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.
Highlights
Nickel (Ni) is a chemical element widely diffused in the environment [1]
High levels of urinary indican and a normal amount of skatole, a condition associated with a fermentative dysbiosis, were revealed in 33 patients, while just two patients showed abnormal values of urinary skatole and normal indican, a condition associated with a putrefactive dysbiosis
Ni-low diet alone or combined probiotic consumption, threemonths months of treatment with the Ni-low diet alone or with combined with probiotic patients were resubmitted to the dysbiosis test and to the Overall, the urinary levels of skatole consumption, patients were resubmitted to the dysbiosis test and to the Ni stimulation stimulation test test (Ni-OST)
Summary
Nickel (Ni) is a chemical element widely diffused in the environment [1]. Topical Ni exposure occurs from metallic items, household products, and cosmetics, whereas systemic exposure is possible from food, water, surgical implants, and dental materials [2]. The ingested Ni-containing compounds, in addition to typical systemic cutaneous lesions, may induce gastrointestinal symptoms like those characterizing inflammatory bowel disease (IBS), i.e., nausea, pyrosis, meteorism, abdominal pain, diarrhea, and constipation. This clinical picture, known as Systemic Nickel Allergy Syndrome (SNAS) [5,6] and considered to be an emergent allergic condition, is associated with immune system dysregulation with massive infiltration of pro-inflammatory CD4+. 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
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