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

  The percentage of people with nickel allergies varies by region. In Europe studies confirm that percentage of the population with nickel allergies varies from 8 to 18% with a female prevalence of 4 to 1. About 40% of these patients show reactions also on the gastrointestinal tract.

  Now we can begin to understand the pathogenesis of SNAS. We know that the nickel contact dermatitis is based on a type IV immune response according to the classification of Gell and Coombs (therefore a cellular response mediated by lymphocytes, and not humoral, ie mediated by IgE).

  Gell & Coombs Classification

  Type I

  Anaphylaxis

  Type II

  Cytotoxic

  Type III

  Immune complex disease

  Type IV

  Delayed

  Type V

  stimulatory

  Type VI

  Killer cells

  Type VII

  Antibodyi anti–receptor

  There is no information available about the pathology of the intestinal tract. The most probable hypothesis, still an educated guess, is that the same mechanism that leads to inflammation of the dermis can affect the mucous membrane of the gastrointestinal tract leading to local inflammation and consequent visceral symptoms.

  Here are the most common symptoms:

  SNAS therapy is based entirely on a low-nickel diet. In literature there are many diets that focus on reducing the content of nuts. It is difficult to understand what led well-known doctors to different conclusions. Perhaps, as mentioned above, different locations have plants with different levels of nickel. Another possibility is that studies have been completed during different periods of the year. What is certain is that the most important consideration is what the patient reports: the effects of a food on a person is key in creating a successful diet with low nickel content.

  Systemic contact dermatitis. Veien N.K.

  Int J Dermatol. 2011 Dec; 50(12):1445-56.

  Contact dermatitis as a systemic disease. Kulberg A., Schliemann S., Elsner P.

  Clin Dermatol. 2014 May–Jun; 32(3):414-9. doi: 10.1016/j.clindermatol.2013.11.008.

  Systemic contact dermatitis.

  Nijhawan R.I., Molenda M., Zirwas M.J., Jacob S.E. Dermatol Clin. 2009 Jul; 27(3):355-64.

  Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?

  Rizzi A., Nucera E., Laterza L., Gaetani E., Valenza V., Corbo G.M., Inchingolo R., Buonomo A., Schiavino D., Gasbarrini A.

  J Neurogastroenterol Motil. 2017 Jan 30; 23(1):101-108.

  A low nickel diet

  Food with high nickel content according to different sources

  ]

  A

  B

  C

  D

  E

  F

  G

  H

  I

  L

  M

  almonds

  apricots

  Asparagus

  Avocado

  Baking powder

  beans

  Beer

  Broccoli

  Cabbage

  Carrots

  Cashevnuts

  Caulifower

  Cocoa chocolade

  Cocunut power

  Coffee

  Corn

  Crustaceans

  Dried fruits

  Figs

  Garlic

  Hazelnuts

  herring

  Lentils

  Lettuce

  Licorice

  Linseed

  Mackerel

  Margarine

  Mushrooms

  A

  B

  C

  D

  E

  F

  G

  H

  I

  L

  M

  nuts

  porrige

  Onion

  Peanuts

  Pears

  Peas

  Pistachio

  Poppy seeds

  Potato

  Prunes

  Raisin

  Raspberries

  Rhubarb

  Rie

  Salmon

  Shellfish

  Soybean seeds

  Spinach

  Sunflower seeds

  Tap water (initial flow)

  tea

  tomatoes

  Tuna

  Whole wheat flour

  a) Flynholm 1984 [1], b) Veien [2, 3]; c) 1994 Venuti [4] d) Christensen 1999; e) Schiavino et al. 2006 [5] f ) Sharma 2007 [5], g) Falagiani, Schiavino et al. 2008 [8] h) Veien, 1993 [8], i) Swedish Food Administration [28], l) Fonacier 2010 [7]; m) Picarelli 2010 [30

  a). Flyvholm MA, Nielsen GD, Andersen A. Nickel content of food and estimation of dietary intake. Z Lebensm Unters Forsch. 1984; 179 (6):427-31

  b). Veien NK, Hattel T, Justesen O, Norholm A. Dietary treatment of nickel dermatitis. Acta Derm Venereol Suppl (Stockh). 1985; 65:138-42.

  c). Venuti A, Di Fonso M, Romano A. Allergia al nichel: stato dell’arte. Not Allerg 1994; 13:95-7.

  d) 6. Schiavino D, Nucera E, Alonzi C, et al. A clinical trial of oral hyposensitization in systemic allergy to nickel. Int J Immunopathol Pharmacol 2006; 19(3):593-600

  e. Schiavino D, Nucera E, Alonzi C, et al. A clinical trial of oral hyposensitization in systemic allergy to nickel. Int J Immunopathol Pharmacol 2006; 19(3):593-600. 27.

  f. Sharma AD. Relationship between nickel allergy and diet. Indian J Dermatol Venereol Leprol 2007; 73:307-12.

  g) Falagiani P, Di Gioacchino M, Ricciardi L, et al. Systemic nickel allergy syndrome (SNAS). A review. Rev Port Imunoalergologia 2008; 16 (2):135-47.

  h) Veien NK, Hattel T, Laurberg G. Low nickel diet: an open, prospective trial. J Am Acad Dermatol. 1993; 29:1002-7.

  i) . www.melisa.org/nickel.php (site web)

  l) . Fonacier L, Dreskin S, Leung D. Allergic Skin Disease. J Allergy Clin. Immunol 2010; 125:S138-49.

  m) Picarelli A, Di Tola M, Vallecoccia A, et al. Oral mucosa patch test: a new tool to recognize and study the adverse effects of dietary nickel exposure. Biol Trace Elem Res 2010 Mar 5 (Epub ahead of print)

  A typical European diet contains 300-600 micrograms of nickel per day, mainly coming from vegetables. Some factors influence the intake of nickel in a diet. For example, eating oranges, foods rich in high vitamin C, and milk can all greatly reduce the intake of nickel. Anemia, on the other hand, is a condition that increases the body’s absorption of nickel. Therefore, treating anemia through martial therapy can reduce the absorption of nickel. Moreover, two of the exact same types of vegetables can contain different levels of nickel since the concentration of nickel is influenced by where the plant is grown, the season, and even the age of the plant’s leaves.

  To achieve a low nickel diet, it is important not to eat many foods with high nickel content in one day. While the food allergies that cause urticaria are not dependent on the dose (a gram of peanuts or a pound makes no difference), as far as nickel is concerned, the manifestation of the allergy is strictly connected to the quantity assumed.

  Low nickel diet in dermatology. Sharma A.D.

  Indian J Dermatol. 2013 May; 58(3):24.

  Relationship between nickel allergy and diet. Sharma A.D.

  Indian J Dermatol Venereol Leprol. 2007 Sep–Oct; 73(5):307–12.

  Nickel content of food and estimation of dietary intake. Flyvholm M.A., Nielsen G.D., Andersen A.

  Z Lebensm Unters Forsch. 1984 Dec; 179(6): 427–31.

  What Role Does Diet Play in the Management of Nickel Allergy? Cunningham E.

  J Acad Nutr Diet. 2017 Mar; 117(3):500.

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

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

  The table below lists the nickel content in some foods and was originally reported in a paper by Rizzi et al (2017). This should be kept in mind when following a low nickel diet.

  Ni 100 µg/kg

>   Ni 200 µg/kg

  Ni 500 µg/kg

  Ni >500 µg/kg

  Carrots

  Apricot

  Artichokes

  Almonds

  Figs

  Broccoli

  Asparagus

  Chickpeas

  Lettuce

  Corn

  Beans

  Cacao

  Green salad

  Lobster and crab

  Cabbag

  Tomato Concentrate

  Liquorice

  Onions

  Cauliflower

  Lentils

  Mushrooms

  Pears

  Green beans

  Wheat

  Plaice (fish)

  Cod

  Raisins

  Whole wheat products

  Nuts

  Rhubarb

  Yeast

  Peanuts

  Tea

  Margarine

  Mussels

  Oysters

  Potatoes

  Peas

  Plums

  Spinach

  Tomatoes

  Risks of a nickel-free diet

  As we have seen nickel is contained in many vegetables. Therefore, a person with a nickel allergy is forced to follow a diet containing very few vegetables.

  We know that an adequate intake of vegetables and fruit is an essential component in a healthy, balanced diet since these foods are rich in fiber, vitamins, minerals, and more. Let's take a deeper look at the benefits of vegetables and fruit consumption in the diet.

  Fruits and vegetables are rich in fiber. This fiber, once in the intestine, delays the absorption of sugar and prevents peaks of hyperglycemia. Hyperglycemia can be harmful for the glycemic metabolism because it can induce the release of insulin which in turn, over time, causes a metabolic syndrome resulting in obesity. No less important is the function of fiber in the regulation of the cinesis and of the intestinal transit. Fiber is made up mostly of cellulose, a substance that is not digested by our intestines and is excreted thus creating fecal mass and facilitating defecation.

  Blue/purple

  Eggplant Blueberries

  Plums

  AnthocyaninPotassium

  Magnesium

  White

  Onions

  Garlic

  porri

  Plyphenols

  Selenium Potatssium

  Green

  Asparagus

  Broccoli Spinach

  Folic acid Beta carotene Lutein

  Yellow

  Lemos

  Grapegruit

  Carrots

  Vitamin C Potassium

  Flavanoids

  Red

  Tomatoes Strawberries Peppers

  AnthocyaninLycopene Selenium

  Finally, fiber helps one to feel full and therefore, helps us to limit the intake of other foods, counteracting obesity. The WHO recommends eating 25 grams of fiber per day which would mean 350 to 450 grams of fruit and/or

  vegetables. The WHO recommends to always consume fruits and vegetables of different colors. This is important since different colors correspond to different substances. The body needs various substances, and therefore, you cannot only eat oranges and mandarins enriched with vitamin C and neglect all other vitamins.

  Furthermore, vegetables help support colon health (see Mediterranean diet) which is linked to the prevention of colon cancer. Carotenoids, selenium, zinc, and flavonoids are all found often in vegetables. These substances have an important antioxidant function, neutralizing free radicals that are harmful to the body and preventing the build-up of cholesterol on the artery walls.

  Potassium and magnesium are also commonly found in vegetables and are incredibly important for our metabolism. Potassium is the element that causes both the contraction of muscle fibrocells and synaptic transmission between nerve cells.

  Factors that influence nickel absorption

  There are some factors that influence the absorption of nickel in a diet:

  1. anemia;

  2. smoking;

  3. cooking methods.

  Anemia is the deficiency of hemoglobin in the blood. Hemoglobin is a protein that binds to oxygen and transports it from the lungs to tissues throughout the body. Then, it is used in the Krebs cycle to supply energy to our body. Anemia, in addition to causing a sense of tiredness, alopecia, and mood changes, also encourages the absorption of nickel. Therefore, it is of even more importance for a nickel-allergic patient is to correct the values ​​of hemoglobin. Once the blood levels of sideremia, folic acid and vitamin B12 are in order, the patient must take iron, folate, and vitamin B12 orally to restore hemoglobin values.

  It is common knowledge that smoking causes lung and bladder cancer, damages the lungs, leads to chronic bronchitis, and causes pulmonary emphysema. Smoking can also increase the risk of infarction, tissues death, and atherosclerosis, the buildup of fats, chloesterol, and other substances in the artery walls which can restrict blood flow.

  Maybe less commonly known, smoking also promotes the absorption of nickel. In fact, the combustion of tobacco creates a substance called "nickel-carbonyl" which is inhaled by the smoker. This substance reaches the pulmonary alveoli and is absorbed by the blood where it favors the haemoconcentration of nickel.

  Cooking food can decrease the nickel concentration in food. It is essential that the food is cooked in nickel-free pans made of non-ferrous materials such as teflon, ceramic, or glass. If you are using steel pans check that they are in 18/10 stainless steel. When cooking food in an oven, cooking sheets must be covered with baking paper. As for stiring, one should choose a spoon made of wood or polycarbonate material, especially at high temperatures.

  Gastrointestinal absorption of metals.

  Diamond G.L., Goodrum P.E., Felter S.P., Ruoff W.L. Drug Chem Toxicol. 1998 May; 21(2):223-51.

  The epicutaneous test, also called the patch test

  The patch test is a special test used to diagnose cutaneous and diffusive allergic skin reactions. The causes of these types of dermatitis can be traced back to the contact with or ingestion of chemical substances often contained in commonly used objects or foods. The mechanism of contact allergy is cellular or delayed type IV in the classification of allergic reactions according to Gell and Coombs.

  The reaction to the allergen is therefore of cellular type and not of antibodies, and, as the name says, is not immediate but delayed. When a patient has contact with an allergen the allergic reaction occurs after about 12 to 24 hours after, unlike the classic humoral or immediate allergy that occurs within a few minutes of contact.

  Here's how the test is performed:

  The patient comes to the office, having been sure not to take cortisone and/or antihistamines for a week. On a special patch the doctor deposits chemicals (allergens) and the patch is applied to the patient's back.

  The patient should refrain from sports and should not bath or shower until the patch is removed by the doctor after 48 to 72 hours. The evaluation will be performed when the patch is removed. Some substances will not cause a reaction. However, in case of a positive correspondence of the chemical substance with an allergy, a local allergic reaction will be present through redness, appearance of eczema, and intense itching. This reaction will clear up on its own within 2 or 3 days