Immunological characterization of the allergic contact mucositis related to the ingestion of nickel-rich foods

Tola, Marco Di; Marino, Mariacatia; Amodeo, Rachele; Tabacco, Fabio; Casale, Rossella; Portaro, Luciano; Borghini, Raffaele; Cristaudo, Antonio; Manna, Fedele; Rossi, Alfredo; Pità, Ornella De; Cardelli, Patrizia; Picarelli, Antonio

doi:10.1016/j.imbio.2014.03.010

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…They also typed the peripheral blood lymphocytes after ePT, showing an increase in γδ T cells in peripheral blood, although there were no significant differences in the distribution of lymphocyte subtypes among patients with positive ePT and controls. All these results support the hypothesis that a delayed-type hypersensitivity (type IV hypersensitivity) may be implied in both Ni allergic contact mucositis and allergic contact dermatitis [7,13]. The above listed techniques actually revealed useful, despite some of them require skilled laboratory personnel and/or imply invasive procedures, such as labial mucosa biopsy.…”

Section: Introductionsupporting

confidence: 68%

“…The first alterations seem related to a toll-like receptor (TLR)4-dependent innate immune response, whereas the latest could be identified as a type IV hypersensitivity reaction. These mucosal abnormalities have been defined as allergic contact mucositis [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, according to Di Tola et al [12], the calculation of post/pre Ni to omPT cell ratio in peripheral blood lymphocyte typing can support omPT in allergic contact mucositis diagnosis, with quantitative and objective data. In another study, the same authors [7] proposed lymphocyte typing and evaluation of specific TLRs by immunohistochemistry performed on biopsy specimens of labial mucosa after positive Ni omPT. In these biopsies, CD3+ T cells were evidenced in all mucosal layers, together with their intra-epithelial migration towards the omPT application site.…”

Section: Introductionmentioning

confidence: 99%

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Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Borghini

Puzzono

Rosato

et al. 2016

Biol Trace Elem Res

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Nickel (Ni) is often the trigger of irritable bowel syndrome (IBS)-like gastrointestinal disorders: its ingestion may cause allergic contact mucositis, identifiable by means of oral mucosa patch test (omPT). OmPT effectiveness has been proven, but it is still an operator-dependent method. Laser Doppler perfusion imaging (LDPI) was tested to support omPT in Ni allergic contact mucositis diagnosis. Group A: 22 patients with intestinal/systemic symptoms related to the ingestion of Ni-containing foods. Group B: 12 asymptomatic volunteers. Ni-related symptoms and their severity were tested by a questionnaire. All patients underwent Ni omPT with clinical evaluation at baseline (T0), after 30 min (T1), after 2 h (T2), and after 24-48 h (T3). LDPI was performed to evaluate the mean mucosal perfusion at T0, T1, and T2. Statistical analysis was performed by ANOVA test and Bonferroni multiple-comparison test. All 22 Ni-sensitive patients (group A) presented oral mucosa hyperemia and/or edema at T2. Eight out of the same 22 patients presented a local delayed vesicular reaction at T3 (group A1), unlike the remaining 14 out of 22 patients (group A2). All 12 patients belonging to control group B did not show any alteration. The mean mucosal perfusion calculated with LDPI showed an increase in both subgroups A1 and A2. In group B, no significant perfusion variations were observed. LDPI may support omPT for diagnostic purposes in Ni allergic contact mucositis. This also applies to symptomatic Ni-sensitive patients without aphthous stomatitis after 24-48 h from omPT and that could risk to miss the diagnosis.

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Section: Introductionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Borghini

Puzzono

Rosato

et al. 2016

Biol Trace Elem Res

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“…Furthermore, we have not performed any study to evaluate the hypothesis that nickel allergy could contribute to the pathogenesis of NCWS. It has been demonstrated that some immunologic pathways involved in the nickel-induced mucositis and dermatitis, i.e., the inflammatory response via the activation of TLR4 and the infiltration of lymphocytes that secrete Interleukin (IL)-17 and Interferon-gamma (IFN)-γ [ 25 , 26 ], have also been supposed or demonstrated in NCWS [ 5 , 7 , 8 , 9 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non‐Celiac Wheat Sensitivity

et al. 2017

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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 gastrointestinal symptoms served as controls. Patients reporting contact dermatitis related to nickel-containing objects underwent nickel patch test ( 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.

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“…A recent work by Di Tola et al using flow cytometry technique demonstrate that in nickel sensitive patients, after oral exposure to nickel, circulating Th and Cytotoxic T cells are significantly increased [65]. With regards to OCA the analysis of peripheral blood population using flow cytometry would be a useful as complementary tool for diagnosis.…”

Section: Unmet Needsmentioning

confidence: 99%

Unmet diagnostic needs in contact oral mucosal allergies

et al. 2016

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The oral mucosa including the lips is constantly exposed to several noxious stimuli, irritants and allergens. However, oral contact pathologies are not frequently seen because of the relative resistance of the oral mucosa to irritant agents and allergens due to anatomical and physiological factors. The spectrum of signs and symptoms of oral contact allergies (OCA) is broad and a large number of condition can be the clinical expression of OCA such as allergic contact stomatitis, allergic contact cheilitis, geographic tongue, oral lichenoid reactions, burning mouth syndrome. The main etiological factors causing OCA are dental materials, food and oral hygiene products, as they contain flavouring agents and preservatives. The personal medical history of the patient is helpful to perform a diagnosis, as a positive history for recent dental procedures. Sometimes histology is mandatory. When it cannot identify a direct cause of a substance, in both acute and chronic OCA, patch tests can play a pivotal role in the diagnosis. However, patch tests might have several pitfalls. Indeed, the presence of metal ions as haptens and specifically the differences in their concentrations in oral mucosa and in standard preparation for patch testing and in the differences in pH of the medium might result in either false positive/negative reactions or non-specific irritative reactions. Another limitation of patch test results is the difficulty to assess the clinical relevance of haptens contained in dental materials and only the removal of dental materials or the avoidance of other contactant and consequent improvement of the disease may demonstrate the haptens’ responsibility. In conclusion, the wide spectrum of clinical presentations, the broad range of materials and allergens which can cause it, the difficult interpretation of patch-test results, the clinical relevance assessment of haptens found positive at patch test are the main factors that make sometimes difficult the diagnosis and the management of OCA that requires an interdisciplinary approach to the patient.

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Immunological characterization of the allergic contact mucositis related to the ingestion of nickel-rich foods

Cited by 16 publications

References 19 publications

Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Nickel-Related Intestinal Mucositis in IBS-Like Patients: Laser Doppler Perfusion Imaging and Oral Mucosa Patch Test in Use

Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non‐Celiac Wheat Sensitivity

Unmet diagnostic needs in contact oral mucosal allergies

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