoid nickel because it is found in so many foods. However, patients can avoid allergy-related symptoms by avoiding direct, prolonged contact with nickel or nickel-plated products.

Because nickel is present in so many everyday items, those with an allergy must constantly watch for its presence. Dimethylglyoxime spot test kits are available to test suspect items for nickel content.

These kits contain two bottles: one containing dimethylglyoxime, and the other containing ammonium hydroxide. When an item containing nickel is used to mix the chemicals together, a pink color will result. Patients should ask their physician or pharmacist about where to purchase these kits.

Those with nickel allergy must avoid skin contact with nickel. This is especially true of skin that is broken, cracked or damaged from frequently being wet.

Tips to avoid contact with nickel include:

  • Ear piercing and other forms of body piercing should only be done with stainless-steel needles. Make sure to use earrings with sterling silver, 18-karat gold or stainless-steel studs in pierced ears. This is especially crucial before the holes heal, because open skin allows nickel to easily pass into a person’s bloodstream.

  • Purchase jewelry carefully, keeping the following in mind:
    • Beware of the term “hypoallergenic.” It is used for some jewelry where nickel is not present in the posts, but is present in the earrings themselves.

    • Gold with 14 karats or less may contain enough nickel to provoke a reaction. Most jewelry is made of 9-karat gold, which may contain nickel. Gold-plated and rolled-gold jewelry should also be avoided because the plating can wear off, exposing the skin to nickel.

    • Pure sterling silver contains no nickel, but is often coated with it.

    • White gold alloy often contains nickel.

  • Stainless steel can be an excellent choice of metal for those with nickel allergy. Although nickel may be present, the structure of stainless steel of high quality is such that the nickel will not be leached out by contact with perspiration or moisture.

  • Try to use substitutes for metal, such as items made of wood, plastic, glass, paper or fabric.

  • Items made of nickel do not usually cause a reaction if they are covered with paint, nail polish, lacquer, varnish or masking tape. This prevents the nickel from coming into contact with the skin. However, if the coating chips or flakes off, it is possible for the nickel to contact the skin again.

  • Keep money in a bag, purse or wallet rather than in a pocket that is next to the skin.

  • Wear cotton gloves when touching things containing nickel.

Since many types of medical implants and prostheses also contain nickel, it is important for individuals with nickel allergy to inform their physicians about the allergy, particularly before a surgical procedure. Patients should also carry a card that identifies their allergies in their wallet.

Questions for your doctor about nickel allergy

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctors the following questions about nickel allergy:

  1. Do my symptoms indicate a nickel allergy?

  2. What tests will you use to determine if I have a nickel allergy?

  3. What treatment options are available to me?

  4. What steps can I take to avoid contact with nickel?

  5. What are examples of common nickel-containing items?

  6. Are there certain foods I should avoid?

  7. Where can I purchase a Dimethylgloxime spot test kit?

  8. How can I prevent nickel-exposed skin from becoming infected?

  9. What symptoms would indicate that I have developed an infection?

  10. Is jewelry labeled “hypoallergenic” safe for me to wear?

  11. How can I avoid becoming sensitized to nickel?
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