Can a Nickel Allergy Cause an Autoimmune Disease?

Published on September 13, 2021

Medically reviewed by Corinne Savides Happel, MD

A nickel allergy could make you more susceptible to autoimmune disease, according to research. Nickel allergy is sometimes called nickel allergic contact dermatitis (NACD).

Nickel is the most common cause of metal allergies. And it’s being increasingly tied to several types of autoimmune disease. Researchers are looking into common underlying mechanisms to understand how the two may be related.

This article will look at what a nickel allergy is, how it may be related to autoimmune disease, how to manage your life with an allergy to something that’s hard to avoid, and what treatments are available.

Nickel Allergy

Nickel is a common metal. It’s used in a lot of everyday items that you come into contact with, including:

Bathroom fixtures
Batteries
Coins
Costume jewelry
Eyeglass frames
Fasteners on clothing (zippers, snaps)
Keys
Machine parts
Metal tools
Mobile phones
Utensils

Medically, nickel is used in:

Dental alloys
Orthopedic implants such as hip replacements and screws
Other implants such as pacemakers and intrauterine devices (IUDs)
Surgical clips and staples

Nickel is part of many metal alloys (combinations of metals) and is often used to plate metal alloys.

Symptoms

In people who are allergic to the metal, nickel causes a skin reaction called allergic contact dermatitis. Once you’ve been exposed to nickel, allergy symptoms can take three days or more to appear.

Symptoms can range from mild to disabling, depending on how sensitive you are. Symptoms may include:

Discolored skin (pink or red on light skin, dark patches on darker skin)
Itchiness
Burning sensations
Flaky dry skin or blistered, cracked, or crusty skin

These signs usually only appear where the nickel touches your skin. However, in some severe cases, swelling and redness can spread to other areas of your body, as well.

Some people have a systemic nickel allergy that involves:

Headaches
Fatigue
Nausea and vomiting
Diarrhea

In rare cases, nickel can cause immediate hives at the contact site.

Causes

Nickel allergy can be acquired anytime during your lifetime, unlike some allergies like food allergies that often occur very early in life.

Your sweat and other bodily fluids can leach nickel from stainless steel and other alloys. Then your skin absorbs the metal. The allergy is often caused by direct and prolonged exposure to items that release a lot of nickel. Once you’re sensitized to it, even small amounts of nickel exposure may be a problem.

How Allergies Work

Allergies are a “misfire” of your immune system. In an allergy, your immune system mistakes something harmless as a threat to your health, like a virus or bacterium. It then tries to rid your body of it, which is what leads to inflammation and other symptoms. The immune response involves sending specialized cells to go after the target substance.

Autoimmunity

If allergies are a misfire, autoimmunity ("auto" means "self") is friendly fire. In autoimmunity, your immune system tries to destroy a part of your body.

The type of cell or tissue subjected to this friendly fire depends on the specific disease. For example:

In multiple sclerosis, the protective lining (myelin) on certain nerves is attacked
In rheumatoid arthritis, it’s the lining of joints (synovium)
In Hashimoto’s thyroiditis and Graves’ disease, it’s the thyroid gland
In Sjögren’s syndrome, it’s moisture-producing glands

Symptoms

Symptoms of autoimmunity vary by disease. Some symptoms they have in common are:

Fatigue
Swollen glands
Inflammation and pain
Skin problems
Digestive problems
Recurring fever

Causes

Researchers haven’t yet uncovered the cause of autoimmune diseases. But it’s believed to involve a genetic predisposition plus exposure to something that confuses your immune system.

This could be pathogens (viruses or bacteria), medications, or environmental exposures, such as chemicals or cigarette smoke. Metal exposure is considered environmental.

Autoimmune reactions typically involve T cells, including CD4+ and CD8+ T cells. These same types of cells play a role in nickel allergy.

The Relationship

The precise relationship between these illnesses is unclear, but allergies and autoimmune diseases both involve similar immune-system activity. Several studies have noted a link between nickel allergies and autoimmune disease.

A 2014 paper suggested that a systemic nickel allergy is a risk factor for developing autoimmune thyroid disease. Another study found that people with nickel allergy from oral exposure were especially likely to have an autoimmune disease.

The International Academy of Oral Medicine and Toxicology (IOAMT) reported that metal can cause inflammation. And that inflammation can lead to the development of both allergic and autoimmune diseases.

A 2020 review of research found that metals may suppress or damage the immune system. That may lead to allergies and/or autoimmunity, depending on your susceptibility.

Research suggests that metal allergies, in general, may be especially linked to autoimmune conditions that affect connective tissues, such as:

Lifestyle Modifications

Avoiding nickel is the most important thing you can do to avoid triggering your nickel allergy. This may mean:

Wearing jewelry that’s nickel-free, hypoallergenic, surgical-grade stainless steel, gold that’s between 18- and 24-karats, pure sterling silver, or platinum
Replacing clothing fasteners (buckles, bra hooks, zippers, etc.) with plastic or plastic-coated versions, or frequently covering them with fingernail polish
Replacing household items with non-nickel versions; these include brass keys, silicone pot handles, plastic eyeglass frames, stainless steel razors

While medical and dental implants often contain a small percentage of nickel, the amount of nickel that the body is exposed to varies significantly based on the implant. If you have any concerns about nickel in your implant, ask your doctor whether any benefit would be gained by replacing the implant. Most patients with allergic contact dermatitis to nickel tolerate medical and dental implants that contain some nickel.

For those with systemic allergic contact dermatitis to nickel, you may also need to cut nickel-containing foods out of your diet. Some of these include:

Soybeans and soy products, including soy sauce and tofu
Licorice
Buckwheat
Cocoa powder
Clams
Cashews
Figs

Nickel allergy is well treated by avoiding nickel contact. Whether nickel avoidance affects autoimmune conditions has not been proven.

Treatments

Treatments are available for both allergic contact dermatitis due to nickel and autoimmune conditions.

For nickel allergy, you may benefit from topical corticosteroids like over-the-counter hydrocortisone 1% or stronger formulations available by prescription. Avoiding nickel can help prevent future rashes from occurring.

For autoimmune diseases, the primary treatments are anti-inflammatory and immunosuppressive drugs.

Your healthcare provider may also suggest other medications depending on your disease, symptoms, and severity.

Frequently Asked Questions

How common is it to be allergic to nickel?

Between about 10% and 17.5% of people in the United States are believed to be allergic to nickel. It’s more common in women. This may be due to higher rates of pierced ears and jewelry wearing by women in general. People usually become aware of a nickel allergy right after getting their ears pierced.

Is nickel allergy life-threatening?

If you have allergic contact dermatitis to nickel, touching nickel is not considered life-threatening and typically will only result in a rash. Anaphylaxis, a severe allergic reaction, is not associated with allergic contact dermatitis to nickel.

Can autoimmunity be cured?

No, autoimmune diseases can’t be cured. They can often be successfully managed with medication. Research into possible cures is ongoing.

Summary

Nickel allergy may lead to autoimmune disease. Nickel is widely used in everyday items plus medical devices and implants. Allergies develop after prolonged exposure causes the immune system to misfire. Autoimmune disease is caused by the immune system mistaking something harmless for something threatening.

Nickel allergy may be managed by avoiding nickel exposure. Topical corticosteroids can usually control symptoms of allergic contact dermatitis to nickel, Anti-inflammatory and immunosuppressant drugs are typically prescribed to treat autoimmune conditions.

A Word From Verywell

If you believe you have a nickel allergy, talk to your healthcare provider. If you have a nickel allergy and start to notice symptoms that could point to an autoimmune disease, let your provider know about that, too. Living with and managing these conditions may not be easy, but it is possible. Your doctor can help you work out the best treatment plan.

13 Sources

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