Sarah Merson explores.

Ninety per cent of us don’t think twice when we pull on our jeans, put on a pair of earrings, cut some vegetables with a metal-handled knife or even pick up a mobile phone. Yet, according to government statistics, at least 10% of the female population and at least 1% of the male population suffer from nickel allergy.

In the 50s and 60s, nickel allergy was most commonly caused by metal buckles found on suspender belts to hold up nylon stockings. Then later on, a change in fashion triggered a new reaction in epidemic-like proportions – piercing. From ears to eyebrows and lips to belly buttons, when piercing first became fashionable, most of the jewellery used was cheap and made with nickel alloys, thus causing widespread reactions.

Today it’s not only the fashion conscious that are affected as domestic or work-related items can also cause problems, especially those that are used frequently or for a long period of time. Dress-makers for example may be susceptible to symptoms through the use of pins and needles whilst hairdressers may be affected by metal hair styling combs, tongs, metal-handled brushes or even dryers. Those in the catering industry may also suffer symptoms through using metal-handled knives and utensils, or even wire wool scouring pads, which can also contain nickel.

A recent study from Stony Brook University, USA, shows that mobile phones and iPods in particular could be causing symptoms in those who are sensitive to various metals, but nickel in particular.

What is nickel
But, what exactly is nickel and how do you know if you have an allergy to it? Nickel is the fifth most common element after iron, oxygen, silicon and magnesium and is most often found in domestic use, in everything from jewellery to stainless steel cooking pots. A reaction to nickel occurs through direct contact with the skin and can vary from a simple rash that comes and goes, to contact dermatitis (swollen, itchy, reddened skin) and angry swollen blisters. The symptoms may develop after initial exposure to nickel, or after repeated or prolonged exposure. In most cases, it occurs only at the site of contact, though it may be found on other parts of the body as well.

Sweating whilst wearing an item containing nickel can also increase the chance and severity of symptoms. There often exists a problem with poppers, metal studs on jeans and metal zips in that, even if they’re covered with fabric, sweating is enough to leach the nickel from the metal and cause a reaction. Some people can get away with painting earrings and the back of wristwatches with clear nail varnish – make sure it’s toluene-free and hypoallergenic – but this tends to wear off after a short period.

Diagnosis
According to Dr Veronica Kirton from the Chiltern Hospital, Great Missenden, the best way to be certain that you have a nickel allergy is by patch testing, a specialist procedure carried out over four days by a dermatologist.

If you’ve got a collection of jewellery at home you can also use a DIY testing kit to see how much nickel it contains. Dr Kirton recommends the simple Chemotechnique Nickel Spot Test. You put a few drops of the solution onto a cotton bud, rub the metal surface of the suspect item and if the cotton bud turns pink, free nickel is present.

Treatment
The normal treatment is to use steroid creams and lots of moisturiser. In very severe cases, it may be necessary to take steroid tablets by mouth. Ideally though, with the right preparations, you can avoid the symptoms of nickel allergy in the first place.

First and foremost, you should try to avoid prolonged physical contact with any objects that contain nickel. According to John Milligan, deputy chairman of the Jewellery Distributors Association and former chairman of the Nickel Working Group, you should start by avoiding jewellery, which isn’t guaranteed to be nickel-free. In this country we’re protected by legislation, which means that we’re exposed to nickel through the jewellery that we wear, less and less. Any new product being sold by a member of the Jewellery Distributors Association undergoes comprehensive testing, thus protecting the consumer.

Nickel in the USA
Much of the bad press on nickel comes from the United States where the Professor of Dermatology at the University of California, Dr Howard Maibach, recently presented evidence that an estimated 5.8% of American adults tested positive to nickel through a routine skin test – probably caused by contact with cheap jewellery. A ‘safe-limit price’ as a guide for consumers who want to avoid excessive nickel exposure but according to Dr Maibach, ‘in the US, it’s advisable to look for jewellery and clothing labelled nickel-free or hypoallergenic and if you know you’re allergic to nickel, wear only stainless steel, platinum or gold jewellery’.

European Directive
In the UK however, we’re fortunate to be protected under the European Directive, which controls the allowable amount of nickel used in items coming into contact with, or piercing the skin. From July 2001 it has been ‘illegal to sell to a consumer any product that was made or imported into the EU after January 2000 and intended to come into direct and prolonged contact with the skin, which releases from the parts of these products coming into contact with the skin more than a set limit of nickel ions’.

For items like rings, watches, bracelets and necklaces, half a microgram per square cm of surface area is the maximum allowed, whilst items intended for use in piercing are restricted to less than 0.2 of a microgram per square cm. Manufacturers have to comply with these standards, whilst retailers have been forced to sell existing stock within a given time frame. The majority of the jewellery and watch trade have taken their responsibilities seriously, and tens of thousands of pounds have been spent on product testing and experiments to remove nickel completely, to reduce the amount of nickel released and to develop compliant products. Since the legislation became enforceable, the amount of non-compliant products being seen by the test houses has dropped drastically and it is estimated that well over 90% of products tested now pass.

Whatever the product specification may say and whatever reassurances the importer or retailer may have received from the original supplier, the practice of ‘due diligence’ to ensure that products are complaint still requires ‘all reasonable steps’ to be taken. This should include some routine and random testing to BS EN 1811, the test stipulated in the UK Nickel regulations (and the European Directive).

There has however been some controversy surrounding the implementation of the directive, largely due to tests being costly and taking up to ten days to complete in an analytical laboratory. For these reasons, the directive was reviewed in 2004. In the UK the negotiations for this were handled by the Department of Trade & Industry with input coming primarily through the Nickel Working Group. For further information on nickel testing according to the European Directive, contact the Nickel Working Group – see below.

Can diet help?
Medical opinion is divided on whether or not diet can help treat symptoms of nickel allergy or not, but natural health experts have long believed that dietary changes can make a significant difference.

‘There are many foods that contain nickel and by avoiding them you can decrease the allergen load on your body and seriously reduce the severity of symptoms’, says naturopath Michael Van Straten.

The danger foods include some food and drink, which contain very small amounts of nickel and are best avoided or taken in very small amounts whilst experiencing an acute attack of dermatitis. They are mackerel, tuna, raw tomato, onion and carrot, apple, citrus fruit and juice.

‘Try limiting or avoiding these foods for at least two months and you may find that your attacks get less frequent and much less severe. Then re-introduce the foods one at a time eating just a little and allowing 48 hours before you add another. Keep a careful note of what happens and you will soon be able to pick out any that obviously aggravate your condition’, says Van Straten.

Cooking
Thinking about the way you cook could also play a role. When cooking with water, it’s advised to let the water run for a good 10 seconds in case any nickel has dissolved out of the pipework. It’s also important not to cook in pots made with nickel. Good quality stainless steel is usually fine but beware if you’re cooking very acidic food, as some of the nickel from the pan could dissolve and leak into the food.

Further information from:
Jewellery Distributors' Association
0845 2260 532

The Nickel Working Group
020 8444 7039

More miscellaneous articles on non-food allergy

First published in 2008

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