Contact Dermatitis Due to Nickel Allergy in Patients Suffering from Non-Celiac Wheat Sensitivity.
BACKGROUND
Non-celiac wheat sensitivity (NCWS) is a new clinical entity in the world of  gluten-related diseases. Nickel, the most frequent cause of contact allergy, can be found in wheat  and results in systemic nickel allergy syndrome and mimics irritable bowel syndrome (IBS).  Objective: To evaluate the frequency of contact dermatitis due to nickel allergy in NCWS patients  diagnosed by a double-blind placebo-controlled(DBPC)challenge,and to identify  the  characteristics  of  NCWS  patients  with  nickel  allergy.  Methods: We performed  a prospective study  of 60 patients (54 females, 6 males; mean age 34.1 ± 8.1 years) diagnosed with NCWS from  December  2014 to November 2016; 80 age- and sex-matched subjects with functional gastrointestina l symptoms served as controls. Patients reporting contact dermatitis related to nickel-containing objects  underwent  nickel  patch  test  (Clinicaltrials.gov  registration number: NCT02750735).


RESULTS
Six  out  of  sixty  patients  (10%)  with  NCWS  suffered  from contact dermatitis and  nickel allergy  and  this  frequency  was  statistically  higher (p = 0.04)than observed in the control group(5%. The main clinical characteristic of  NCWS  patients with nickel allergy was a  higher frequency  of  cutaneous  symptoms  after  wheat ingestion compared to NCWS patients who did not suffer  from  nickel  allergy  (p < 0.0001.


CONCLUSIONS
Contact dermatitis and nickel allergy  are more  frequent  in  NCWS  patients than  in  subjects  with  functional gastrointestinal disorders;furthermore, these patients had a very high frequency of cutaneous manifestations after wheat  ingestion.  Nickel  allergy  should  be  evaluated  in  NCWS  patients  who  have  cutaneous  manifestations after wheat ingestion.
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. adalcamo@hotmail.it.
Alberto
A
D'Alcamo
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. pasquale.mansueto@unipa.it.
Pasquale
P
Mansueto
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. maurizio.soresi@unipa.it.
Maurizio
M
Soresi
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. iacobuccirosario@gmail.com.
Rosario
R
Iacobucci
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. francescolablasca@gmail.com.
Francesco La
F
Blasca
Surgery Department, University Hospital, Palermo 90100, Italy. girolamo.geraci@unipa.it.
Girolamo
G
Geraci
Pediatric Unit, "Giovanni Paolo II" Hospital, Sciacca (ASP Agrigento) 90100, Italy. francesca_cv@inwind.it.
Francesca
F
Cavataio
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. francesca.fayer@libero.it.
Francesca
F
Fayer
DiBiMIS, Gastroenterology Unit, University Hospital, Palermo 90100, Italy. a.arini@libero.it.
Andrea
A
Arini
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy.
Laura
L
Di Stefano
Pediatric Gastroenterology Unit, "ARNAS Di Cristina" Hospital, Palermo 90100, Italy. stoai@inwind.it.
Giuseppe
G
Iacono
Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (Ste.Bi.CeF), University of Palermo, Palermo 90100, Italy. liana.bosco@unipa.it.
Liana
L
Bosco
Dipartimento di Biologia e Medicina Interna e Specialistica (DiBiMIS), Internal Medicine Unit, University Hospital, Palermo 90100, Italy. acarroccio@hotmail.com.
Antonio
A
Carroccio
D000328:Adult; D016022:Case-Control Studies; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications*; D008297:Male; D009532:Nickel / Q000009:adverse effects*; D011446:Prospective Studies; D014908:Triticum / Q000009:adverse effects*; D021182:Wheat Hypersensitivity / Q000150:complications* / Q000175:diagnosis
D009532:Nickel
non‐celiac  wheat  sensitivity;   cutaneous  symptoms;   irritable  bowel  syndrome;   nickel  allergy