Veien, Hattel, Laurberg 1993 — Low nickel diet: an open, prospective trial
This Journal of the American Academy of Dermatology open prospective trial from the Aalborg (Denmark) dermatology group is the second-generation low-nickel-diet study after Kaaber 1978 and remains a foundational reference for the dietary-nickel-and-dermatitis literature. 90 nickel-sensitive patients with a documented flare of dermatitis after oral 2.5 mg nickel challenge (and no reaction to placebo) were instructed to follow a low-nickel diet. The short-term and long-term benefits are large: 64.4 percent had short-term benefit; 73 percent of those who responded short-term sustained the improvement at 1 to 2 years follow-up. The paper also documents that patients with strongly positive patch tests to nickel had less benefit from the diet than patients with moderately positive patch tests, an early observation that complicates the simple patch-test-positivity-predicts-diet-response model.
Key numbers
| Outcome | Result |
|---|---|
| Patients enrolled (positive oral Ni challenge, negative placebo) | 90 |
| Short-term diet benefit | 58/90 (64.4 percent) |
| Possible short-term benefit | 15/90 (16.7 percent) |
| No short-term benefit | 17/90 (18.9 percent) |
| Long-term sustained improvement at 1-2 years | 40 of 55 responders to follow-up (72.7 percent) |
| Pattern with patch test strength | Strongly positive < moderately positive in diet response |
Methods (brief)
Open prospective design. Inclusion: positive oral nickel challenge (2.5 mg) with negative placebo response. Intervention: low-nickel diet protocol. Outcomes: short-term dermatitis assessment at 4-6 weeks and long-term questionnaire follow-up at 1-2 years.
Implications
- Certification: Foundational primary clinical-trial evidence for dietary-nickel-as-dermatitis-driver. The 72.7 percent long-term sustained improvement is the headline number that supports HMTc Ni-threshold rationale for vulnerable populations beyond acute LOAEL.
- Microbiome / immunology: Type IV hypersensitivity mechanism via systemic nickel; mucosal route from gut to skin.
- Courses: Standard older reference for low-nickel-diet evidence base. Companion to Kaaber 1978.