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

Rizzi, Angela; Nucera, Eleonora; Laterza, Lucrezia; Gaetani, Eleonora; Valenza, Venanzio; Corbo, Giuseppe Maria; Inchingolo, Riccardo; Buonomo, Alessandro; Schiavino, Domenico; Gasbarrini, Antonio

doi:10.5056/jnm16027

Cited by 33 publications

(39 citation statements)

References 25 publications

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“…In the present study, we have analyzed the effectiveness of the combination of a low-Ni diet with the supplementation of a specific probiotic, selected on the basis of the dysbiosis type. First of all, confirming what some groups have previously reported [5,8,10,11,13,41], we want to emphasize that the low-Ni diet was very effective in reducing the clinical symptoms associated with SNAS, resulting in a significant increase in skin and oral Ni-tolerance levels. The assessment of urinary marker levels of gut microbiota functional imbalance, i.e., indican and skatole, allowed us to identify the type of dysbiosis in the 51 patients with SNAS, thus helping to accurately prescribe the most appropriate probiotic formulation.…”

Section: Discussionsupporting

confidence: 88%

The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

Lombardi

Fiasca

Minelli³

et al. 2020

Nutrients

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Background: Nickel (Ni) oral consumption may elicit systemic reactions in patients affected by systemic nickel allergy syndrome (SNAS), including gastrointestinal symptoms, which in turn are associated with gut dysbiosis. We evaluated the effects of a low-Ni diet alone or in combination with the oral consumption of appropriate probiotics on Ni-sensitivity and urinary dysbiosis markers in SNAS patients. Methods: n = 51 patients with SNAS and concomitant intestinal dysbiosis were enrolled in the study. According to the urinary indican/skatole levels, quantified through a colorimetric and a high-performance liquid chromatographic method, respectively, patients were assigned to a dysbiosis type/grade and followed a low-Ni diet for three months. Along with the diet, 22 patients also consumed probiotics based on the dysbiosis type. In particular, a Lactobacilli- or Bifidobacteria-containing formulation was administered to patients with fermentative or putrefactive dysbiosis, respectively, while a broad-spectrum probiotic formulation containing both Lactobacilli and Bifidobacteria was administered to patients with mixed dysbiosis. After three months, patients were invited to repeat the Ni-stimulation and the dysbiosis tests. Results: The fermentative dysbiosis group represented the largest group followed by the mixed dysbiosis group, while only two patients had putrefactive dysbiosis. Overall, at three months of treatment in general (diet alone with or without probiotics), the Ni-sensitivity and dysbiosis levels were strongly ameliorated. The association of a low-Ni diet with a specific probiotic oral supplementation was significantly more effective in decreasing dysbiosis levels or reaching eubiosis than with diet alone. Conclusion: Our results, while confirming the benefits of a low-Ni diet in SNAS patients, strongly support that appropriate adjuvant treatment with probiotics significantly helps to improve intestinal dysbiosis or restore a healthy microbiota.

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Section: Discussionsupporting

confidence: 88%

The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

Lombardi

Fiasca

Minelli³

et al. 2020

Nutrients

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“…Replacement of dental alloys with non-metal materials, as well as dietary control of nickel and palladium intake, may thus enhance the therapeutic effect of existing pharmacotherapy for UC patients. In this context, it is interesting to note that a low-nickel diet clearly alleviates the gastrointestinal symptoms of patients with irritable bowel syndrome [28], a disease that involves low-grade mucosal inflammation and aberrant T-cell activation similar to those in UC [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Higher Prevalence of Nickel and Palladium Hypersensitivity in Patients with Ulcerative Colitis

Kageyama

Shimokawa

Kawauchi

et al. 2020

Int Arch Allergy Immunol

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Background: The etiology of ulcerative colitis (UC) remains elusive even though many genetic and environmental pathogenic factors have been reported. Aberrant inflammatory responses mediated by specific subsets of T cells have been observed in ulcerative lesions of UC patients. Objectives: To elucidate the involvement of a delayed-type hypersensitivity reaction in UC, we focused on dental metal hypersensitivity, a T cell-mediated, delayed-type allergic reaction that causes oral contact mucositis and systemic cutaneous inflammation. Method: We recruited 65 Japanese UC patients and 22 healthy controls (HC) and used the in vitro lymphocyte stimulation test to quantify their sensitivity to zinc, gold, nickel, and palladium -the metals that have been widely used in dentistry. All subjects were users of metallic dental implants and/or prostheses containing zinc, gold, nickel, and/or palladium as major constituents. Results: Sixty percent of the UC patients were hypersensitive to at least one metal species, whereas 32% of the HC were hypersensitive to only a single metal species. The overall incidence of metal hypersensitivity was significantly higher for UC patients than for HC. Furthermore, a significantly greater proportion of UC patients were hypersensitive to nickel or palladium. The severity of the sensitivity to nickel and palladium was also significantly greater for UC patients than for HC. Conclusions: This pilot study demonstrates that UC patients have a significantly higher incidence of hypersensitivity to nickel and palladium, suggesting the possible involvement of dental metal hypersensitivity in UC pathogenesis.

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“…Sensitivity to dietary nickel has been recently proposed as a cause of IBS symptoms. In a clinical study, IBS patients with a positive nickel patch test were found to respond well to a low nickel diet with significant reductions in gastrointestinal symptoms [110]. It was hypothesized by the study investigators that dietary nickel may contribute to IBS symptoms by inducing a pro-inflammatory state.…”

Section: Nickel-related Intestinal Mucositismentioning

confidence: 99%

“…Diagnosis of dietary nickel sensitivity can be performed with a skin or oral mucosa patch test [110,112]. All patients reporting to a gastroenterology unit with IBS symptoms and suspected sensitivity to nickel containing foods had a positive response to an oral mucosa patch test characterized by local hyperemia and/or edema, compared to no response in a control group [113].…”

Section: Nickel-related Intestinal Mucositismentioning

confidence: 99%

Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not

Brown

2019

Gastrointestinal Disorders

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Significant shortcomings in irritable bowel syndrome (IBS) diagnosis and treatment may arise from IBS being an “umbrella” diagnosis that clusters several underlying identifiable and treatable causes for the same symptom presentation into one classification. This view is compatible with the emerging understanding that the pathophysiology of IBS is heterogeneous with varied disease mechanisms responsible for the central pathological features. Collectively, these converging views of the pathophysiology, assessment and management of IBS render the traditional diagnosis and treatment of IBS less relevant; in fact, they suggest that IBS is not a disease entity per se and posit the question “does IBS exist?” The aim of this narrative review is to explore identifiable and treatable causes of digestive symptoms, including lifestyle, environmental and nutritional factors, as well as underlying functional imbalances, that may be misinterpreted as being IBS.

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

Cited by 33 publications

References 25 publications

The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

Higher Prevalence of Nickel and Palladium Hypersensitivity in Patients with Ulcerative Colitis

Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not

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