title: Oral nickel exposure may induce Type I hypersensitivity reaction in nickel-sensitized subjects.
abstract: BACKGROUND
  Little is known about the clinical and immunological changes in the nickel allergic patients with systemic symptoms. We aimed to evaluate T helper cell responses of patients with different clinical presentations due to nickel.
  
  
  METHODS
  Patients having various allergic symptoms and positive patch test results to nickel and 20 controls underwent skin prick tests with nickel. IL-10, IL-4, IL-5 and IFN-gamma were measured in the culture supernatants of PBMC stimulated by nickel during lymphocyte proliferation test (LTT).
  
  
  RESULTS
  69 patients (56 female, mean age: 49.2 ± 13.1), 97% having nickel containing dental devices and 20 controls (8 female, mean age 34.9 ± 12.06) were evaluated. Skin prick tests with nickel were positive in 70% of the patients (p<0.001), being significantly higher in the patients with urticaria/angioedema (p=0.02). The LTT stimulation index (p<0.0001), IL-4 (p=0.002), IFN-gamma (p=0.01), IL-5 (p=0.04) and IL-10 (p=0.003) were higher in the patient group. LTT stimulation index, IL-4 and IL-10 were significantly elevated in patients having urticaria, angioedema and respiratory symptoms when compared to those who had only oral symptoms or systemic dermatitis (p=0.004, p=0.002 and p=0.01, respectively).
  
  
  CONCLUSIONS
  This study suggests the presence of Type I hypersensitivity in addition to a Type IV immune reaction in patients with chronic systemic symptoms related to nickel. Nickel containing dental alloys and oral nickel intake seem to trigger systemic symptoms in previously nickel sensitized patients.
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Allergy, Istanbul, Turkey.
authors: Suna
authors: S
authors: Büyüköztürk
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Allergy, Istanbul, Turkey. Electronic address: gelincik@istanbul.edu.tr.
authors: Aslı
authors: A
authors: Gelincik
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Allergy, Istanbul, Turkey.
authors: Derya
authors: D
authors: Ünal
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Allergy, Istanbul, Turkey.
authors: Mustafa
authors: M
authors: Demirtürk
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Istanbul, Turkey.
authors: Dolay Damla
authors: DD
authors: Çelik
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
authors: Sacide
authors: S
authors: Erden
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Allergy, Istanbul, Turkey.
authors: Bahattin
authors: B
authors: Çolakoğlu
authors: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Istanbul, Turkey.
authors: Serap
authors: S
authors: Erdem Kuruca
mesh_terms: D016022:Case-Control Studies; D049109:Cell Proliferation / Q000187:drug effects; D002478:Cells, Cultured; D016207:Cytokines / Q000276:immunology; D003722:Dental Alloys; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000276:immunology; D007428:Intradermal Tests; D007963:Leukocytes, Mononuclear / Q000187:drug effects* / Q000276:immunology; D008213:Lymphocyte Activation / Q000187:drug effects / Q000276:immunology; D008214:Lymphocytes / Q000187:drug effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000276:immunology*; D010328:Patch Tests; D012867:Skin / Q000276:immunology
chemical_list: D016207:Cytokines; D003722:Dental Alloys; D009532:Nickel
keywords: Dental alloys; Lymphocyte transformation test; Nickel allergy; Systemic nickel allergy; Type I reaction