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Some patients with nickel (Ni) allergic contact dermatitis suffer from systemic (intestinal or cutaneous) symptoms after ingestion of Ni-rich foods and experience symptoms reduction with low-Ni diet, a condition termed "systemic Ni allergy syndrome" (SNAS). We aimed at evaluating whether oral administration of low nickel doses improved clinical conditions and modulated immunological aspects of SNAS, without significant side effects. Thirty-six SNAS patients were enrolled. Treatment started after L-month of lowNi diet and consisted in an incremental oral NiOH dose phase (O.3ng to 1.5 ug/week) followed by a 12-months maintenance phase (1.5 ug/week). Randomly, twenty-four patients added Ni therapy to low-Ni diet and 12 remained with diet alone. All patients were allowed rescue medications (antihistamines and topical steroids). After 4 months, Ni-rich foods were gradually reintroduced. In vitro allergen-driven IL13, IL5 and IFNy release by peripheral blood mononuclear cells was evaluated before and after treatment. Twenty-three patients receiving NiOH and the 12 control patients completed the study. Evaluation of SNAS clinical severity (by VAS and drug consumption) showed a significant difference in favor of NiOHtreated patients compared to controls. Twenty of 23 patients in the NiOH group and none in the control group tolerated Ni-rich food reintroduction. Release of all studied cytokines in culture supernatants was significantly lower after NiOH treatment. In conclusion NiOH is effective in reducing symptoms and drug consumption in SNAS and is able to modulate inflammatory parameters.Nickel (Ni), a ubiquitous metal, is the commonest cause of allergic contact dermatitis (ACD), with a prevalence of about 10% in the adult population (1-4). Ni allergy can cause dermatological lesions not only in skin regions in contact with the metal, but also in other regions, as demonstrated by cases of generalized eczema and urticaria in patients with Nicontaining dental (5-7) or orthopedic (8) prostheses.

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