Nickel Allergy - Symptoms, Causes, Management, and Prevention

What Is Nickel Allergy?

Nickel is a common metal found in many metallic items, including jewelry (earrings, silver, white gold), apparel, eyeglasses, keys, coins, utensils, instruments, bathroom fixtures, metal tools, batteries, mobile phones, and machinery parts. Nickel is a common cause of an allergic reaction that causes itchy and inflamed, red skin and rashes, referred to as allergic contact dermatitis.

Allergic contact dermatitis occurs when skin that has become allergic to a substance comes into contact with that substance. Symptoms may take about 72 hours or more after exposure, often at the site of nickel contact. Other rare cases of immediate nickel allergy appear as contact urticaria or hive-like reaction at the contact site with the nickel-containing item. Nickel allergy is more common in women than men because women are more likely to wear jewelry or have piercings.

What Are the Signs and Symptoms of a Nickel Allergy?

The allergic reaction, contact dermatitis, usually begins within hours to days after nickel exposure. This reaction may last for two to four weeks. The reaction tends to occur only where the skin comes into contact with nickel, but sometimes it may appear in other places on the body. The nickel allergy symptoms may be mild or severe.

The common signs and symptoms of nickel allergy include:

• Rash or bumps on the skin.

• Intense itching.

• Redness.

• Dry skin patches that may resemble a burn.

• Blistering.

• Cracked skin.

• Draining fluid and swelling in severe cases.

• A severe form of nickel allergy called systemic nickel allergy syndrome can also cause symptoms like headaches, fatigue, nausea, vomiting, and diarrhea.

• The skin may become darker, leathery, and cracked if left untreated.

What Causes Nickel Allergy?

The exact cause of nickel allergy is still not known. However, like other allergies, nickel allergy develops when the immune system considers nickel as a harmful substance. Normally, the immune system only reacts to protect the body against bacteria, viruses, or toxic substances. However, once the body reacts to nickel, the immune system becomes sensitive to it. This means that anytime the skin comes into contact with nickel, the immune system will respond and produce an allergic response.

What Are the Risk Factors for Nickel Allergy?

Several factors may increase the risk of developing nickel allergy, including:

1. Ear or Body Piercings: Because nickel is commonly found in jewelry, nickel allergy is mainly associated with earrings and other body-piercing jewelry that contain nickel.

2. Occupational Exposure: For workers engaged in an occupation that constantly causes nickel exposure, the risk of developing a nickel allergy may be higher than those who do not work with the metal. Other people with an increased risk of nickel allergy include metalworkers, tailors, and hairdressers.

3. Being Female: Females tend to have a nickel allergy more than males because females usually have more ear or body piercings.

4. Having a Family History of Nickel Allergy: A person may inherit a tendency to develop a nickel allergy if other people in their family are sensitive to nickel.

5. Allergy to Other Metals: People sensitive to other metals may also develop nickel allergy.

How Is Nickel Allergy Diagnosed?

There is no specific cure for nickel allergy, but avoiding contact with the metal often clears the rash. In suspected cases, the doctor may recommend a patch test. During a patch test, small amounts of substances (including nickel) that may cause an allergic reaction are applied to the skin and covered with small patches that remain in place for two days. The doctor then analyzes the patched test sites after two or more days. In case of a nickel allergy, the skin under the patch remains inflamed when the patch is removed. However, patch tests are often safe for people with severe allergies because of the low concentrations of the substances or allergens.

How Are the Symptoms of Nickel Allergy Managed?

There is no specific cure for nickel allergy, but avoiding contact with the metal often clears the rash. Once sensitivity is developed to nickel, a rash (contact dermatitis) will likely be developed whenever skin comes into contact with the metal.

The doctor may prescribe one of the following medications to reduce irritation and improve the symptoms of a nickel allergy:

• Corticosteroid creams, such as Clobetasol.

• Nonsteroidal creams, such as Tacrolimus.

• If the reaction is severe or a rash covers a large area, oral corticosteroids, such as Prednisone.

• Oral antihistamines.

• Phototherapy. This treatment involves exposing the skin to controlled amounts of artificial ultraviolet light. It is a good alternative for people who do not get better with topical or oral steroids. However, it may take months for phototherapy to affect a nickel allergy reaction.

How to Avoid the Exposure of Nickel?

To avoid exposure and reduce symptoms, the following tips may be helpful:

• Choose jewelry carefully. Wear nickel-free, hypoallergenic jewelry or jewelry made from metals such as surgical-grade stainless steel to avoid nickel exposure.

• Check the clothing items. It is also common for belt buckles, metal buttons, and zippers to contain nickel. Replace these items with ones that are plastic or plastic-coated.

• Cover the electronic devices. Some devices, including cell phones, laptops, and tablets, may contain nickel. Always use a protective cover on electronic devices to avoid nickel exposure.

• Substitute household objects or articles that contain nickel with objects made of other harmless materials, including brass keys, titanium-coated or stainless steel razors, pots, and pans with silicone handles.

• Avoid foods containing nickel in case of extreme sensitivity to nickel. Some food products that contain high amounts of nickel include soybeans, soy sauce, and tofu.

When to See a Medical Professional?

If a person develops a skin rash and is unsure about how they got it, it is better to talk to a doctor or dermatologist. If a person has already been diagnosed with nickel allergy, use the over-the-counter treatments the doctor recommended. However, if these treatments fail to help, see a doctor immediately. The rash can become infected. Rashes from a nickel allergy are not life-threatening, but they can be uncomfortable. If the rash becomes infected, immediately see a doctor or dermatologist for the proper diagnosis and effective treatment plan.

Signs and symptoms indicating an infection include:

• Increased redness.

• Rapidly spreading rash.

• Warmth.

• Pus in the affected area.

• Pain.

• Fever.

• Rash around the eyes.

Conclusion

Nickel allergy is a common cause of contact dermatitis. Nickel allergy is often associated with jewelry and everyday items. Repeated exposure to objects containing nickel results in a nickel allergy. Treatments can relieve symptoms of nickel allergy. However, people with nickel allergy often remain sensitive to metals for life. Symptoms will gradually improve if a person avoids the foods and everyday items that contain nickel.