Kaaber, Veien, Tjell 1978 — Low nickel diet in chronic nickel dermatitis
This British Journal of Dermatology study from the Finsen Institute (Copenhagen) and the Technical University of Denmark Department of Sanitary Engineering is the foundational paper of the low-nickel-diet literature. It is the first systematic test of whether reducing dietary nickel can improve chronic nickel dermatitis in patients with documented oral nickel reactivity. 28 chronic-nickel-dermatitis patients were enrolled, 17 had clear oral nickel reactivity (positive 2.5 mg challenge, negative placebo), and 9 of 17 (53 percent) had dermatitis improvement during a 6-week low-nickel diet. Seven of the 9 improvers flared again when normal diet was resumed. The companion biomarker work measured 24-hour urinary nickel excretion by atomic absorption spectrometry in 14 patients before, during, and after diet, documenting that the diet reduced urinary excretion but with no statistically significant difference between improvers and non-improvers.
Key numbers
| Outcome | Result |
|---|---|
| Patients with chronic Ni dermatitis enrolled | 28 |
| Patients with positive oral 2.5 mg Ni challenge (negative placebo) | 17 of 28 (60.7 percent) |
| Patients with dermatitis improvement on 6-week low-Ni diet | 9 of 17 (52.9 percent) |
| Patients flaring after return to normal diet | 7 of 9 (77.8 percent) |
| Reduced urinary Ni excretion during diet | Documented in 14 measured patients |
Methods (brief)
Single-site prospective. Inclusion: chronic nickel dermatitis with positive oral 2.5 mg nickel sulphate challenge and negative placebo. Intervention: 6-week low-nickel diet. Outcomes: dermatitis assessment plus 24-hour urinary nickel quantification by AAS pre, during, and post diet.
Implications
- Certification: This is the foundational primary-evidence source for the low-nickel-diet intervention. The 1978 date makes it the canonical citing reference for the diet-modulates-dermatitis concept. HMTc Ni-threshold rationale for vulnerable populations rests on the body of evidence that begins with this paper.
- Microbiome / immunology: Documents that dietary nickel reduction reduces systemic nickel exposure (urinary excretion) as well as clinical endpoint (dermatitis); establishes the mechanistic link.
- Courses: Foundational reference for nickel-allergy clinical management.