Q:

6/4/2013
Does nickel allergy play a role in eosinophilic esophagitis? My patient is a 15 year old male with moderate nickel allergy characterized by rash at the site of nickel contact. He is also diagnosed with eosinophilic esophagitis. His percutaneous skin tests to foods and food patch tests are negative. An empiric 6 food elimination diet did not result in reduction of eosinophils on biopsy or clinical improvement. He is sensitized to multiple aeroallergens which may be swallowed and playing a role. Could nickel allergy produce a localized reaction in his esophagus? I have not seen this reported in the literature and am considering a strict nickel free diet for him. Please advise re: nickel free diet for eosinophilic esophagitis with appropriate follow up such as a repeat biopsy.

A:

Thank you for your inquiry.

To my knowledge, and based upon a literature search, there has been no documented association between nickel allergy and eosinophilic esophagitis. In addition, it follows that I could find no evidence in the literature that a nickel-free diet would be beneficial in patients with eosinophilic esophagitis. However, I doubt that such a diet would be of help because when one speaks of allergy to nickel, in most instances one is referring to a delayed hypersensitivity reaction which would not be associated with eosinophilia. There are of course cases of occupational asthma which demonstrate IgE against metals (1), but the route of sensitization is via the respiratory tract and not the gastrointestinal tract.

For these reasons, I would think that nickel would be highly unlikely as an allergen producing or exacerbating eosinophilic esophagitis in your patient, and would personally be reluctant to place him on a nickel-free diet.

Thank you again for your inquiry and we hope this response is helpful to you.

Reference:
1. Murdoch RD, Pepys J, Hughes EG. IgE antibody responses to platinum group metals: a large scale refinery survey. Br J Ind Med. 1986 January; 43(1): 37-43.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology