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. 2020 Apr 9;12(4):1040.
doi: 10.3390/nu12041040.

The Effects of Low-Nickel Diet Combined With Oral Administration of Selected Probiotics on Patients With Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

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Free PMC article

The Effects of Low-Nickel Diet Combined With Oral Administration of Selected Probiotics on Patients With Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis

Francesca Lombardi et al. Nutrients. .
Free PMC article

Abstract

Background: Nickel (Ni) oral consumption may elicit systemic reactions in patients affected by systemic nickel allergy syndrome (SNAS), including gastrointestinal symptoms, which in turn are associated with gut dysbiosis. We evaluated the effects of a low-Ni diet alone or in combination with the oral consumption of appropriate probiotics on Ni-sensitivity and urinary dysbiosis markers in SNAS patients.

Methods: n = 51 patients with SNAS and concomitant intestinal dysbiosis were enrolled in the study. According to the urinary indican/skatole levels, quantified through a colorimetric and a high-performance liquid chromatographic method, respectively, patients were assigned to a dysbiosis type/grade and followed a low-Ni diet for three months. Along with the diet, 22 patients also consumed probiotics based on the dysbiosis type. In particular, a Lactobacilli- or Bifidobacteria-containing formulation was administered to patients with fermentative or putrefactive dysbiosis, respectively, while a broad-spectrum probiotic formulation containing both Lactobacilli and Bifidobacteria was administered to patients with mixed dysbiosis. After three months, patients were invited to repeat the Ni-stimulation and the dysbiosis tests.

Results: The fermentative dysbiosis group represented the largest group followed by the mixed dysbiosis group, while only two patients had putrefactive dysbiosis. Overall, at three months of treatment in general (diet alone with or without probiotics), the Ni-sensitivity and dysbiosis levels were strongly ameliorated. The association of a low-Ni diet with a specific probiotic oral supplementation was significantly more effective in decreasing dysbiosis levels or reaching eubiosis than with diet alone.

Conclusion: Our results, while confirming the benefits of a low-Ni diet in SNAS patients, strongly support that appropriate adjuvant treatment with probiotics significantly helps to improve intestinal dysbiosis or restore a healthy microbiota.

Keywords: SNAS; gut dysbiosis; indican; low-nickel diet; probiotics; skatole; systemic nickel allergy syndrome; urinary dysbiosis markers.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summary of study design and patient flow diagram.
Figure 2
Figure 2
Pre- and post-treatment levels of skatole, indican, and oral Ni stimulation test (Ni-OST). Skatole and indican levels were represented by spaghetti plots (A, B) and the amounts of Ni used in the Ni-OST were graphed by boxplots (C).
Figure 3
Figure 3
Comparison of pre- and post-treatment levels of urinary dysbiosis markers. Data are stratified for dysbiosis type based on the pre-treatment levels of skatole and indican.
Figure 4
Figure 4
Percent distribution of dysbiosis types before and after treatment.
Figure 5
Figure 5
Representation of pre- and post-treatment concentrations of skatole (µg/L) and indican (mg/L) in patients with pre-treatment abnormal values by spaghetti plots. (A) Pre- and post-treatment levels of skatole in patients who followed the low-Ni diet alone. (B) Pre- and post-treatment levels of skatole in patients who followed the low-Ni diet combined with probiotics. (C) Pre- and post-treatment levels of indican in patients who followed the low-Ni diet alone. (D) Pre- and post-treatment levels of indican in patients who followed the low-Ni diet combined with probiotics.
Figure 6
Figure 6
Pre- and post-treatment percentage distribution of eubiosis or dysbiosis condition, stratified for type of treatment (low-Ni diet alone or combined with probiotics).

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References

    1. Thyssen J.P., Menne T. Metal allergy—A review on exposures, penetration, genetics, prevalence, and clinical implications. Chem. Res. Toxicol. 2010;23:309–318. doi: 10.1021/tx9002726. - DOI - PubMed
    1. Ahlstrom M.G., Thyssen J.P., Wennervaldt M., Menne T., Johansen J.D. Nickel allergy and allergic contact dermatitis: A clinical review of immunology, epidemiology, exposure, and treatment. Contact Dermat. 2019;81:227–241. doi: 10.1111/cod.13327. - DOI - PubMed
    1. Torres F., das Gracas M., Melo M., Tosti A. Management of contact dermatitis due to nickel allergy: An update. Clin. Cosmet. Investig. Dermatol. 2009;2:39–48. doi: 10.2147/ccid.s3693. - DOI - PMC - PubMed
    1. Bechara R., Pollastro S., Azoury M.E., Szely N., Maillere B., de Vries N., Pallardy M. Identification and Characterization of Circulating Naive CD4+ and CD8+ T Cells Recognizing Nickel. Front. Immunol. 2019;10:1331. doi: 10.3389/fimmu.2019.01331. - DOI - PMC - PubMed
    1. Falagiani P., Di Gioacchino M., Ricciardi L., Minciullo P.L., Saitta S., Carní A., Santoro G., Gangemi S., Minelli M., Bozzetti M.P., et al. Systemic nickel allergy syndrome [SNAS]: A review. Rev. Port. Immunoallergol. 2008;16:135–147.
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