Nickel allergy
A very common contact allergy, from jewellery and metal objects.
About nickel allergy
Nickel is the most common cause of allergic contact dermatitis, a delayed, T-cell mediated (type IV) reaction that typically appears 12 to 72 hours after skin contact. It is present in costume and some fine jewellery, watch straps, belt buckles, jeans studs, zips, spectacle frames, coins and many everyday metal objects. Sensitisation is strongly linked to skin piercing, especially ear piercing, and nickel allergy is considerably more common in women, though anyone can develop it. Once established, the sensitivity is usually lifelong.
The rash is itchy, red and sometimes blistered or scaly, appearing exactly where the metal touches the skin, such as the earlobes, wrist, neck, waistline or fingers. A patch below the navel from a jeans stud is a classic sign. With repeated contact the dermatitis can become dry, thickened and chronic, and in some people it can flare at sites away from the original contact. Nickel and cobalt allergy often occur together because the metals are frequently present in the same items.
Diagnosis is by patch testing with a dermatologist, not skin-prick testing. Management is avoidance: choosing nickel-free or hypoallergenic jewellery and fasteners, using barrier measures such as a protective coating on studs, and covering metal that contacts the skin. Emollients and, when advised, topical steroids settle flares. See your GP or a dermatologist if the rash is persistent, widespread or interfering with daily life.
Common triggers
- Cheap jewellery and watches\nBelt buckles, zips and buttons\nCoins, keys and phones
Symptoms
- Red, itchy rash (contact dermatitis)
- Dry, cracked or scaly skin
- Blistering or weeping in severe cases
- Burning or stinging where skin met the trigger
Avoidance & management
- Avoid skin contact with the trigger
- Wear gloves or use barrier creams
- Choose products labelled free from the allergen
- Rinse skin promptly after contact
- Use emollients or prescribed steroid creams
Sources & references
Allergy safety: what everyone should know
Mild-to-moderate reaction signs
- Itching, hives or a raised rash
- Swelling of lips, face or eyes
- Tingling mouth, sneezing, runny nose
- Stomach pain, nausea or vomiting
Anaphylaxis — call 999 (UK) or 112 (EU) immediately
- Difficult or noisy breathing, wheeze, persistent cough
- Swelling of the tongue or tightness in the throat
- Dizziness, collapse, pale and floppy (young children)
- Use an adrenaline auto-injector (e.g. EpiPen) at once if prescribed, then call an ambulance even if symptoms improve
Allergy or intolerance? A true allergy involves the immune system and can escalate quickly; an intolerance (e.g. lactose intolerance) is unpleasant but not life-threatening. The symptoms overlap, so self-diagnosis is unreliable.
Getting tested: home-testing kits based on IgG are not diagnostically valid. If you suspect an allergy, ask a GP for referral to an allergy clinic for skin-prick or specific-IgE testing and a supervised food challenge where appropriate.