Dietary Intervention for Control of Clinical Symptom in Patients with Systemic Metal Allergy: A Single Center Randomized Controlled Clinical Study.

Reiko Mikajiri, Atsushi Fukunaga, Makoto Miyoshi, Noriaki Maeshige, Ken Washio, Taro Masaki, Chikako Nishigori, Ikuko Yamamoto, Akiyo Toda, Michiko Takahashi, Shun-Ichiro Asahara, Yoshiaki Kido, Makoto Usami

Journal: The Kobe journal of medical sciences 2024;69(4):E129-E143

PMID: 38379275

Free Full Text on Kobe Journal of Medical Sciences Publisher View on PubMed

Plain Language Summary

Systemic metal allergies can cause significant clinical symptoms, particularly in patients with eczema. In the treatment of any metal allergy over the whole body, avoiding related antigens, including transcutaneous contact, is necessary. If the symptoms do not show any improvement, a restriction of metal intake should be considered for the dietary intake of the patient. The aim of this study was to assess the effectiveness of a registered dietitians dietary intervention in controlling clinical symptoms in patients diagnosed with systemic metal allergy. This study was a single-centre randomised controlled clinical study. A group of 30 patients participated in a nutritional intervention programme and 15 patients were randomly included in the control group (who did not participate in the intervention programme). Results showed that the intervention group showed a decrease in intake of metals like nickel, cobalt, chromium, and tin, and an improvement in clinical symptoms measured by the SCORAD index. Notably, there was a significant reduction in eczema area, erythema, edema/papulation, oozing/crust, excoriation, lichenization, and dryness after one month of dietary intervention. Authors concluded that dietary intervention, when guided by a registered dietitian, can effectively reduce metal intake and improve clinical symptoms in patients with systemic metal allergy. Thus, dietary management should be considered a viable component of treatment strategies for these patients.

Abstract

Patients with eczema with a systemic metal allergy, such as nickel (Ni), cobalt (Co), chromium (Cr), and tin (Sn), should pay attention to symptomatic exacerbation by excessive metal intake in food. However, dietary intervention for systemic metal allergy can be difficult. In this study, we evaluated the effect of dietary intervention by a registered dietitian on clinical symptoms in patients with a systemic metal allergy. Forty-four patients with cutaneous symptoms who were diagnosed with a metal allergy were randomly assigned to the dietary intervention group (DI group, n = 29) by a registered dietitian or the control group (C group, n = 15). The DI group was individually instructed by a registered dietitian how to implement a metal-restricted diet and then evaluated 1 month later. Dermatologists treated skin lesions of patients in both groups. Skin symptoms assessed by the Severity Scoring of Atopic Dermatitis (SCORAD) index, blood tests, and urinary metal excretion were evaluated. The DI group showed decreased Ni, Co, Cr, and Sn intake (all P ≤ 0.05), and an improved total SCORAD score, eczema area, erythema, edema/papulation, oozing/crust, excoriation, lichenization and dryness after 1 month of intervention compared with before the intervention (all P ≤ 0.05). However, the C group showed decreased Ni and Sn intake and an improved oozing/crust score (all P < 0.05). It showed the effective reduction of dietary metal intake controls dermatitis due to a metal allergy. In conclusion, dietary intervention by a registered dietitian is effective in improving skin symptoms with a reduction in metal intake.

Address: Department of Nutrition, Kobe University Hospital, Kobe, Japan.; Division of Metabolism and Disease, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.; Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.; Division of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Division of Nutrition and Metabolism, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.; Department of Dermatology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.; Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.; Department of Nutrition, Kobe University Hospital, Kobe, Japan.; Department of Nutrition, Kobe University Hospital, Kobe, Japan.; Faculty of Clinical Nutrition and Dietetics, Konan Women's University, Kobe, Japan.; Department of Nutrition, Kobe University Hospital, Kobe, Japan.; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.; Division of Metabolism and Disease, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.; Division of Metabolism and Disease, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.; Faculty of Clinical Nutrition and Dietetics, Konan Women's University, Kobe, Japan.

DOI: 10.24546/0100486230