What Is The Best Treatment For Nickel Allergy?

Nickel is a common type of substance responsible for eliciting an allergic response in the form of skin changes commonly labeled as allergic contact dermatitis. The mechanism for it is when the body of the patient comes in contact with the nickel for the first time, which detects nickel as a foreign substance with antigenic properties. After this deduction, the body forms an immune response against the nickel antigen. This response is a primary immune response caused by innate immunity and tries to eliminate it.

Since the response is nonspecific, it is a very mild form of an allergic reaction but at the same time, the body tries to develop the most specific antibodies against the nickel antigen and tries to keep it in memory of immune system with the help of the per cells. It is known as the phenomenon of sensitization.

Once the body becomes sensitized to a particular antigen like nickel, it then forms a secondary immune response if the body is exposed to the same antigen again. When the immune system comes in contact with nickel again, this time the reaction is much more severe and prolonged in time because of preformed antibodies and their memory in the immune system.

The treatment relies on the effort to reduce the sensitization of the body against the nickel. Nickel products and ornaments should not be worn by the people who are at risk of developing sensitization or have already developed it because prevention remains the best form of treatment in allergic contact dermatitis caused by nickel.

The best medical treatment available and effective for the nickel allergy is topical corticosteroids. These are very powerful in suppressing the local immune response against the nickel allergy and provide relief to the symptoms like pruritis, edema, erythema, vesicle formation, etc. It down-regulates the process of inflammation by decreasing the cellular response to a foreign antigen.

Topical and local methods for temporary relief includes soaking with cool water. Saline water, Burow’s solution, and aluminum acetate can be used for the same but are better than the water in relieving local symptoms ^[1]. Various soothing agents like petroleum jellies are used as emollients which decreases the pruritis and other symptoms of the information by reducing the urge to scratch. Topical antihistamine drugs are used sometimes in mild cases but oral antihistaminics are the commonly used drugs in moderate nickel allergy ^[2].

Oral glucocorticoids are not used commonly because these are very effective drugs and are preferred only for severe cases. A course for a few weeks is needed to get the affective responses by systemic corticosteroids and their dosage is gradually tapered down. Long term usage of systemic corticosteroids can be dangerous and increase the morbidity in patients so it should be used judiciously under the adequate care of a recognized health professional preferably a doctor.

Surgical treatment is usually not required but sometimes the blisters become large and fluid-filled which if automatically burst would leave a large raw surface area behind and superadded infections would spread easily. To prevent it, therapeutic drainage of the blister fluid with the help of a small-bore needle is referred and the covering of the blister is not removed.

Conclusion

Nickel allergy is not a onetime response and also is not seen on first exposure to it. Prior sensitization is required as a foreign antigen for the immune system to develop antibodies against the nickel and attack it when exposed again. The response could be mild or severe depending upon the amount of exposure, the ability of the immune system and other factors also.

Topical glucocorticoids remain the mainstay of treatment and hydrocortisone ointment is the drug of choice for nickel allergy. Immune modulators like tacrolimus etc. can also be used in refractory cases. Despite all the treatments available, refraining from the nickel-coated substances and ornaments is the best form of prevention and treatment for its allergy.

References

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What Is The Best Treatment For Nickel Allergy?