What is systemic nickel allergy syndrome

The Facts

Metal hypersensitivity is a disorder of the immune system. It is a common condition that affects 10% to 15% of the population. It can produce a variety of symptoms, including rashes, swelling, or pain due to contact with certain metals (see the symptoms and complications section, below).

In addition to the local skin reactions, metal hypersensitivity can also manifest itself as more chronic conditions such as fibromyalgia and chronic fatigue syndrome. There are numerous local and systemic symptoms that, when considered together, can be caused by metal hypersensitivities.

It is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1% to 3% of people are allergic to cobalt and chromium.

What is systemic nickel allergy syndrome

These types of reactions can be localized reactions that are limited to one area, but they can also be more generalized and affect other more distant parts of the body.

What causes systemic contact dermatitis?

Systemic contact dermatitis is caused by four main groups of allergens:

  1. Metals (including nickel, mercury, gold)
  2. Plant and herbal products (including balsam of Peru, propolis, Compositae, perfumes)
  3. Medications (including aminophylline, corticosteroids, antibiotics)
  4. Preservatives and excipients (parabens, formaldehyde, propylene glycol).

The following table shows examples of allergens that own caused contact dermatitis from topical application/exposure and subsequent systemic contact dermatitis after systemic exposure.

Allergen causing ACD after topical exposure Allergen causing SCD after systemic exposure
Topical cream containing sorbic acid Foods containing sorbic acid, such as strawberries, candies, margarine and cheese
Jewelry, zippers or buckles containing nickel Food containing nickel such as cocoa, beans, tinned foods.

Nickel alloy on an intratubal birth control device

Balsam of Peru in cosmetics and perfumes Spices such as cinnamon, vanilla, cloves that are used to flavour foods, drinks and medicines
Formaldehyde in fabrics, cosmetics and paints Artificial sweetener aspartame used as a sugar substitute in numerous drinks and foods is metabolized in the body to formaldehyde
Parabens in cosmetics and pharmaceutical/self-hygiene products Paraben-containing foods such as marinated fish products, jams and jellies, pickles and preserves
Propylene glycol in topical corticosteroid cream Propylene glycol in oral antihistamine tablets
Direct contact with plants or pollens from the Compositae group of plants Vegetable and herbs such as lettuce, endive, chamomile and echinacea
Ethylenediamine in topical antibiotic/steroid creams Intravenous or oral istration of aminophylline
Neomycin in over-the-counterantiseptic preparations Intravenous or sub-conjunctival istration of neomycin

Symptoms and Complications

Signs and symptoms of metal hypersensitivities can range from little and localized to more severe and generalized.

Limited reactions can appear as a contact dermatitis on the skin that has been exposed to the metal.

The skin may appear red, swollen, and itchy. Hives and rashes may also develop.

More severe metal hypersensitivity reactions generally happen from prolonged exposure to a metal allergen through implants or metal ions that are inhaled or eaten. These reactions often cause chronic joint or muscle pain, inflammation, and swelling, leading to generalized fatigue and lack of energy. In addition, fibromyalgia (pain without known cause) and chronic fatigue syndrome can also be seen in people with metal hypersensitivities.

Common symptoms of metal hypersensitivity include:

  1. blistering of the skin
  2. reddening of skin
  3. depression
  4. muscle pain
  5. joint pain
  6. cognitive impairment
  7. fibromyalgia
  8. hives
  9. rash
  10. chronic inflammation
  11. chronic fatigue
  12. swelling

Related conditions

The following symptoms and conditions own been linked to metal hypersensitivity.

If you own any of these conditions, you may wish to speak to your doctor about the possibility of a metal hypersensitivity:

  1. chronic fatigue syndrome
  2. osteomyelitis
  3. eczema
  4. fibromyalgia
  5. rheumatoid arthritis

Treatment and Prevention

Treatment of metal hypersensitivity is highly individualized, as the allergens and reactions can be extremely diverse from person to person.

Skin hypersensitivities can often be resolved by avoiding the item that causes the reaction. If the dermatitis is more significant, the doctor can also prescribe corticosteroid creams and ointments to reduce the local inflammation.

The doctor can also prescribe oral antihistamines to further reduce the allergic reaction. Oral corticosteroids can also be used, but they can cause problematic side effects.

Systemic reactions are more hard to resolve, as they are often caused by implants. Removal of the implant is sometimes considered when a non-metal replacement is available and may be used. For example, a plastic-based dental filling material may be used to replace a previous metal dental filling.

However, if the allergy is caused by an artificial knee or hip, replacement with a non-metal option is rarely done due to the difficulty of replacement. For these situations, treatment generally involves both topical (surface-applied) and oral medications to reduce the allergic reaction. Due to the hard nature of treating systemic metal allergies, doctors sometimes recommend a hypersensitivity test before an implant is chosen.

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What is systemic nickel allergy syndrome

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What is systemic contact dermatitis?

Systemic contact dermatitis (SCD) or systemically reactivated allergic contact dermatitis (ACD) isdermatitis/eczema that occurs when a person who is already sensitised to a substance through skin contact is exposed to that substance (allergen) via a systemic route. Exposure may be through oral, inhalational, injectable, and trans-mucosal routes.

Systemic contact dermatitis was first described in , where individuals with contact sensitivity to mercury developed dermatitis after systemic mercury exposure.

Throughout the years, numerous other allergens own been identified and the routes of exposure increased significantly.

Making the Diagnosis

Your doctor may suspect metal hypersensitivities based on a combination of your personal history and your signs and symptoms. To determine possible causes of metal exposure, your doctor may enquire if you own any type of implants, if you smoke, or if you regularly use any cosmetics.

Aside from a thorough personal history, your doctor may also order laboratory tests to confirm whether you own a metal hypersensitivity.

These tests generally involve giving a blood sample at a laboratory. The laboratory technicians will test the white blood cells for their activity against metal ions by using radioisotopes and microscopically observing physical changes within the cells. If the test shows that the white blood cells own increased activity when exposed to the metal ions, it indicates the presence of a metal hypersensitivity.

A dermatologist can also conduct an allergy test in which they expose various metal ions to your skin to test for a hypersensitivity reaction. This allergy test, which is similar to a regular "scratch test," is often done as a "patch test." The metal ions that are believed to be causing the allergic reaction are applied to a patch, which is then placed on the skin.

The patch is left in put for 48 hours, after which it is removed from the skin at a return visit to the doctor.

What is systemic nickel allergy syndrome

Skin that is red or irritated under the patch may be an indication of an allergy.


The symptoms of metal hypersensitivity are caused when the body’s immune system starts to view metal ions as foreign threats. The cells that make up the immune system normally kill foreign bacteria and viruses by causing inflammation. If they start attacking metal ions that you touch, eat, inhale, or own implanted in you, they can produce a variety of symptoms (see the symptoms and complications section, below).

Potential metal allergens (triggers of allergic reactions) are extremely common in everyday life. Typical sources such as watches, coins, and jewellery come readily to mind.

However, there are also other less obvious sources of metal in our daily lives. For example, cosmetic products and contact lens solutions may also contain metals that can trigger a reaction at the area of contact.

What is systemic nickel allergy syndrome

Nickel is one of the most frequent allergens, causing significant local contact dermatitis (skin reddening and itching). Cobalt, copper, and chromium are also common culprits.

What is systemic nickel allergy syndrome

These metals can be found in consumer items such as jewellery, cell phones, and clothing items.

Aside from everyday items, medical devices also contain possible allergens such as chromium and titanium. Older dental implants and fillings are often made of metals. A few intra-uterine devices (IUDs) for birth control are made of copper and can also cause hypersensitivities. Implantable devices such as artificial knees, artificial hips, pacemakers, stents, and fracture plates, rods, or pins may contain metals that can cause metal hypersensitivity reactions.

These reactions are often more severe in nature when the allergens own been implanted within the body for an extended period of time.

In addition, people who already own an autoimmune disorder (a disorder where the immune system is overactive) can own a higher risk of a metal hypersensitivity, as their immune system is in a constant state of activity.