The Open Chemical and Biomedical Methods Journal, 2009, 2, 55-57

55

Open AccessRole of Diet in Nickel Dermatitis
Francesco Petrucci*,1, Beatrice Bocca1, Giovanni Forte1, Stefano Caimi1 and Antonio Cristaudo2
1

Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy2

Istituto Dermatologico S. Gallicano, Via Elio Chianesi 53, 00144 Rome, Italy
Abstract: Nickel is the twenty-second most abundant element and the seventh most abundant transitional metal. It is anubiquitous trace element and it is mostly adopted to manufacture stainless steel used to produce food processing equipment and containers. The metal allergy is often caused from Ni and females are affected more commonly than males.
When Ni allergy develop it tends to persist life-long. Food is considered to be a major source of Ni exposure for the general population. Significant Ni concentration was found in the following foods: mixed nuts, dried fruits, tea bag, cocoa,
chocolate, varieties of crisps, soy products, legumes and wheat flour. Moreover, cooking acidic food in stainless steel
utensils may increase the Ni content. Nickel content in food may vary considerably due to the difference in Ni content of
the soil. Nickel-sensitive person can develop dermatitis when in their diet is present the element. Then, careful selection offood with relatively low Ni concentration can bring a reduction in the total dietary intake of Ni per day. This can influence
the outcome of the disease and can benefit the nickel-sensitive patients.

Keywords: Nickel, diet, contact dermatitis.
1. INTRODUCTION
Nickel is a silvery-white heavy metal and is highly resistant to attack by air and water. Nickel forms numerous alloys
with other metals. Its alloy with iron, nickel steel, is extremely tough and corrosion resistant. For this reason mostof the Ni produced world-wide is used for the manufactureof stainless steel, which is mostly used to produce food processing equipment and containers. It is also used to manufacture fashion jewellery, machinery parts, coins; finely-divided
Ni is used as hydrogenation catalyst.
Nickel is the most allergic metal; the sensitivity is morecommon in females than males and the prevalence varies
from 4% to 13.1% in different countries [1, 2]. Today, infemale population, the prevalence is around 10% (all age
groups are affected) [3]. In some occupational groups, suchas hairdressers the prevalence rate may be as high as 27-38%[4]. As concern the non occupational contacts exposure (forexample, ear piercing and fashion jewellery that contains
free Ni), women are more commonly sensitized. On theother hand, males are mostly sensitized by occupational exposure. Nickel allergy may appear with different degree andpattern. Some times the contact dermatitis develop fromeven brief contact with nickel-containing items, while others
times allergy can develop only after many years of skin contact with Ni. A "secondary rash" due to spread of dermatitis
to distant regions is rarely observed at present [5]. The
chronic contact with nickel-containing detergents, nickelplated items, nickel-containing coins, etc. can often develop
hand eczema many years after primary sensitization. It wasreported that patients develop vesicular type of hand eczema
following the ingestion of Ni in diet [6]. This type of eczema*Address correspondence to this author at the Istituto Superiore di Sanità,
Viale Regina Elena 299, 00161 Rome, Italy; Fax: (+39) 06 4990 2081;
E-mail: francesco.petrucci@iss.it
1875-0389/09

flares up when such patients are treated with oral nickel sulphate. Is well known that chronic urticaria, a type 1 hypersensitivity response, has been attributed to dietary Ni [7].
Cases of erythema multiforme, vasculitis and Baboon syndrome have been reported following Ni ingestion [8-10].
This last syndrome present a pattern of systemic contact
dermatitis with a generalized rash with particular involvement of buttock, anogenital area, flexures and eyelids.
2. NICKEL DERMATITIS AND DIET
An average diet supplies 300-600 μg of Ni to the humanbody per day [11]. The presence of sufficient amounts of Ni
in the diet of a nickel-sensitive person can provoke dermatitis. It has been observed that nickel sulfate when orally administered in the range of 600-5600 μg as a single dose may
provoke hand eczema [12]. The hands are the most commonly affected sites for systemic Ni dermatitis. However,other body areas may be affected as well. There are reportsof serious reactions such as erythema multiforme and vasculitis following oral challenge [8, 9]. Improvement of dermatitis has been noted on a low Ni diet [13] and by oral disulfiram, which chelates Ni and increases its excretion [14].
Moreover, it has been noted that children with orthodontic
braces, who are therefore exposed to low continuous levels
of ingested Ni, may have less subsequent Ni allergy [15].
2.1. Source of Nickel
Nickel is present in soil with a concentration ranging
from 5 μg/g to 500 μg/g even if it may be higher locally. In
fresh water its level vary from 5 μg/L to 100 μg/L and inplant and animal tissues the concentration is 0.5-5 μg/g and
0.1-5 μg/g, respectively [16]. The nickel content of food isstrongly influenced by the concentration of Ni in the soil.
The concentration of Ni in the soil varies from place toplace. Some of the important factors that influence the concentration of Ni in soil are: a) type of soil; b) use of modern
agricultural practices such as the use of synthetic fertilizers
2009 Bentham Open56 The Open Chemical and Biomedical Methods Journal, 2009, Volume 2

and pesticides; c) contamination of soil with industrial effluents and urban wastes; d) distance of the soil from the Ni
smelters [17]. It is noteworthy that even seasons can influence the concentration of Ni in plant tissues; it has been observed that Ni concentration increases in spring and autumn
and falls during mid summer [18].
2.2. Nickel in Foods and Beverages
In the general population food is the major source of Ni
exposure and plant food is a major dietary source of thiselement. Plant tissues contain more Ni than animal tissues.
Therefore, the total dietary intake of Ni per day varies depending on the amount of consumption of plant and animal
foods. The amount of Ni in foods may vary considerablyfrom place to place due to the Ni content of the soil. It was
found that Ni was present in the following amounts in various foods (mg/Kg fresh weight): green vegetables, 0.11; cereals, 0.17; other vegetables, 0.09; potatoes, 0.10; carcass
meat, 0.04; poultry, 0.04; fish, 0.08; eggs, 0.03; milk, <0.02;
dairy products, 0.02; nuts, 2.5; fresh fruits, 0.03; oils andfats, 0.03; etc. [19]. Another study found significant Ni content in the following foods (mg/Kg): a green tea bag contained 235.57; a black tea bag, 62.79; chocolate, 27.87;
crisps, 12.70; wheat flour, 12.15; welsh onion, 0.02; garlic,
0.016, milk, 0.004; egg, 0.002 [20]. Selected snack and convenience foods showed these values of Ni content (mg/Kg):
instant tea, 7.8-12; instant coffee, 0.62-1.3, roasted cashews,
4.1-4.7; custard, 0.02-0.03; lentils, 1.6-2.3; mixed nuts, 0.995.29; dried peas, 0.39-0.76; haricot beans, 0.65-2.3; varietiesof crisps, 0.06-0.61 [21]. Furthermore, the following listshows food with high Ni content irrespective of the soil content: whole wheat, whole grain, rye, oat, millet, buckwheat,cocoa, chocolate, tea, gelatin, baking powder, soy products,
red kidney beans, legumes (peas, lentils, peanut, soya beans
and chickpeas), dried fruits, canned foods, beverages, strong
licorice, and certain vitamin supplements [13].
In the western world examples of diets are reported. In
UK, the mean total dietary intake of Ni has been reported tobe between 0.12-0.21 mg [19]. In Finland, USA and Canada
has been reported a content of 0.13, 017 and 0.207-0.406
mg, respectively [22-24]. The dietary intake of Ni in Denmark is comparatively higher and could reach over 900
g/day, and this was due to the high intake of oatmeal andlegumes, including soybean, nuts, cocoa and chocolate [25].
Indian diets, representing the eastern example of food consumption, are rich in plant food and therefore it contains
considerable amount of Ni. Cereals, pulses and vegetables
constitute the main bulk of the Indian diet. Pulses comprisevarieties of lentils, beans and peas, which have high Ni content. Vegetables used in Indian diets include green leaves,roots and tubers and other vegetables. Vegetables such as
spinach, onion and garlic are very popular and are found tocontain moderately high amounts of Ni. Even the cows' milk,
which is an essential part of majority of Indians' diet, is notfree from Ni and its Ni content is approximately 0.03 μg/g ofNi [21]. Tea is consumed throughout India; dried tea leaves
used for beverage making have been found to contain 3.9-8.2
mg/Kg of Ni [26]. Jaggery (a locally available form of sucrose, also known as Indian sugar), which is commonly
eaten in rural India, is found to have Ni in the concentrationof 0.011 mg/g of jaggery [27]. Coffee, which is very popular
in South India, is found to contain Ni in the concentration ofPetrucci et al.

43 mg per 100 g of coffee beans (roasted, ground) [28]. Cocoa beans, from which cocoa and chocolate are made may
contain up to 10 mg/Kg of Ni and are common constituentsof fast-foods in India [29]. High concentration of Ni is sometimes found in processed foods. This is free Ni, picked up
from the stainless steel used in the manufacture of equipment
and containers. In general, cooking in stainless utensils releases negligible amount of Ni; however, cooking acidic
food in these utensils may increase the Ni content.
3. NICKEL METABOLISM IN HUMAN
In typical diet only 1-10% of the ingested dietary Ni isabsorbed; following absorption, Ni is transported in bloodbound to serum albumin. Most of the absorbed Ni is excretedby the kidneys linked to complexes with low molecularweight and it is also lost through sweat and bile. It is not significantly accumulated by any tissue in the body. Relatively
high Ni concentrations was found in the thyroid and adrenal
glands in comparison to other tissues [11]. The role of Ni inbiochemical functions of human body is not quite clear and adaily dietary requirement of 25-35 g of Ni has been suggested [29].
4. STRATEGIES FOR
NICKEL DERMATITIS

THE

TREATMENTOFAs known over the world, Ni is one of the commonest
sensitizers and once sensitized, the sensitization tends to persist for many years, often life-long. Therefore, Ni allergy
shows a chronic recurring course. As concern the treatments,
different strategies have been recommended: a) systemic
steroids; b) cyclosporine; c) topical steroids; d) wet dressing;e) psoralen and ultraviolet A light (PUVA) therapy, etc. Unfortunately the result of different treatment is often mostly
unsatisfactory as the relapse rate is high. In fact, the humans
are always exposed to Ni. The contact with this metal should
be avoided to a certain extent. However, this is not always
helpful because Ni is present in most of the dietary items ofhumans. Unless this continuous supply of Ni is reduced, Ni
eczema will continue to relapse, particularly the vesicular
type of hand eczema. The careful selection of food with relatively low Ni concentration can result in the reduction in the
total dietary intake of Ni per day. Therefore, a good knowledge of the presence of Ni in food is helpful for the management of Ni allergy [30].
5. CONTROL NICKEL DERMATITIS THROUGH
THE DIET
Nickel cannot be completely avoided from diet; however,a daily reduction in the total dietary intake of Ni is possibleby the selection of the food with relatively low Ni concentration. Many studies have confirmed the benefit of low Ni dietin the reduction of Ni eczema even if the dermatitis will not
clear completely during the diet period. In addition to the
dietary some food habit must be taken into consideration
while drafting a low Ni diet. Animal tissues generally contain less Ni than plant tissues. Meat, poultry and eggs are
suitable for low Ni diet. Fishes can be used for low Ni dietexcept tuna, herring, shellfish, salmon and mackerel thatshow high concentration of Ni. Milk and its products such asbutter, cheese, curd and cottage cheese (paneer) can be consumed. Nickel content of cereals is low. Vegetables such as
potatoes, cabbage and cucumber can be used. Onion, garlic,

Role of Diet in Nickel Dermatitis

The Open Chemical and Biomedical Methods Journal, 2009, Volume 2bananas, apples (up to 3-4 times a week) and citrus fruits (upto 3-4 times a week), tea and coffee (up to 2 cups a day)should be used in moderation. Vegetables such as green
leafy vegetables may be taken sparingly due to the possibility of high concentration of Ni. Mushroom can be used,while it is preferable to avoid all foods that are routinely
high in Ni content such as cocoa, chocolate, soya beans,oatmeal, nuts, almonds, fresh and dried legumes. The avoidance of vitamin supplements with Ni and canned food may
also be of help in reducing the Ni intake. Nickel dissociatefrom the alloy of the can and thus increase the total Ni content of the canned food. Finally, during the cooking it is important to consider that acidic food should not be cooked instainless steel utensils. In fact, the acids may lead to the dissociation Ni from the utensils and it may increase the Ni
content of the food. Nickel-plated utensils should not be usedand should be replaced. Nickel may be released from the tap
during night and then the initial water flow from the tap in
the morning should not be drunk or used for cooking [30].
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Revised: January 5, 2009

Accepted: January 5, 2009

© Petrucci et al.; Licensee Bentham Open.
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