Nikel-free Cooking: Tips and recipes for people with nickel allergies Read online

  Maurizio Sansone MD

  Clinical allergy and immunology specialist

  www.mauriziosansone.it

  [email protected]

  Graphics: Andrea Errigo

  Word processing: Dr. Anita Vecchioli MD

  Edutor: Carli Williams

  . Maurizio Sansone MD

  Nikel-free Cooking

  Tips and recipes for people with nickel allergies

  Table of Contents

  8 Preface

  10 The basics of allergies

  14 Nickel, the stranger

  15 Contact dermatitis

  17 The allergy to nickel sulphate

  19 SNAS

  21 A low nickel diet

  26 Risks of the nickel-free diet

  28 Factors influencing nickel absorption

  31 The epicutaneous test, also known as the patch test

  33 The correlation between celiac disease and nickel allergies

  35 Contact reactions to foods

  37 Food intolerances: fake news or reality?

  39 Clinical Cases

  45 Appetizers

  Buttered anchovies - Bruschetta - Salmon carpaccio - Shrimp cocktail - Sea bass bruschetta –Cream frites - Seafood salad - Sea bass paté- Codfish balls - Ham and melon - Stuffed rusks - Sautéed clams - Smoked kebabs - Ground kebabs

  60 First courses

  Arancini di riso - Neapolitan Calzone - Cannelloni with ricotta cheese and spinach - Fettuccine with meat sauce - Gnocchi with gorgonzola - Gricia pasta - Mezze with tuna - Ricotta soup - Broccoli orecchiette - Paccheri with calamari - Pasta with oven – Four cheese penne pasta - Penne with cooked ham - Penne with ricotta - Penne with saffron - Penne with salmon and saffron - Pennette with vodka – Four cheese pizza - Pizza with croutons – Capricciosa pizza - Pizza with carbonara - Ravioli with ricotta - Rigatoni with lemon - Rigatoni with sausage and cream - Lying rice - Veal risotto - Smoked risotto - Risotto with castelmagno – Orange risotto - Risotto with - Risotto with Milanese style - Risotto with risotto – Seafood risotto - Risotto with black sauce - Spaghetti with garlic and olive oil - Spaghetti alla provolone - Spaghetti alla bottarga - Spaghetti alla carbonara - Spaghetti with clams Tagliolini with sea bass - Tortellini - soup patatea

  103 Main dishes

  Fried lamb - Lamb chops - Baked lamb - Baked anchovies - Orange duck in the microwave - Pork loin with milk - Braciato - Bourguignonne meat - Beef carpaccio - Salmon carpaccio - Baked lamb roast leg - Mussels with marinara sauce - Marsala slices - Cod fillets - Beef fillet in butter - Beef fillet in salt - Valdostana fondue - Breaded cheese - Ham frittata – Mixed fried fish - Fish of the poor - Seafood salad - Octopus salad - Tuna rice salad - Rolls - American rolls - Beef boiled meat - Lard in the microwave - Baked pork with apples - Baked meat - Omelette stuffed - Ossobuchi alla Milanese - Grilled swordfish - Chicken breast with lemon - Chicken breast with wine - Chicken cacciatore - Chicken Marengo - Boneless chicken - Fried chicken - Meatballs in the pan - Meatballs impanate - Veal roulade - Sausages with roast potatoes - Saltimbocca alla romana - Grilled scamorza - Mogliia sole - Beer stew - Meat skewers - Sea bass - Meat tartare - Tuna tartar - Bolognese tortellini - Eggs with bacon - Boiled eggs with cheese - Boiled eggs with ham - Boiled eggs with truffles - Boiled eggs with tuna - Boiled eggs with prawns - Boiled eggs with sausage- Scrambled eggs with ham - Veal tonnato

  164 Side dishes

  Potato bombs - Cacioimperio - Potato croquettes – Boiled potatos - Potatoes and bacon- Mashed potatoes - Ricotta au gratin - Potato pie

  173 Desserts and sweets

  Bananas flambé - Cream puffs - Fig biscuits - Creme caramel – Crepes with butter and sugar - Fruit tart without cooking - Fruit tart - Sweet chestnut fruit tart - Sponge cake - Panna cotta - American cake - Apple pie with ricotta – Apple cake- Apple and cheese cake - Tartar soup

  Preface

  The author’s goal is to provide both scientific and practical information on the different types of nickel allergies, which affect between 9 and 13% of the global population (percentages varying between 9 and 13% of the population with a clear prevalence of the female gender). There are two types of nickel allergies.

  1. Contact dermatitus (DAC): the classic contact dermatitis that occurs due to contact with the skin;

  2. Systemic nickel allergy syndrome (SNAS): the dietary form that affects the entire body

  A patient can experience symptoms from both types of the allergy, either seperately or in conjunction. Since this allergy’s symptoms not only occur via physical contact, but also through ingestion of substances containing high nickel content, this book is equipped with many tasty “nickel-free” recipes to support those who have difficulties finding risk-free food options.

  The basics of allergies

  To understand the conept of allergies and possible therapies and prevention strategies, it is important to learn about the protagonist of the allergic reaction, the allergen. Allergens are antigens which are substances recognized as foreign by the immune system. Due to the characteristics of the antigen, this introduction of an antigen can lead to an allergic reaction by contact, ingestion, inhalation, exposure, or inoculation. To summarize, an allergic reaction is a particular type of immunologic response that the human body produces in reaction to specific heterologous substances.

  In general, when our body encounters a foreign substance, the immune system acts much like that of any countries "customs". In fact, all substances present a series of antigens, which the human body’s immune system groups into one of two categories: 1) "self", that which is belonging to the organism and, 2) "non-self", that which is foreign.

  If the substance introduced into the body is recognized as "non-self", the immune system, through the production of antibodies (IgA, IgG IgE and IgM class immuno-globulins) and specific cells, will try to eliminate the "danger". Not all substances have antigens on the surface. In fact, only high molecular weight proteins can induce an immune response, unlike sugars and amino acids which have low molecular weights or "linear" structures. Proteins, which you already may know, are the basis of all organic structures. They are also on the surface of viruses and bacteria as proof of the fundamental role of the recognition of “self” and “non-self” in protecting us from infections. When we ingest a protein through food consumption, it is broken down into its basic components, the amino acids, before being assimilated. In this way the proteins, both animal and vegetable, that are taken with the diet do not risk inducing an antibody response. Furthermore, our digestive system has a barrier to prevent proteins from entering circulation.

  According to the original classification by Gell and Coombs, the abnormal immunological reactions are of four types:

  1. immediate reaction type (or anaphylaxis);

  2. cytotoxic type;

  3. type of immune complex;

  4. cell-mediated type.

  Type 1 and 4 reactions (immediate and cell-mediated) relate to the typical allergic immune response.

  Immediate reaction or anaphylaxis

  Some individuals are genetically predisposed to allergies. The bodies are such people produce antibodies (of the IgE series) in response to some external agents. These antibodies are different from those that non-allergic subjects produce. Now let's see what happens when our allergic patient takes a walk in a park in the middle of spring. The pollen, abundantly present in the atmosphere, is inhaled. The immune system recognizes it as "non-self" and produces antibodies of the IgE series. At this point it is necessary to make a chemical clarification to u
nderstand structure of these antibodies. They are shaped roughly like the letter “Y”. With the two upper arms they attach themselves to the external agent, while with the lower arm they weld themselves to the wall of specific cells of our organism called "mast cells". These cells are rich in histamine. Let us look at an example. When two IgE immunoglobulins, which have reacted with an external pollen, are next to each other, they change their chemical structure. With the arm attached to the mast, they pierce the cell wall. This leads to the leakage of the contents of the mast cell, that is, histamines, which induces vasodilation and then edema (swelling). This is the the allergic reaction in practice. What has happened in this example corresponds to the first type of reaction, the one defined as immediate.

  The cell-mediated reaction

  The intermediaries of the cell-mediated immunological response are the lymphocytes. The cellular response of our body is mainly, but not only, connected to intracellular pathogens. A typical example is that of tuberculosis. At first contact with the extraneous agent, the lymphocytes (CD4 +) bind to the antigen and are transformed over a couple of days into

  sensitized lymphocytes (TH1). Our organism’s next contact with the antigen will provoke an activation of the TH1 lymphocyte. This involves the release of toxic substances from the cell which are able to fight the foreign agent. The on-site presence of toxic substances provokes evident tissue damage (eczema) which is manifested by cutaneous infiltration, redness, swelling, itching and sometimes small lacerations of the skin. This is what happens, for example, when contact occurs with nickel. Thus, contact dermatitis is a typical example of the cell-mediated reaction.

  Perivascular leukocyte clusters are essential for efficient activation of effector T cells in the skin. Natsuaki Y., Egawa G., Nakamizo S., Ono S., Hanakawa S., Okada T., Kusuba N., Otsuka A., Ki- toh A., Honda T., Nakajima S., Tsuchiya S., Sugimoto Y., Ishii K.J., Tsutsui H., Yagita H., Iwakura Y., Kubo M., Ng L.G., Hashimoto T., Fuentes J., Guttman-Yassky E., Miyachi Y., Kabashima K. Nat Immunol. 2014 Nov; 15(11):1064-9.

  Contact Hypersensitivity.

  Gaspari A.A., Katz S.I., Martin S.F.

  Curr Protoc Immunol. 2016 Apr 1; 113:4.2.1-7.

  Contact dermatitis considerations in atopic dermatitis. Rundle C.W., Bergman D., Goldenberg A., Jacob S.E. Clin Dermatol. 2017 Jul–Aug; 35(4):367-374.

  The role and relevance of mast cells in urticaria. Church M.K., Kolkhir P., Metz M., Maurer M. Immunol Rev. 2018 Mar; 282(1):232-247.

  Nickel, the stranger

  Nickel is a natural element discovered in 1757 by the chemist Cronestedt. Its atomic weight is 28 and it has 5 isotopes. This element is ubiquitous and is found mostly in igneous rocks, often linked with iron. The earth's crust is made up of 0.008% nickel. More specifically, in the soil we find 5-500 µg / g, in plants 0.5-5 µg / g, in the animal kingdom 0.1-5 µg / g, in water 0.0005-0.0010 µg / g .

  To avoid the common confusion between nickel and iron it is important to emphasize that iron, also a chemical element, is different from nickel. Nickel is a ferromagnetic element. In nature it is often found associated with cobalt and is used in alloys for its properties.

  The largest nickel reserves are in Australia and New Caledonia and amount to about 50% of total known reserves. Nevertheless, Russia is a the large nickel producer with around 20% of the world’s production and is closely followed by Canada, Australia, Indonesia and the Philippines.

  A great advantage of nickel is its ability to resist oxidation. Therefore, it is used to make coins, laboratory instruments, commonly used cutlery, and pipes.

  In human biology, nickel contributes to numerous enzyme reactions necessary for cellular activity.

  Our body’s intake of nickel occurs mainly through oral consumption and, to a lesser extent, through respiration and skin contact. When consumed orally, nickel is almost eliminated in an unchanged state through feces. Instead, the metal absorbed through respiration or skin contact is exclusively eliminated via urine. Consequently, there is no toxic nickel accumulation in the general population except for those whose work puts them in daily contact with large quantities of this metal.

  Relationship between nickel allergy and diet. Sharma A.D.Indian J Dermatol Venereol Leprol. 2007 Sep–Oct; 73(5):307–12.

  Trace metal metabolism in plants. Andresen E., Peiter E., Küpper H. J Exp Bot. 2018 Feb 13.

  Sensitization to nickel: etiology, epidemiology, immune reactions, prevention, and therapy. Hostynek J.J.Rev Environ Health. 2006 Oct–Dec; 21(4):253-80.

  Minerals in foods: dietary sources, chemical forms, interactions, bioavailability. Hazell T.World Rev Nutr Diet. 1985; 46:1–123.

  Contact dermatitis

  Contact dermatitis, as the name suggests, is a dermatologic manifestation caused by contact with certain chemical substances. At the foundation of contact dermatitis there is an abnormal reaction in the body involving certain white blood cells called lymphocytes. The clinical form manifests itself through:

  - erythema (redness of the skin);

  - intense itching;

  - edema (swelling of the skin).

  Unlike urticaria, which manifests itself through welts that can last just a few hours or even through lesions that last several days.

  In the field of contact dermatitis there are two types: the "professional" form and a "common" form”. The first form relates to contact with chemical substances with uncommon uses. Therefore, it usually affects workers in particular sectors including construction, welding, plumbing, electricity, and cosmotology. The second type concerns contact with commonly used substances and therefore can affect anyone.

  There are numerous types of dermatitis caused by contact with rubber, metals, detergents, cosmetics, perfumes, and much more. For obvious reasons, the most affected areas are the hands, but any part of the body can be affected through the use of cosmetics, detergents, and so on.

  All contact dermatitis nickel sulphate allergies are distinguished by both frequency and symptomatology.

  Contact dermatitis: facts and controversies.

  Wolf R., Orion E., Ruocco E., Baroni A., Ruocco V. Clin Dermatol. 2013 Jul–Aug; 31(4):467-47.

  Metals in cosmetics: implications for human health. Borowska S., Brzóska M.M.

  J Appl Toxicol. 2015 Jun; 35(6):551-72.

  Nickel sulphate allergy

  Nickel is easily found and is a universal substance. It is contained in almost all metal alloys and is used in numerous consumer products such as detergents, cosmetics, dyes, fixers, stains, and more. Unlike other contact dermatitis, that of nickel is more widespread. Nickel dermatite has no specific site and may not be located.

  The allergic reaction is delayed. In fact, it occurs about 24 to 36 hours after contact. This is a common situation. A woman puts on silver earrings and, after a day she finds herself with the red, edematous, itchy lobes. A similar reaction could also occur after she touches the button on her pants or the metal hook of her bra.

  The allergic reaction tends to calm down after contact with nickel ceases, until the symptoms disappear. New contact, even in locations other than that previously exposed, can cause the appearance of similar skin reactions.

  It is very important to try to avoid contact with nickel. Although this may be possible for many people, it may be more difficult for those whose profession exposes them to nickel. For these people it is advisable to use protective equipment such as gloves or protective creams which limit direct and prolonged contact with the allergen in question.

  As previously mentioned, nickel can cause allergies even when consumed orally. Ingesting nickel-rich foods can cause similar reactions to that of contact dermatitis, an eczematous, itchy, reaction on the skin.

  To limit allergic reactions, it is essential to follow a low nickel diet. The total amount of allergen consumed during the day is the main factor to consider. Therefore, when planning a diet, the person suffering from the nickel allergy should track total daily intake, limiting the intake of products with high nickel content
.

  +++=

  In this book you will find a quick guide to foods that are richer in nickel, and therefore should not be consumed. You will also find information about foods that have little or no nickel and can be consumed freely.

  Systemic contact dermatitis to foods: nickel, BOP, and more. Fabbro S.K., Zirwas M.J.

  Curr Allergy Asthma Rep. 2014 Oct; 14(10):463.

  Diet and dermatitis: food triggers. Katta R., Schlichte M.

  J Clin Aesthet Dermatol. 2014 Mar; 7(3):30-6.

  Prevalence of nickel allergy in Europe following the EU Nickel Directive–a review. Ahlström M.G., Thyssen J.P., Menné T., Johansen J.D.

  Contact Dermatitis. 2017 Oct; 77(4):193-200.

  The SNAS

  SNAS (systemic nickel allergy syndrome) is a syndrome characterized by a dietary intolerance to nickel. Symptoms affect the gastrointestinal tract and can include as swelling, diarrhea and cramps, frequently accompanied by eczema and itchy skin.

  The diagnosis of SNAS is based anamnesis and patch tests. A negative result of the epicutaneous nickel sulphate test fully confirms that the patient does not have SNAS. On the other hand, a positive result does not confirm a SNAS diagnosis. Many sulphate allergy sufferers who react to nickel either through contact or ingestion show symptoms only through the skin, usually through widespread very itchy eczema that is resistant to therapy.