What Are The First Symptoms Of Nickel Allergy & How Do You Test For It?

Nickel allergy is a form of allergic contact dermatitis in which the nickel acts as an allergic substance to which the body reacts in the same manner as that of an allergic reaction. Nickel is the most common substance responsible for allergic contact dermatitis among the metallic elements in the world. It is worn in the form of earrings, nose pin, ring, anklet, etc. and as other ornaments [1]. Sometimes few metals can have nickel coating upon them like a zipper, button, etc.

What Are The First Symptoms Of Nickel Allergy?

What Are The First Symptoms Of Nickel Allergy?

The symptoms of nickel allergy are similar to that of an allergic reaction by the body. It is commenced in a similar process because the mechanism is the same. The earliest or the first symptom to arrive is redness or erythema. All the signs of inflammation appear at the earliest which are described by Celsus as Rubor (redness), Calor (warm), dolor (pain) and Tumor (swelling). The area in contact with nickel becomes inflamed and the local dilation of vessels occurs leading to the increased blood supply to the area causing the redness. Eventually, there is the development of vesicles filled with exudate or papules which are extremely pruritic in nature. These papules are surrounded by the erythematous base. Burning sensation or itching are common symptoms experienced by the patient. This may increase in size and form blisters filled with fluid.

A severe form of presentation is seen as erythema multiforme. These are characterized by target lesions that have three different zones with circular appearance. These are more difficult to treat and have higher morbidity. These are caused due to a variety of reasons and are more difficult to diagnose because of generalized appearance. (1)

How Do You Test For Nickel Allergy?

For testing the allergic response to the nickel or any other element, a common test is done known as a patch test. In this test, the variety of antigens which are capable of initiating immune response are put on a membrane with different pits for different antigens or they can we put directly upon the skin of the individual. It is left for a few days and the response of the skin is noted on day 2, day 4 and day 7. Day 2 shows only a few heavy metals to elicit an allergic response. Day 4 shows a maximum number of allergic responses to metallic elements and other antigens and is the best reading for a patch test. Day 7 shows a few of antigen containing antibiotics and is usually less required. Nickel also shows the allergic reaction on the fourth day of the patch test.

For the quantitative measurement of nickel exposure and its sufficiency or insufficiency to cause the allergic response is measured by a test known as the dimethylglyoxime test. It can detect the amount of nickel exposure to the individual and can elucidate whether it is sufficient to cause an allergic reaction in the body or not. Sometimes the testing is not as conclusive as it should be and it comes as weakly positive. In those cases, a repeat open application test is done to elucidate more response for confirmation of the allergy to a particular substance like nickel. (1)


Allergy to nickel ornaments and nickel-coated products is the most common form of allergy to a metallic element in the world. The triple response of Lewis is seen as the first symptom like in any allergic reaction. It includes the formation of redness, flare, and wheal formation. It may develop into a papular rash or vesicle formation which can present as either in localized form or generalized form in severe conditions.

Patch testing is the most common and efficient method for testing and diagnosis of various allergic antigens including metallic elements. Nickel is also tested with the same and 4th-day reading is the best for its diagnosis. Quantitative measurement is also available for nickel exposure and in cases of insufficient evidence, a repeat test could be done.


  1. https://emedicine.medscape.com/article/1049216-overview?src=android&devicetype=android&osversion=9&appversion=6.2.1&src=medscapeapp-android&ref=share

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