Nickel allergy?

[Sly Saint]

About 4 weeks ago I had a bad reaction to something which made my hands break out in bad contact dermatitis (back and front of both hands). This has happened before but I've never got to the bottom of it.
(It's a long story but, I cannot use steroids or any creams that contain petroleum products).
My hands are taking a long time to heal.

Anyway, I have a strong suspicion that it is the result of handling some plumbing fittings which are nickel plated, then putting on washing up gloves without washing my hands, subsequently recontaminating myself (and the backs of my hands). That's my current theory anyway.

I've been reading up on nickel allergy and came across this paper from 2011.

Systemic nickel hypersensitivity and diet: myth or reality?
https://pubmed.ncbi.nlm.nih.gov/21409856/

full paper here: http://www.eurannallergyimm.com/con...kel-hypersensitivity-diet-myth-563allasp1.pdf

(I was surprised to find a number of mentions of CFS.)

Unbeknown to me my diet is generally quite nickel rich but I am dubious about it being a contributory factor as it has been pretty much the same for several years (in fact since the last time this happened). I already have a number of diet restrictions so I simply can't do any kind of elimination diet.

I know that a couple of people on the forum have nickel allergy so am hoping someone might come up with some suggestions.

(I have never had any patch testing done; it has never been offered and I gather the NHS are not too keen and anyway with the current situation it's not an option, and the chances are it would be put down to 'stress' anyway!).

 

[Kitty]

I've had nickel allergy since I was a kid, and it showed up as confirmed on a set of NHS allergy tests I had a few years ago. I've never suspected dietary nickel had any influence, though...it doesn't sound very plausible.

Nickel is ubiquitous, and it's probably more likely you came into contact with it via your hands than your food.

Also worth mentioning, though, that for years I've developed severe contact dermatitis if I use any hand washing product except Dermol 500*. I don't know which ingredient or combination of ingredients it is, but I went as far as making a spreadsheet and systematically going through every type of soap and washing product sold by major supermarkets, and trying them in turn over a couple of years. They all contain whatever it is!

The reaction appeared out of the blue – I hadn't been using an unusual number of cleaning products or anything – and has been a permanent fixture ever since. It's worth considering this kind of thing as a possibility, as well as common allergens such as nickel and latex.


* It's possible some other specialist hand creams for people with eczema would also be okay, but as Dermol works well, I haven't tried them.

 

[Jonathan Edwards]

I think the paper implies that systemic nickel allergy is indeed myth - although they may have wanted not to be too up front about that.

 

[Wits_End]

I know a family member of mine has a zinc allergy - which I think may cause the same dermatitis - but not a nickel one.

 

[Sly Saint]

It's possible some other specialist hand creams for people with eczema would also be okay, but as Dermol works well, I haven't tried them.

Unfortunately Dermol, as with most creams and lotions, is basically liquid paraffin so I can't use them.

Found this out the last time round. Even 'natural' products are a minefield.
Have done all the trial and error re-gloves(can't use rubber or latex), and soap etc etc.
There are a lot more 'oil-free' (ie petroleum free) moisturising products on the market but as you say the lists of other ingredients is usually quite extensive.

I would just like to get to the cause.

 

[Kitty]

I would just like to get to the cause.

You'll get there eventually. It does often take a long time, especially if there's more than one factor.

My first discovery was that I have lanolin sensitivity, which meant the creams I was prescribed to alleviate the symptoms were making them much worse. Luckily I worked out that petroleum jelly is helpful to me, and heals raw, splitting skin caused by hand wash quite quickly. It was several more years before I accidentally discovered Dermol, though.

Can you use coconut oil on your skin? I find it quite persistent, in that you can rinse your hands if they get sticky with food without removing it. It's not as good a water barrier as petroleum jelly, but it's definitely superior to olive oil. If my skin feels sore I'll cover my hands in it, then wipe my palms and finger ends with paper towel so that I don't get it all over the house.

I also have several pairs of cheap cotton gloves for when I've run out of Dermol (at £10-odd a bottle, I can't always afford to buy it). Covering my hands with coconut oil or vaseline at bedtime and then sleeping in gloves helps ease the soreness, though of course it won't cure the problem.

 

[Sly Saint]

Can you use coconut oil on your skin?

no. last time I spent a small fortune trying just about every natural oil (pure not commercial products)
under the sun. The best turned out to be rosehip oil (avocado oil was also quite good); I've bought some, but can't use it on broken skin so no go at the moment.

olive oil

is actually bad;
"Currently available evidence suggests that olive oil may exacerbate xerosis and atopic dermatitis."
https://onlinelibrary.wiley.com/doi/abs/10.1111/pde.13621

I also have several pairs of cheap cotton gloves

yes, I had to buy some more of these; although no longer doing the al jolson impressions.
Only trouble is they stick to my hands making removing them painful.

 

[Kitty]

last time I spent a small fortune trying just about every natural oil (pure not commercial products) under the sun.

Oh, I only suggested it because many people have a jar of coconut oil in the cupboard anyway – I use it for frying my garlic, ginger and onions for curries. It's not expensive and keeps for ages.

 

[Kitty]

So going back to the nickel allergy – I've just been pondering in the shower about what I'd do if I suspected nickel had got inside my washing up gloves and possibly triggered an allergic reaction.

I can tolerate surgical tape on my skin for a while, so what I'd do is cut two small pieces of gauze 1 - 2cm square. I'd rub one against the metal fitting, and leave the other clean. I'd tape them to some part of my skin that doesn't have especially large numbers of nerve endings or hair, and that isn't rubbed by clothing, and leave them there for several hours.

If the nickel was to blame, the square that was in contact with the fitting should provoke some kind of reaction – though the fact that it wasn't also dipped in hot washing-up water and held tight against already sore skin might mean it's much less obvious. And if it is inflamed for a while, at least it's easier to protect from further irritation than hands!

 

[Creekside]

They all contain whatever it is!

Perhaps it's just the alkalinity of non-solvent cleaners. If baking soda or washing soda causes your dermatitis, then you'll have to avoid all alkaline cleaners.

My hands are always really clean after kneading bread dough. Maybe try flour&water?

 

[Sly Saint]

This seemed as good a thread as any to post this.
It's about MELISA;
https://melisa.org/testing/

I thought it interesting because they also do a Lyme test.
The tests are in vitro.

How the MELISA test works
MELISA tests the patient’s white blood cells against a panel of suspected allergens based on the patient’s medical and dental history. The reaction is measured by two separate methods: uptake of radioisotope by dividing lymphocytes and evaluation by microscope. The test report shows the strength of the reaction as a Stimulation Index and lists the most common sources of exposure.

Also I thought this was interesting:

Prof. Stejskal passed away in 2017. She was the inventor of the MELISA test, formerly head of Immunotoxicology at Astra Pharmaceuticals (now known as AstraZeneca), where she played a key role developing Losec, Astra’s multi-billion-dollar stomach ulcer drug. She left Astra in 1996 to concentrate full-time on MELISA and became Associate Professor of Immunology at the University of Stockholm. She has written numerous articles on metal allergy and gave frequent lectures.

(I'm actually trying a less expensive way to test if I am allergic to nickel; pinning a safety pin to underside of my t-shirt).

 

[Arnie Pye]

I have never been tested for nickel allergy or metal allergy or any other allergy or intolerance, but I think I have this problem. In my case I had my ears pierced as a teenager. I was okay for the first ten years, but then things changed and every time I put earrings in, my ear lobes would go septic and they would itch to an insane degree. I stopped wearing cheap earrings (although I'd rarely worn them anyway), and stuck to gold. But low-carat gold often has nickel in - or used to. I don't know if it still does. I eventually spent a lot of money on some 18 carat gold earrings (the best I could afford) with the same result - septic ear lobes. I haven't worn earrings since my 20s as a result, which I was never happy about because I like earrings.

Titanium earrings caused me problems too.

Away from the subject of earrings, I can't tolerate lanolin and I also can't tolerate petroleum jelly (vaseline) either. Or standard sticking plasters - the glue irritates my skin. I've had eczema on my hands for many years and was treated with standard hydrocortisone creams but stopped being able to tolerate them in my 20s too.

I eventually found a prescription product I could treat my eczema with - its a scalp lotion called Elocon, although I use it anywhere I get eczema - and that doesn't include my head. I don't even get dandruff.

https://www.medicines.org.uk/emc/product/1139/smpc

It's considered to be a potent steroid preparation. But I found it so good that it only requires, at most, two applications before any eczema flare up starts to recede.

Nobody has ever suggested that I get investigated for all these various intolerances. The biggest problem I've had with them all in recent decades has been my total intolerance of all hearing aids. I finally got one that I could tolerate (just), last year or the year before. It only took the NHS 35 years.

 

[Ravn]

(I'm actually trying a less expensive way to test if I am allergic to nickel; pinning a safety pin to underside of my t-shirt).

How did you get on?
In my experience reactions can depend on where on the body you test. I react to wool (lanolin?) if it touches my neck or wrist but I can wear woollen socks no problem.
Similar with metals, some areas react worse than others. Much like @Arnie Pye I got my ears pierced and some years later started reacting to el cheapo earrings of unknown composition, earlobes got red hot and inflamed and itchy. Then reacted to silver. Then to gold. Then to titanium. Stopped trying.

Also started reacting to metal fastenings on necklaces with some sort of contact dermatitis though gold is still ok. Rings the same, cheap metal concoctions are a no no but titanium is still ok. Wrist watches are hit and miss, some are ok, some are not, I don't know what metals they contain.

 

[ladycatlover]

I'm pretty certain I'm allergic to nickel too. The same as others over earrings, but can manage with gold. Not found a watch I could wear for about 40 years.

Worst thing was I bought a wonderful Mexican silver and turquoise necklace, which I paid far too much for on eBay . I wore it for about 2 hours before the itching began. Every place the silver had touched my skin erupted (the turquoise stones were backed with gilded silver) came up, it was striking at how it perfectly matched every stone! That did seem to make the whole nickel thing a whole lot worse.

Took weeks for the marks to disappear completely, and strangely sometimes those marks re-appear in the shape of that necklace, I don't know why, or haven't worked out any theory of causation. Fortunately it doesn't happen very often.

Am also allergic to latex, so at dentist they have to use the latex free gloves. Plus have to buy the expensive hypo-allergenic washing up gloves too, though since I don't do much (if any!) washing up these days it's not much of an expense for me! Have a feeling that I read somewhere nickel and latex allergy can develop together, don't quote me on that though, as I don't have the energy to look for source at present.

I don't know why NHS is so unkeen on testing for allergies (other than in cases of anaphylaxis), though suspect it may be down to a shortage of dermatologists.

 

[Kitty]

I don't know why NHS is so unkeen on testing for allergies (other than in cases of anaphylaxis), though suspect it may be down to a shortage of dermatologists.

I think it's also because allergies are so common, and for the most part are more a pain in the butt than a threat to health. It's possible for patients to fathom many of them out with trial and error, and if the reaction's not too serious, it may not even matter much whether something is an intolerance or a true allergy – either way, they need to avoid it.

They'd no interest in my allergies, until I appeared to develop a reaction to an ingredient in sunscreens. Given that my fair skin is unable to tan at all and I have a family history of melanoma, this was potentially important, so I was referred straight away. Turned out to be a new and energetic case of polymorphic light eruption, so all good.

Away from the subject of earrings, I can't tolerate lanolin

I do wish healthcare workers were better trained on lanolin allergy/sensitivity. When my very elderly mum was released from hospital after treatment, her shins were in a bad way after getting badly scraped in a fall. I was too unwell myself to manage the drive for the first few weeks, and when I remarked on how awful her skin looked, she told me it was just getting worse and worse – it must have been so sore. Then the carer arrived and started slathering E45 all over her legs, and I realised there were huge pots of it in the bedroom and bathroom, sent on prescription by the local pharmacy.

I over took some lanolin-free barrier cream, and asked the carers to try it for a week. They did, and it worked like a magic potion. I explained that, as I can't tolerate lanolin, there's a chance my mum couldn't either, and that the E45 was actually the cause of the problem. No-one had ever bothered to tell them that a cream prescribed for practically every skin condition under the sun causes contact dermatitis in some people, which given the fragile skin of very elderly people, could progress to a worrying infection risk if not acted on.

 

[Sly Saint]

Then the carer arrived and started slathering E45 all over her legs, and I realised there were huge pots of it in the bedroom and bathroom, sent on prescription by the local pharmacy.

I don't think pharmacists are even aware of what's in half the things they sell;

another example is Aqeuous cream which is available just about everywhere (including pharmacies) very cheaply in huge tubs and sold as an allover body moisturiser. But it contains SLS (Sodium Lauryl Sulfate) which is a well known allergen/irritant and not meant to be used in 'leave on' products.
In research it was found that it actually damages the skin, even in healthy participants.
"Why is aqueous cream no longer recommended as a leave on moisturiser?"
https://www.sps.nhs.uk/wp-content/uploads/2019/11/UKMi_QA_aqueous-cream_August_2019-2.pdf

yet look at this on Superdrug for example:

Benefits
Aqueous cream is a moisturising cream suitable for use all over the body to help restore the skin's softness and smoothness. It may also be used as a substitute for soap to cleanse the skin whilst washing and bathing. Suitable for sensitive skin.

Massage gently into face, hands and body. Use frequently or as required.

https://www.superdrug.com/Skin/Body-Care/Dry-Skin/Superdrug-Aqueous-Cream-500G/p/201021#pdp__details

 

[Kitty]

another example is Aqeuous cream which is available just about everywhere (including pharmacies) very cheaply in huge tubs and sold as an allover body moisturiser.

Yup – and GPs are even worse!

Aqueous cream is another thing my late mum was prescribed by the doctor, without any explanation at all about how to use it. When she mentioned to the pharmacist that her eczema wasn't getting any better, he asked whether she was putting more on her skin after washing her hands. She said she was, and he explained that it's long been known to cause irritation if left on, but GPs often don't tell patients that it should only be used as a soap substitute. It actually worked well for her after that – she didn't even need an additional moisturiser once the initial irritation had settled – but it aggravates my skin even if I only use it for washing.

 

[Sly Saint]

I don't know why NHS is so unkeen on testing for allergies

As with many things, it's much easier for them to just go with the 'standard treatment' (which for any kind of skin problem is steroids and emollient) rather than get to the cause of the problem.

it's long been known to cause irritation if left on, but GPs often don't tell patients that it should only be used as a soap substitute

begs the question why that information is not on the product itself?

 

[Sly Saint]

How did you get on?

tried the safety pin test several times, no reaction.
If the problem is nickel then its a newly acquired sensitivity as I never had problems with jewellery etc.
I have been reading umpteen articles, research papers (NZ seem to be much better informed in this area) and have a very long list of 'potential' allergens.
Along with nickel, tend to also be cobalt and chromium both used in the nickel plating process. Being allergic to one does not necessarily mean you are allergic to the others.

Of course I could be completely barking up the wrong tree. But as I have only recently got comfortable use of my hands back, I am a bit nervous about handling what I thought were the offending items to prove I was wrong.

 

[Invisible Woman]

. I stopped wearing cheap earrings (although I'd rarely worn them anyway), and stuck to gold. But low-carat gold often has nickel in - or used to. I don't know if it still does. I eventually spent a lot of money on some 18 carat gold earrings (the best I could afford) with the same result - septic ear lobes. I haven't worn earrings since my 20s as a result, which I was never happy about because I like earrings.

There was an EU - might have been long enough ago to be EEC- regulation introduced addressing nickel content in jewellery.

I couldn't wear costume jewellery at all, 9 carat gold or silver earrings. I found I could wear jewellery made after the new regs were introduced and now happily wear 9ct gold earrings and silver earrings.

If there's a favourite piece you want to wear for a short period (if you were if you well enough to see a friend for lunch & covid didn't exist) and want to avoid a reaction then coating the surface the comes into contact with your skin with clear nail varnish or wearing some microtape on your skin underneath might help you get away with it. I wouldn't push my luck with that though.

Apparently, nowadays they focus more on how easily the nickel migrates from the jewellery onto your skin rather than total nickel content of the metal alloy.

Nickel
Nickel is an abundant metallic element, and is often used to create a white colour in gold jewellery. Its low cost also lends itself to being widely used in the costume jewellery industry, and is often found in plating layers.

Prolonged contact with these products may lead to nickel sensitisation, which is the most common cause of nickel contact dermatitis.

Nickel has to be present on the skin in the form of nickel ions in a solution, such as sweat. So rather than restricting the total content of nickel within the alloy, the REACH legislation sets limits for the migration of nickel from the article; 0.5 mg/cm2/week for articles intended to come into direct and prolonged contact with the skin (non-compliant below 0.88 mg/cm2/week) and 0.2 mg/cm2/week for all post piercing assemblies (non-compliant below 0.35 mg/cm2/week).

There is no correlation between how much nickel is present in the alloy and how much of it will migrate (some stainless steel watches contain up to 28% nickel but do not release enough to cause an issue). Also, the manufacturing process may alter the physical properties of the metal, so simply testing the raw material may not indicate that the finished product will pass the test.

From - https://www.assayoffice.co.uk/news/does-your-jewellery-reach-the-standard