Indian Journal of Dermatology
CORRESPONDENCE
Year
: 2010  |  Volume : 55  |  Issue : 4  |  Page : 407--408

Benefit of iron therapy in the management of chronic urticaria due to nickel sensitivity


Ashimav Deb Sharma 
 Consultant Dermatologist, Bongaigaon, Assam, India

Correspondence Address:
Ashimav Deb Sharma
Consultant Dermatologist, Bongaigaon, Assam
India




How to cite this article:
Sharma AD. Benefit of iron therapy in the management of chronic urticaria due to nickel sensitivity.Indian J Dermatol 2010;55:407-408


How to cite this URL:
Sharma AD. Benefit of iron therapy in the management of chronic urticaria due to nickel sensitivity. Indian J Dermatol [serial online] 2010 [cited 2021 May 14 ];55:407-408
Available from: https://www.e-ijd.org/text.asp?2010/55/4/407/74576


Full Text

Sir,

Although not common, chronic urticaria due to nickel allergy, is a challenging task for the dermatologist. Dietary nickel acts as a major precipitating factor in this condition. One of the accepted methods of treating such urticaria is a low nickel diet (LND). In this method, the patient is given a list of dietary items that contain low amounts of nickel and the patient is instructed to stick to these items. The purpose is to reduce the uptake of nickel by the body from the diet and thereby, to minimize the risk for endogenous activation of immunocompetent cells in nickel-sensitive individuals.

Usually retention of dietary nickel by the human body is low; it is estimated to be 3-6% of the total nickel absorbed. It is seen that absorption of nickel in the human body can be enhanced by iron deficiency [1] and thus, an individual with iron deficiency anemia (IDA) tends to retain more nickel from the diet. This is due to the upregulation of divalent metal transporter (DMT) protein in intestinal the mucosa of the individual with IDA. DMT protein is present on the luminal surfaces of enterocytes of the intestinal epithelium, whose function is to transport iron (Fe ++ ) from the diet into the enterocyte of the intestinal mucosa. In the absence or paucity of iron in the diet, the DMT protein tends to immediately bind and transport other available divalent cation(s), including nickel across the membrane. This is important for those suffering from nickel allergy because nickel is a ubiquitous trace element and is present in most of the human foods. In other words, individuals with IDA are at a higher risk to accumulate nickel in their body. Conversely, it has also been found that adequate iron intake and status can limit nickel absorption due to the downregulation of DMT protein on the luminal surfaces of enterocytes. [2],[3]

It is a fact that IDA is widely prevalent in India. The National Family Health Survey 3 (2005-2006) estimates reveal the prevalence of anemia to be 70-80% in children, 70% in pregnant women, and 24% in adult males. The report also estimates that at least 65-75% of adolescent girls in India are anemic, the most common cause for IDA is a diet that is poor in iron.

A small study was undertaken to observe the benefits of the addition of oral iron to an LND in the treatment of chronic urticaria due to nickel sensitivity in women with iron deficiency anemia (IDA). The study included five female patients (age group: 18-25 years) with chronic urticaria due to nickel allergy (confirmed by patch testing) and mild to moderate IDA. A oral challenge was done with nickel sulfate to confirm the diagnosis of nickel allergy. Patients were thoroughly investigated to rule out the problems of bleeding gums, hematemesis and melaena, bleeding per anum, menorrhagia, hematuria, worm infestation, and abnormal blood picture. None of the patients reported the use of any surgical prosthesis. Both verbal and written consent was taken from all the patients. Pregnant or lactating patients were not included in this study.

Patients were divided into two groups: patients in the study group (n = 3) were advised a LND along with oral iron (50 mg of elemental iron thrice daily) for a period of six weeks; patients in the control group (n = 2) were advised a LND alone for the same duration. All were advised to avoid contact with articles that might contain nickel during this period. Clinical improvement was evaluated with the help of urticaria activity scores (UAS) at weekly intervals. Patients were asked take oral antihistaminics on sos basis only.

The results observed in the study group were interesting. The severity of the urticaria reflected in the UAS, was reduced significantly in all three cases by the end of two weeks. Two patients were free from urticaria by the end of the 3rd week and the remaining one patient was free from urticaria by the end of the 4th week. They no longer needed to use oral antihistaminic agents. All of them were free from urticaria for the rest of the trial period. Partial reduction was observed in the severity of urticarial activity by the end of two weeks in the control group. A further reduction in the severity of urticaria was noted in these patients by the end of the 4th week. However, no further improvements were observed in the remaining two weeks. Patients were able to reduce the frequency of use of oral antihistaminic agents.

The author concluded that a combination of an LND and oral iron can bring about a faster reduction in the severity of urticarial activity in nickel-sensitive individuals with IDA. However, the present study is a small clinic-based study. A further multicentric study comprising of large number of patients with longer follow-up will be more informative.

References

1Kelly C. Nickel, Boron, Vanadium, cobalt and other trace metal nutrients. In: Kelly C, editor. The Nutritional trace Metals. Blackwell Publishing Ltd, UK; 2004. p. 211-233.
2Gunshin H, Mackenzie B, Berger UV, Gunshin Y, Romero MF, Boron WF, Nussberger S, Gollan JL, Hediger MA. Cloning and characterization of a mammalian proton -coupled metal ion transporter. Nature 1997;388:482-8.
3Tallkvist J, Bowlus CL, Lonnerdal B. Pharmacology and Toxicology 2003;92:121-4.