title: Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?
abstract: OBJECTIVE
  Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain or discomfort accompanied by abnormal bowel movements. In sensitized subjects, ingested nickel (Ni) may induce gastrointestinal symptoms similar to IBS, in addition to typical systemic cutaneous lesions (systemic nickel allergy syndrome [SNAS]). A low nickel diet could improve the systemic manifestations. We evaluated prevalence of nickel allergy in IBS and effects of low Ni diet on (1) gastrointestinal symptoms control, (2) intestinal barrier function, (3) quality of life, and (4) psychological status of patients with IBS and Ni-sensitized patients.
  
  
  METHODS
  Twenty consecutive patients affected by IBS and suspected SNAS underwent intestinal permeability tests. Gastrointestinal symptoms were evaluated using the visual analogue scale before and after 3 months low Ni diet. Subjects with increased intestinal permeability at baseline repeated nuclear examination after the diet.
  
  
  RESULTS
  The most frequent profile was diarrhea-predominant IBS (8/20). The low Ni diet induced a significant and constant improvement of gastrointestinal symptoms and an equally significant improvement of visual analogue scale. Mean urinary output of ⁵¹Chromium ethylene-diamine-tetra-acetate (⁵¹Cr-EDTA) was 5.91%/24 hr (± 2.08), significantly different from the control group (2.20%/24 hr ± 0.60,P< 0.0001).
  
  
  CONCLUSIONS
  This pilot study shows that low Ni diet improves gastrointestinal symptoms in patients with IBS and SNAS.
authors.affiliation: Allergy Unit, Department of Rheumatology, Immunology, Dermatology and Uro-Nefrological Sciences, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Rizzi
authors.affiliation: Allergy Unit, Department of Rheumatology, Immunology, Dermatology and Uro-Nefrological Sciences, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Nucera
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Laterza
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Gaetani
authors.affiliation: Department of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Venanzio
authors.initials: V
authors.lastname: Valenza
authors.affiliation: Department of Pulmonary Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Corbo
authors.affiliation: Department of Pulmonary Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Inchingolo
authors.affiliation: Allergy Unit, Department of Rheumatology, Immunology, Dermatology and Uro-Nefrological Sciences, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buonomo
authors.affiliation: Allergy Unit, Department of Rheumatology, Immunology, Dermatology and Uro-Nefrological Sciences, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Schiavino
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
keywords: Diet; Hypersensitivity; Irritable bowel syndrome; Nickel; Permeability