Dr. Ron’s Research Review – October 11, 2017

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This week’s research review focuses on Celiac disease and nickel contact allergy.

Nickel, the most frequent cause of contact allergy, can be found in wheat and results in systemic nickel allergy syndrome and mimics irritable bowel syndrome (IBS). A prospective study of 60 patients (54 females, 6 males) diagnosed with non-celiac wheat sensitivity (NCWS) found six patients (10%) with NCWS suffered from contact dermatitis and nickel allergy and this frequency was statistically higher (p = 0.04) than observed in the control group (5%). The main clinical characteristic of NCWS patients with nickel allergy was a higher frequency of cutaneous symptoms after wheat ingestion compared to NCWS patients who did not suffer from nickel allergy (p < 0.0001. Contact dermatitis and nickel allergy are more frequent in NCWS patients than in subjects with functional gastrointestinal disorders; furthermore, these patients had a very high frequency of cutaneous manifestations after wheat ingestion. Nickel allergy should be evaluated in NCWS patients who have cutaneous manifestations after wheat ingestion. (D'Alcamo et al., 2017)

Over the 20th century, the frequent use of nickel in consumer products resulted in an increasing prevalence of nickel allergy. Risk items included suspenders in the 1950s-1960s; buttons, zippers and rivets in the 1970s; and ear-piercing jewelry in the 1980s.
Mobile Phones may be a source of nickel and cobalt exposure for metal allergic patients. Of the 72 cell phones tested, no iPhones or Droids(®) tested positive for nickel or cobalt. About 29.4% of Blackberrys [95% confidence interval (CI), 13%-53%] tested positive for nickel; none were positive for cobalt. About 90.5% of flip phones (95% CI, 70%-99%) tested positive for nickel and 52.4% of flip phones (95% CI, 32%-72%) tested positive for cobalt. (Aquino et al., 2013)
A study found that stainless steel leaches nickel and chromium into foods during cooking. After 6 h of cooking, Ni and Cr concentrations in tomato sauce increased up to 26- and 7-fold, respectively, depending on the grade of stainless steel. Longer cooking durations resulted in additional increases in metal leaching, where Ni concentrations increased 34-fold and Cr increased approximately 35-fold from sauces cooked without stainless steel. Cooking with new stainless steel resulted in the largest increases. (Kamerud et al., 2013)

 

Dr. Ron


 

Articles

Mobile Phones: Potential Sources of Nickel and Cobalt Exposure for Metal Allergic Patients.
            (Aquino et al., 2013) Download
The use of cellular phones has risen exponentially with over 300 million subscribers. Nickel has been detected in cell phones and reports of contact dermatitis attributable to metals are present in the literature. We determined nickel and cobalt content in popular cell phones in the United States. Adults (>18 years) who owned a flip phone, Blackberry(®), or iPhone(®) were eligible. Seventy-two cell phones were tested using SmartPractice's(®) commercially available nickel and cobalt spot tests. Test areas included buttons, keypad, speakers, camera, and metal panels. Of the 72 cell phones tested, no iPhones or Droids(®) tested positive for nickel or cobalt. About 29.4% of Blackberrys [95% confidence interval (CI), 13%-53%] tested positive for nickel; none were positive for cobalt. About 90.5% of flip phones (95% CI, 70%-99%) tested positive for nickel and 52.4% of flip phones (95% CI, 32%-72%) tested positive for cobalt. Our study indicates that nickel and cobalt are present in popular cell phones. Patients with known nickel or cobalt allergy may consider their cellular phones as a potential source of exposure. Further studies are needed to examine whether there is a direct association with metal content in cell phones and the manifestation of metal allergy.

Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non-Celiac Wheat Sensitivity.
            (D'Alcamo et al., 2017) Download
BACKGROUND: Non-celiac wheat sensitivity (NCWS) is a new clinical entity in the world of gluten-related diseases. Nickel, the most frequent cause of contact allergy, can be found in wheat and results in systemic nickel allergy syndrome and mimics irritable bowel syndrome (IBS). Objective: To evaluate the frequency of contact dermatitis due to nickel allergy in NCWS patients diagnosed by a double-blind placebo-controlled (DBPC) challenge, and to identify the characteristics of NCWS patients with nickel allergy. Methods: We performed a prospective study of 60 patients (54 females, 6 males; mean age 34.1 ± 8.1 years) diagnosed with NCWS from December 2014 to November 2016; 80 age- and sex-matched subjects with functional gastrointestina l symptoms served as controls. Patients reporting contact dermatitis related to nickel-containing objects underwent nickel patch test (Clinicaltrials.gov registration number: NCT02750735). RESULTS: Six out of sixty patients (10%) with NCWS suffered from contact dermatitis and nickel allergy and this frequency was statistically higher (p = 0.04)than observed in the control group(5%. The main clinical characteristic of NCWS patients with nickel allergy was a higher frequency of cutaneous symptoms after wheat ingestion compared to NCWS patients who did not suffer from nickel allergy (p < 0.0001. CONCLUSIONS: Contact dermatitis and nickel allergy are more frequent in NCWS patients than in subjects with functional gastrointestinal disorders; furthermore, these patients had a very high frequency of cutaneous manifestations after wheat ingestion. Nickel allergy should be evaluated in NCWS patients who have cutaneous manifestations after wheat ingestion.

Stainless steel leaches nickel and chromium into foods during cooking.
            (Kamerud et al., 2013) Download
Toxicological studies show that oral doses of nickel and chromium can cause cutaneous adverse reactions such as dermatitis. Additional dietary sources, such as leaching from stainless steel cookware during food preparation, are not well characterized. This study examined stainless steel grades, cooking time, repetitive cooking cycles, and multiple types of tomato sauces for their effects on nickel and chromium leaching. Trials included three types of stainless steels and a stainless steel saucepan, cooking times of 2-20 h, 10 consecutive cooking cycles, and four commercial tomato sauces. After a simulated cooking process, samples were analyzed by ICP-MS for Ni and Cr. After 6 h of cooking, Ni and Cr concentrations in tomato sauce increased up to 26- and 7-fold, respectively, depending on the grade of stainless steel. Longer cooking durations resulted in additional increases in metal leaching, where Ni concentrations increased 34-fold and Cr increased approximately 35-fold from sauces cooked without stainless steel. Cooking with new stainless steel resulted in the largest increases. Metal leaching decreases with sequential cooking cycles and stabilized after the sixth cooking cycle, although significant metal contributions to foods were still observed. The tenth cooking cycle resulted in an average of 88 μg of Ni and 86 μg of Cr leached per 126 g serving of tomato sauce. Stainless steel cookware can be an overlooked source of nickel and chromium, where the contribution is dependent on stainless steel grade, cooking time, and cookware usage.

 

References

Aquino, M, et al. (2013), ‘Mobile Phones: Potential Sources of Nickel and Cobalt Exposure for Metal Allergic Patients.’, Pediatr Allergy Immunol Pulmonol, 26 (4), 181-86. PubMed: 24380018
D’Alcamo, A, et al. (2017), ‘Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non-Celiac Wheat Sensitivity.’, Nutrients, 9 (2), PubMed: 28157173
Kamerud, KL, KA Hobbie, and KA Anderson (2013), ‘Stainless steel leaches nickel and chromium into foods during cooking.’, J Agric Food Chem, 61 (39), 9495-501. PubMed: 23984718