Is There Nickel In Titanium Implants & Is Nickel Toxic?

A nickel allergy is an allergic reaction caused by contact with nickel-containing substances, a so-called contact allergy. It can also happen when you ingest food containing nickel. Nickel ranks first worldwide in the hit list of contact allergens (a cause of allergy). The allergy to nickel is particularly common among hairdressers. Women are more susceptible to nickel allergy than men with 0.8 to 5.9% of men are affected in the population, but around 11% of women are affected. Nickel allergy is more common in people under the age of 30 years.1

Is There Nickel In Titanium Implants?

Is There Nickel In Titanium Implants?

Titanium implants are usually free of nickel. However, sometimes nickel-titanium alloys are used. Nickel deposits in biocompatible titanium implants may also cause nickel allergy and subsequent allergic reactions.4,5

Is Nickel Toxic?

For individuals with no nickel allergy, the metal is toxic only when consumed in large amount (more than 500mg). But, to an allergic person, a lower dose may trigger severe allergic conditions. Nickel is more toxic when inhaled through the air. Some compounds of nickel such as nickel carbonyl cause severe toxicity when inhaled. Inhalation of nickel can be carcinogenic as well.6

The most common form of nickel allergy is in the form of eczema at the point of contact with itching, redness and watery blisters. With increasing sensitivity, eczema can also occur on more distant areas of the skin, for example, in the armpits or on the face, and in particularly severe cases all over the skin. In people with high sensitivity to nickel, eating nickel-containing foods can trigger eczema that affects the entire body parts, especially the eyelids, elbows, neck, and hands. Also, ear canal eczema, head itch, hair loss, joint pain, migraine, and fatigue are possible.2

Skin tests, drinking tests, and so-called patch tests are used for the diagnosis. Especially common is the dimethylglyoxime test. In this case, the suspected object is dipped in a solution with dimethylglyoxime and then some of the solutions are applied to the skin. If the affected skin area shows an allergic reaction within 72 hours, this will substantiate the suspicion of a nickel allergy.3

Nickel Is An Important Trace Element In Our Body

Nickel is present mainly in the skin, in the bone marrow and in various enzymes. In addition, scientists have found that nickel and iron concentrations in the human body are closely linked. However, all these nickel does not trigger an allergic reaction. A prerequisite for an allergy is long-term skin contact with nickel and a hereditary predisposition to allergies, while the nickel allergy it is not inherited. People with atopic dermatitis seem to be particularly vulnerable to the nickel allergy. It has become clear that there are binding sites for nickel in the immune system itself, which trigger an immune reaction. This explains why one can be allergic to nickel, but not to other metals.

The Nickel Allergy Is Triggered By Nickel Ions

These are the smallest nickel particles that can be released from nickel-containing objects during prolonged skin contact. These nickel ions penetrate the skin and can alert the immune system to people who are prone to allergies. It subsequently forms antibodies against the intruder. Renewed contact then triggers allergic symptoms. This does not have to be done through the skin; even the inhalation of nickel-containing smoke (cigarettes) or the consumption of nickel-containing foods can cause allergic symptoms.

Often the smallest amounts of nickel are sufficient. The manifestation often happens in childhood, especially in girls who are adorned early with a necklace or stud earrings. Since 1993, however, allergy to young girls has been on the decline.2

Inflammation Promotes The Development Of Nickel Allergy

Inflammation of the skin in the area of nickel contact has an effect on the development of nickel allergy. So, piercing of earlobes (and other areas of the body, such as the nose, naval, etc.) with nickel-containing pins and then attaching nickel-containing jewelry in the wound area very often leads to nickel allergies.2

Conclusion

Exposure to nickel through skin contact can cause contact allergy to certain individuals who are sensitive to nickel. The most common form of nickel allergy is usually in the form of eczema at the point of contact with itching, redness and watery blisters. Skin tests, drinking tests, and so-called patch tests are used for the diagnosis. Nickel deposits in biocompatible titanium implants may also cause nickel allergy. Nickel is toxic only when consumed in high doses for non-allergic individuals. But inhalation of nickel-containing compounds can pose serious health risks. People with a nickel allergy should avoid contact or ingestion of nickel even in a small amount.

References:  

  1. Ahlström M, Thyssen J, Menné T, et al. Short contact with nickel causes allergic contact dermatitis: an experimental study. British Journal of Dermatology. 2018;179(5):1127-1134.
  2. Ahlström MG, Thyssen JP, Wennervaldt M, Menné T, Johansen JD. Nickel allergy and allergic contact dermatitis: a clinical review of immunology, epidemiology, exposure and treatment. Contact dermatitis. 2019.
  3. Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel allergy in adults in the US: 1962 to 2015. Dermatitis. 2015;26(5):216-223.
  4. Albrektsson T, Chrcanovic B, Mölne J, Wennerberg A. Foreign body reactions, marginal bone loss and allergies in relation to titanium implants. European journal of oral implantology. 2018;11.
  5. Pulikkottil VJ, Chidambaram S, Bejoy P, Femin P, Paul P, Rishad M. Corrosion resistance of stainless steel, nickel-titanium, titanium molybdenum alloy, and ion-implanted titanium molybdenum alloy archwires in acidic fluoride-containing artificial saliva: An in vitro study. Journal of pharmacy & bioallied sciences. 2016;8(Suppl 1):S96.
  6. Alhadrami HA, Mbadugha L, Paton GI. Hazard and risk assessment of human exposure to toxic metals using in vitro digestion assay. ChemiCal SpeCiation & BioavailaBility. 2016;28(1-4):78-87.

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