Symptoms

If you have nickel allergy and you're exposed to a nickel-containing item, the allergic reaction (contact dermatitis) usually begins within 12 to 48 hours after exposure. The reaction may persist for as long as two to four weeks. The features of contact dermatitis usually appear only where your skin came into contact with nickel, but they may appear elsewhere on your body. Nickel allergy symptoms include:

• Rash or bumps on the skin
• Itching, which may be severe
• Redness or changes in skin color
• Dry patches of skin that may resemble a burn
• Blisters and draining fluid in severe cases

Sweating at the point of contact with nickel may worsen the symptoms.

When to see a doctor If you have a skin rash and don't know how you got it, talk to your doctor. If you've already been diagnosed with nickel allergy and are sure you're reacting to nickel exposure, use the over-the-counter treatments and home remedies your doctor has recommended in the past. However, if these treatments don't help, call your doctor. If you think the area may have become infected, see your doctor right away. Signs and symptoms that might indicate an infection include pain, increased redness, warmth or pus in the affected area.

Causes

An allergic reaction is somewhat like a case of mistaken identity within your body's immune system. Normally, your immune system reacts to protect your body against bacteria, viruses or toxic substances.

If you have nickel allergy, your body reacts to nickel and possibly to other metals, such as cobalt and palladium. In other words, it's mistakenly identified nickel as something that could harm you. Once your body has developed a reaction to a particular agent (allergen) — in this case, nickel — your immune system will always be sensitive to it. That means anytime you come into contact with nickel, your immune system will respond and produce an allergic response.

Your immune system's sensitivity to nickel may develop after your first exposure or after repeated or prolonged exposure. Once you're sensitized to nickel, the immune reaction is generally faster each time you're exposed to the metal.

The cause of nickel allergy is unknown, but sensitivity to nickel may, in part, be inherited (genetic).

Sources of nickel exposure Nickel allergy is most commonly associated with earrings and other jewelry for body piercings that contain some nickel. Common sources of nickel exposure include:

• Jewelry for body piercings
• Other jewelry, including rings, bracelets, necklaces and jewelry clasps
• Watchbands
• Clothing fasteners, such as zippers, snaps and bra hooks
• Belt buckles
• Hairpins
• Eyeglass frames
• Coins
• Kitchen utensils
• Paper clips
• Pens
• Keys
• Tools, such as hammers and screwdrivers
• Dental fillings
• Artificial body parts (prostheses), such as artificial heart valves
• Drinking water
• Alkaline batteries
• Cell phones

Nickel is also found in some foods, such as oatmeal, chocolate, nuts, beans and dried fruit. Nickel may also be found in canned foods. If you're allergic to nickel, ask your doctor if a low-nickel diet might be helpful.

Risk factors

Certain factors may increase your risk of developing a nickel allergy, including:

• Having ear or body piercings. Because nickel is common in jewelry, nickel allergy is most often associated with earrings and other body-piercing jewelry containing nickel. If the first jewelry you wear after a piercing contains nickel, your body is constantly exposed to the metal during the healing time. And people who have piercings often wear jewelry every day. The more piercings you have, the greater your risk of developing a nickel allergy.
• Working with metal. If you work in an occupation that constantly exposes you to nickel, your risk of developing an allergy may be higher than it is for someone who doesn't work with the metal. In addition, people who have regular exposure to nickel while doing "wet work" — as a result of either sweat or frequent contact with water — may be more likely to develop nickel allergy. These people may include bartenders, people who work in certain food industries and domestic cleaners. Other people who may have an increased risk of nickel allergy include metalworkers, retail clerks and hairdressers.
• Being female. Women and girls are more likely to have a nickel allergy than are men and boys. This may be because females tend to have more piercings and get them at a younger age.
• Having a family history of nickel allergy. You may have inherited a tendency to develop a nickel allergy if other people in your family are sensitive to nickel.
• Being allergic to other metals. People who have a sensitivity to palladium, cobalt or chromium may also be allergic to nickel.

Appointment

You're likely to see your family doctor first if you are experiencing an itchy rash that may be related to nickel allergy. Because time with your doctor may be limited, preparing beforehand can help you make the best use of your time.

What you can do

• Write down a description of your symptoms and whether they occur in a pattern.
• Make a list of any medications you take, including vitamins and dietary supplements.
• Prepare a list of questions.

Questions that you might want to ask your doctor include:

• What is the most likely cause of my rash?
• What else might cause it?
• Is there a test that can confirm a nickel allergy? Do I need to prepare for this test?
• What are the treatments available for nickel allergy, and which do you recommend?
• What side effects can I expect from these treatments?
• Do I need to see a specialist?
• Can I use over-the-counter medications to treat the condition?
• What home remedies do you recommend, and what home remedies should I avoid?

What to expect from your doctor Your doctor is likely to ask you a number of questions:

• When did you first begin experiencing symptoms?
• Have your symptoms changed over time?
• What at-home treatments have you used?
• What effect did those treatments have?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

Your doctor can usually diagnose nickel allergy based on your:

• Skin's appearance
• Recent history of contact with items that may contain nickel

If the cause of your rash isn't apparent, however, your doctor may recommend a patch test (contact hypersensitivity allergy test). He or she may refer you to an allergy specialist (allergist) or a skin specialist (dermatologist) for this test.

Patch testing During a patch test, very small quantities of potential allergens (including nickel) are applied to small patches, which are then placed on your skin to check for a reaction. The patches remain on your skin for two days before the doctor removes them. If you have a nickel allergy, the skin under the nickel patch will be inflamed when the patch is removed or in the days after removal of the patch.

Because of the low concentrations of allergens used, patch tests are safe even for people with severe allergies.

Treatments and drugs

There is no cure for nickel allergy. Once you develop a sensitivity to nickel, you will develop a rash (contact dermatitis) whenever you come into contact with the metal. Once an allergic reaction to nickel exposure has begun, it will most likely continue for two to four weeks.

Medications Your doctor may prescribe one of the following medications to reduce irritation and improve the condition of a rash from a nickel allergy reaction:

• Corticosteroid cream, such as clobetasol (Temovate, Cormax, others) and betamethasone dipropionate (Diprolene)
• Oral corticosteroid, such as prednisone, if the reaction is severe or a rash covers a large area
• Oral antihistamine, such as fexofenadine (Allegra) and cetirizine (Zyrtec), for relief of itching

Home remedies

You may use some of the following treatments at home to treat contact dermatitis due to nickel allergy. If these treatments don't help or the rash worsens, contact your doctor. Home remedies include the following:

• Soothing lotions, such as calamine lotion, may ease itching.
• Wet compresses can be placed over the rash to help dry blisters and relieve itching. A wet compress can be made by soaking a clean cloth in Burow's solution, an over-the-counter medication containing aluminum acetate.
• Over-the-counter corticosteroids may lesson itching and improve the condition of the rash. Talk to your doctor about how long you can safely use the product.
• Over-the-counter oral antihistamine, such as diphenhydramine (Benadryl), may help relieve itching.

You should avoid certain over-the-counter ointments, such as antibiotic creams, which may contain ingredients that can worsen an allergic reaction.

Prevention

The best strategy to prevent developing nickel allergy is to avoid prolonged exposure to items containing nickel, especially jewelry. If you already have a nickel allergy, the best way to prevent an allergic reaction is to avoid contact with the metal.

However, it's not always easy to avoid nickel because it's present in so many products and is sometimes even in products labeled hypoallergenic. The following tips may help you avoid nickel exposure:

Wear hypoallergenic jewelry Purchase jewelry that's made of materials that aren't likely to cause allergic reactions. Look for jewelry made from such metals as nickel-free stainless steel, surgical-grade stainless steel, titanium, 18-karat yellow gold, or nickel-free 14-karat yellow gold, sterling silver, copper and platinum. Avoid jewelry with nickel, as well as cobalt and white gold, which may contain nickel and trigger allergic reactions. Surgical-grade stainless steel may contain some nickel, but it's generally considered hypoallergenic for most people.

Get rid of jewelry that contains nickel or has caused an allergic reaction. Be sure that your earring backings also are made of hypoallergenic materials.

Choose a piercing studio carefully Tattoo and body piercing studio regulations differ from state to state. Contact your state or local health department to find out what rules apply to your area and be certain to choose a reputable studio with licensed piercers.

Visit a studio before getting a piercing to make sure that the piercer:

• Provides a clean, tidy, professional environment
• Uses sterile, nickel-free or surgical-grade stainless steel needles in sealed packages
• Sells only hypoallergenic jewelry and can provide documentation of metal content
• Doesn't use a piercing gun, which may not be sterile or nickel-free and may cause other complications, such as a bacterial infection

Use substitute materials Look for safer substitutes for common nickel-containing items:

• Watchbands made of leather, cloth or plastic
• Zippers or clothing fasteners made of plastic or coated metals
• Plastic or titanium eyeglass frames

Create a barrier If you have to be exposed to nickel at work, creating a barrier between you and the nickel may help. If your hands have to touch nickel, wearing gloves may help. If you need to cover buttons or snaps, or tool handles, covering these items with duct tape may help.