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A 19-year-old woman with known strong contact sensitization to nickel sulfate presented with persistent periumbilical eczema even though she had been careful to avoid exposure to the allergen. She had childhood atopic dermatitis which had been latent but had flared a year previously, presenting as flexural eczema. Double-blind placebo-controlled oral challenge with 5 mg nickel revealed a hematogenous contact dermatitis, accompanied by fever and malaise. It resolved quickly after treatment with systemic steroids and antihistamines. The possibility of hematogenous contact dermatitis should be considered in patients with strong delayed-type hypersensitivity suffering from persistent or relapsing eczema.

Materials used in osteosynthesis or artificial joint replacement are usually well tolerated. Complaints after such operations are mostly related to infection or mechanical problems but may also be caused by allergic reactions. The latter encompass skin changes, e.g., eczema, delayed wound/bone healing, recurrent effusion, pain, or implant loosening. In contrast to the high incidence of cutaneous metal contact allergy, allergies associated with implants are a rare condition. However, epidemiological data on the incidence of implant-related allergic reactions are still missing. Typical elicitors are nickel, chromium, cobalt, and constituents of bone cement (acrylates und additives such as gentamicin or benzoyl peroxide). After exclusion of the most common differential diagnoses, allergy diagnostic procedures are primarily based on patch tests including a metal and bone cement component series. Additional analysis of periimplant tissue is recommended. However, further studies are necessary to show the significance of the histologic findings and the role of the lymphocyte transformation test (LTT). Which combinations of factors will induce allergic sensitization to implants or trigger periimplant allergic reactions in the case of preexisting cutaneous metal allergy is still unknown. Titanium-based osteosynthesis materials are recommended for metal allergic patients. In elective hip replacements, a ceramic/polyethylene (PE) articulation should be used, and in knee replacements "alternative materials". If a regular, potentially applicable CoCr/PE articulation is preferred, the patient must be well informed and must give his/her written consent.

In spite of some unsolved questions, an influence of orally ingested nickel on some forms of chronic eczema is generally accepted. In cases of chronic relapsing dermatitis with typical location, positive nickel patch test and positive oral nickel challenge, a nickel-restricted diet may be recommended for a limited period of time. Regional nutritional habits should be considered in the design of diets. Indications, practice and evaluation criteria for oral nickel challenge and nickel-reduced diets are described.

In two-factorial experiment with variable Zn- and Ni-content of the diet effects of interactions between iron and zinc on growth, food intake, food efficiency and protein concentration is serum, liver and pancreas of rats were investigated through a wide range of supply of both elements. Besides food efficiency interactions between zinc and nickel influenced all parameters, if certain relations of the both elements were imbalanced. Especially by growth it could be shown that either zinc deficiency could be reduced by excessive Ni supply nor Ni toxicity by elevated Zn content of the diet.

With reference to endogenous nickel contact dermatitis, the quantity of nickel resorbed is dependent on the individual capacity for absorption, the element species of nickel in the food matrix and the total nickel content in the food. As the content of nickel varies widely in individual foods, it is difficult to make any definite dietary recommendations. The wide fluctuation in the nickel content of vegetable food stuffs is due to variations in the composition of soil. This means the availability of nickel to plants is not constant. The fluctuating content of nickel in the soil also has a heavy influence. Nickel contamination can be considerable when food is prepared in the usual way. The danger of nickel contamination during industrial preparation of food has not yet been fully explored. In tests for endogenous nickel contact eczema, organic nickel should be used. Another way is to administer a diet containing only defined minute amounts of nickel.

Since half a century the toxicity and carcinogenicity of nickel and its compounds is in discussion. Problems coming therefrom are of high relevance concerning occupational medicine. According to the new national and international literature the present findings are described and discussed. Starting from occurrence, refining and occupational hazards, in the first part, toxicologic mechanisms and characteristic symptoms are represented in detail. Inorganic and organic Ni-compounds are handled separately. In the second part of this study we are giving opinion to the questions of carcinogenicity. Experiences to occupationally nickel-exposed workers as well as a review about the topical findings in animal experiments are described. Of importance there are questions referring to the different carcinogenic potential of nickel and its compounds and the influence to techniques of application. Current results to the mechanism of carcinogenesis, which can be derived from animal experiments, are shown. The carcinogenicity for nickel and some especial water insoluble Ni-compounds in human beings must be seen as a fact. Malignoms in the respiratory tract are regarded by workers breathing dust/aerosols of metallic nickel, nickel subsulfide, Ni-oxide and in electrolysis. By critical review of the present literature a cancerogenicity of nickel-carbonyl has to be assumed too. According to this review measures in the field of occupational hygiene and medicine are required. Illness caused by nickel or its compounds should be included to the valid list of occupational diseases in the FRG.

Model experiments were carried out with rats showing that the average Ni concentrations in the milk of the experimental animals receiving a Ni deficient diet (40 ppb of dietary Ni), relative to those of the controls (20 ppm), declined from 1088 ng/g to 726 ng/g (33%). This produced a Ni deficiency in the youngs of the rats resulting in retarded growth, reduced Fe absorption and a decline in enzymatic activity. An increase in the Ni content of the milk from both the experimental animals and the controls was observed during lactation. In the Ni deficient group this upward trend was longer noticeable from about the middle of the lactation period onwards. Animals in the Ni deficient group excreted about three times as much Ni through the milk as was ingested with the food. Because of the wide range of deviations of the Ni content in the different animals the Ni content of the milk cannot be used, under practical conditions, as an index of a state of Ni deficiency.