The Metal Allergy Guide

By Alex Gazzola

Metal allergies — principally to nickel, but also to cobalt, chromium and other metals — may affect up to one in eight of the population, mainly women, and yet those diagnosed with metal hypersensitivity or systemic nickel allergy syndrome (SNAS) are often given little information or practical advice on either managing symptoms or avoiding contact with triggers.

In this authoritative and in-depth guide, specialist allergy writer Alex Gazzola not only helps you to identify the exposures causing you problems, but also shows you how to protect your skin against triggers, and how to care for it when things go wrong.

The Metal Allergy Guide gives extensive advice for everyone with allergic contact dermatitis (ACD) to metals. There are detailed sections on how to find cosmetics and other everyday products which are safe for your metal allergy, as well as a chapter of advice on diet and nutrition for those with metal allergies — especially useful if you need to reduce your exposure to nickel, or cobalt, or chromium in the food you eat.

The book is complemented by plenty of tips throughout, and provides dozens of useful resources, all to help you manage every aspect of living with a metal allergy, day in, day out.

• Language: English
• Publisher: Alex Gazzola
• Release date: Sep 3, 2022
• ISBN: 9798215334188

Book preview

About the author

Alex Gazzola has been a health writer for over twenty years, and now specializes in gut health, allergies and other food and environmental sensitivities.

He is the author of six other health books — including Living with Methylisothiazolinone Allergy, Coeliac Disease: What you need to know, and IBS: Dietary Advice to Calm Your Gut — as well as four books for aspiring writers.

He has contributed to magazines and newspapers in over twenty countries, as well as specialist allergy publications both in print and online.

He edits the Allergy Insight website.

Introduction

Characterized and defined by their lustrous quality and their ability to conduct electricity, metal elements constitute a quarter of the earth’s crust.

Metals are durable, tough, reliable, valuable, versatile. They underpin our technologies, our transport systems, in fact our entire infrastructures. We have copper wires and pipes in our homes. Our buildings are supported and built on steel. Planes of aluminum and titanium fly us overseas.

Such powerful commanders are familiar to us all, but the metallic army’s lesser-known foot soldiers perhaps don’t always get the credit they deserve. We gather energy in solar panels containing small quantities of germanium, beryllium, gallium and molybdenum. We spend hours chatting on smartphones bearing traces of gadolinium, palladium, yttrium and lanthanum.

Life as we recognize it now could not conceivably have developed without metals.

In fact, our lives wouldn’t exist to begin with, given the essentiality of metals within our own biology — iron in our blood, calcium in our bones, not to mention minerals such as zinc and cobalt which we need in trace amounts to keep our chemical systems in sound working order.

The great esteem in which we hold metals is clear from the value we place on adorning ourselves with the most precious and attractive of them, and through the gifts of jewelry to lovers. Their material strength is represented in how we reward athletic achievement — with medals, and sometimes trophies, of gold, silver and bronze.

And these are all qualities which have transferred into our everyday vocabulary too. We talk of having iron will, or nerves of steel, or the strength of a Titan — one of the Gods of Greek mythology after whom titanium was named. A well-behaved child is as good as gold. If you’re brazen and brave you may be as bold as brass. A positive outlook on a negative situation may be dubbed a silver lining.

We have embraced metals in ways many of us now take for granted.

Yet in bringing them into our lives, ever more intimately, touching us, piercing us, even now installed within us, there has been a price to pay for millions across the world.

A history of metal allergy

Metal allergy was first described in 1895 by a pioneering German dermatologist, Josef Jadassohn, who is regarded as the ‘father’ of patch testing for the diagnosis of contact dermatitis.

It was Jadassohn’s belief that a patient with syphilis, who was being treated with grey mercury ointment and who’d experienced a skin eruption, might have developed a sensitivity to the metal. He confirmed his suspicion by applying mercury to the patient’s upper arm, covering it with tape, and monitoring the subsequent response — a reaction which extended beyond the point of contact to both the patient’s chest and wrist. Jadassohn thereby recognized the potential for eczema to occur as a consequence of sensitization to materials applied to the skin.

Curiously and coincidentally, it was at around the same time that a significant step was made by another German on the path towards the production of stainless steel.

The history of this superior alloy is a complex one, but chemist Hans Goldschmidt developed a process at the end of the 19th century to produce carbon-free chromium. This was important because although metallurgists had found that high-chromium alloys resisted corrosion, they were too brittle, due to the undesirably high quantities of natural carbon present in it. A very small amount of carbon is needed in a steel alloy for toughness and strength, and Goldschmidt’s method provided a means of ensuring its levels could be carefully controlled.

In 1913, English metallurgist Harry Brearly created what was arguably the first stainless steel — what he first wished to call ‘rustless steel’ — with 12.8% chromium and 0.24% carbon, and soon identified its ability to withstand exposure to everyday chemicals such as lemon juice and vinegar. Its applications were obvious — affordable cutlery and kitchen equipment — because up until then, knives were prone to rusting and only costly silver could mitigate against the problem.

World War I interrupted further progress, but in 1924 what remains the most common form of stainless steel was invented by another English metallurgist, Dr William Herbert Hatfield. He incorporated nickel into the mix, and this introduced additional qualities, such as improved resistance to high temperatures and corrosion.

Stainless steels, however, do not necessarily release significant amounts of nickel or chromium, so further exposure to these common metallic allergens must have come from someplace else, beyond the confines of our kitchens and dinner tables ...

What was it?

The metal we wear

Changing fashions throughout the 20th century brought metallic elements increasingly into contact with our skins, partly in the name of style — watches and buckles and jean studs and zips and spectacle frames and more. Metal was cool, even chic, as well as practical.

It was after World War II that the phenomenon of metal allergy among ordinary members of the public began to attract more medical attention, after previously only being commonly seen in metal workers, or those employed in the electroplating industry, who were exposed to nickel and other metals almost daily.

Writing in The British Journal of Dermatology in 1955, C. D. Calnan, Senior Registrar at St John’s Hospital for Diseases of the Skin in the UK, expressed the view that he had been very impressed by the prevalence of contact dermatitis due to nickel sensitivity in women while conducting a patch test clinic with a colleague, adding over 95% of them had stocking suspender dermatitis as their first manifestation.

While suspender belts may have fallen out of everyday women’s fashion, jewelry certainly has not. The opposite is true, in fact. The use of nickel in jewelry has become standard over the last century, serving to harden softer metals, such as silver, while still looking aesthetically appealing. It is now abundant in the costume or cheap high-street jewelry with which we increasingly adorn ourselves, men included.

And it is jewelry through which our intimacy with nickel, especially, has been taken to a new level. Although we humans have been physically piercing various parts of our bodies for thousands of years, it was only in the 1970s that sites other than the ears became popular, first within some sub-cultures, but then by the 90s and the turn of the millennium finding more mainstream favor. Be it for self-expression, sexual pleasure, rebellion, religion, spiritual practice, aesthetic value or otherwise, we now routinely bejewel not only our ears, but nose, lips, nipples, umbilicus and genitals.

Piercing introduces a more direct challenge to our immune systems, and unsurprisingly has become the primary risk factor for metal allergy sensitization.

It may or may not be a coincidence that, during the period these issues have been unfolding, we have seen a corresponding increase to allergies and sensitivities to foods and food ingredients, cosmetics and cosmetic ingredients, pollens, dust mites, pets, medicines, fragrances and other agents to which we have become increasingly exposed.

Whether such allergens are consumed or inhaled, or gain access through our skin or mucous membranes, we have not always successfully coped with these new challenges.

Our bodies’ responses have taken many forms — be they through auto-immune disorders such as celiac disease (extreme gluten intolerance), anaphylaxis (the most severe and life-threatening allergic reaction, often to nuts or the hair-dye allergen PPD), gut disorders such as irritable bowel syndrome (IBS, which affects up to 1 in 5), or the seasonal misery of hay fever.

Hygiene, modern medicines, vaccinations, a safe food and water supply, and scientific advancements have all combined to ensure that we are healthier than we have ever been in some respects, and that we have never enjoyed longer lifespans than we do now.

But our changing lifestyles and the modern world growing around us appear to have presented us with new challenges to manage and overcome.

The Nickel Directive

When allergy problems become apparent in society, the relevant authorities often take collective action — for instance, through mandated improvements in product labelling, or the restricting or outright banning of certain ingredients — although these are rarely quick processes, and not always as strict or effective as we might hope.

In the summer of 1989, Denmark introduced legislation banning the importation and manufacturing of consumer items which released nickel above a certain level upon contact with the skin. This was in a bid to prevent new sensitizations in consumers, and to limit reactions in most of those already sensitized.

Its continental fellows followed suit. Wider legislation was introduced in 1994 throughout the European Union (at the time known as the European Commission), which imposed similar limits. The legislation was adapted over the years, and was later subsumed into the wider regulation known as REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals), but it is still popularly referred to as the Nickel Directive. It places limits on products intended to come into direct, prolonged contact with the skin, and even stricter limits on those inserted into pierced parts of the body.  

Although not as prevalent as nickel allergy, chromium allergy also became an increasing problem, particularly among bricklayers and construction workers, due to the presence of certain chromates (chromium salts) in cement mixes. This led to new European Union legislation, effective from 2005, prohibiting the use or supply of cement containing greater than 0.0002% chromate. This was The Chromium VI Directive. It was followed in 2015 by further regulations limiting the levels in leather of chromium VI, in which it is used for tanning, to no more than 0.0003%.

Have these legislative measures enjoyed any measure of success?

Without doubt they have.

The Danish move at the end of the 1980s slashed rates of sensitization among the under-18s from a quarter to under a tenth over a twelve-year period. Dozens of studies since have shown similarly significant decreases across Europe, and retrospective analyses continue to be conducted by researchers, several decades on. A review published by a Danish team in the journal Contact Dermatitis in 2017 of 46 studies published in the preceding decade found that the prevalence of nickel allergy fell from approximately 20% to 11.5% in women aged 18–35, from 29% to 14.5% in female children with dermatitis, from 36.5% to 20% in adult women with dermatitis, and 6.5% to 5% in men — all following implementation of the Nickel Directive.

The future

But outside Europe, legislation hasn’t been forthcoming, not even in the United States, where tens of millions may be affected, although there have been many calls for it.

Let’s hope it will soon come.

The Nickel Institute has expressed support for the EU’s nickel restrictions, but points out that despite the lack of specific legislation to restrict the release of nickel in items marketed to the general public in the US, there are some voluntary industry standards, namely for costume and children’s jewelry, whose guidelines mirror those of the Nickel Directive and with which manufacturers have largely complied.

But these apply only to jewelry, and in an ever-moving modern world, our metal exposures are changing and developing, mainly thanks to technology — cell phones and fitness trackers and smartwatches and tablets and laptops and bluetooth headsets and more besides. There’s even a published case report of a young boy’s worsening allergic dermatitis being pinpointed to a button on an Xbox system.

Quite what will come in future years — be it in the form of innovation, or new treatments — is not easy to forecast, but in the meantime, there are literally millions out there with allergy to nickel, and indeed to chromium, and to cobalt, and to other metals, and what follows is written with the aim of supporting them and improving their lives.

I hope it does both.

Alex Gazzola

Author’s notes

I’m a British writer with a British English turn of phrase, who has aimed to use mostly American spellings in the text. I hope readers from both sides of the pond will forgive any inconsistencies and linguistic peculiarities!

The chapter on emotional health bears close similarities to corresponding chapters in a couple of my other books. Apologies to readers of those books, then, who may find a lot of repeated advice in Chapter 10, albeit lightly tailored to metal allergy and eczema.

Feedback on the book, and suggestions for revisions or additional content, are always welcome from readers. You can email me at [e-mail] or contact me through various social media channels (see Resources).

1. What is metal allergy?

Before we consider what metal allergy — or metal hypersensitivity (MHS) — actually is, it will benefit us to be clear on what a metal is, and what an allergy is too.

What is a metal?

A metal is defined as a lustrous, usually hard material which is often malleable or ductile and which conducts heat and electricity well.

We can consider two types of metal:

Elemental metals

Elements are the