Metal Allergy Guide: Symptoms, Treatments, and Alternatives
What was intended as a thoughtful gift could unintentionally result in dermatological symptoms, including irritation and rash. A review on metal allergies estimates that up to 17% of women and 3% of men are allergic to nickel, while 1-3% are allergic to cobalt and chromium. The review also states that allergies are becoming more common in the U.S., and the frequency of metal allergies is often higher among dermatitis patients.
Allergic reactions can make jewelry and other fashion items (including buttons and other clothing fasteners) uncomfortable, as well as unwearable. Other common devices that can trigger a reaction are dental restorations and medical device replacements, such as prostheses and implants. Reactions with these devices may result in failure or inability to use them.
It is important to recognize the symptoms of metal allergies and know what metals and alloys may create allergic reactions. Those with sensitive skin and/or those that experience allergic reactions should transition to metals that are hypoallergenic, such as titanium, which is considered biocompatible and is frequently used for allergen-free jewelry and medical devices.
What Is A Metal Allergy?
Metal allergies, or metal hypersensitivity, is a disorder of the immune system that produces a variety of symptoms. The reaction may be specific to the location of the contact, but can also sometimes affect distant parts of the body. Reactions occur when the body’s immune system views metal ions as foreign threats. The body’s immune system often deals with threats by inflammation and attacks the metal ions that the body considers to be foreign bacteria or viruses.
- Chronic fatigue syndrome;
- Rheumatoid Arthritis.
Metal sensitivity can be tested with a Metal-LTT blood test. Metal-LLT testing identifies if people are susceptible to metal hypersensitivity by testing the immune cell responses to differing metal allergens. The test can also identify which specific metals cause severe excessive immune reactions, as well as minor sensitivity responses.
Most Common Metal Allergies
Allergies can be developed for any metal, though there are three primary metals that are considered the most common: chromium, cobalt, and nickel. These metals are often used by manufacturers as alloys with other metals. Alloys are the combination of metals, creating a different substance that often has different properties than the original elements. Alloys are used in a variety of applications such as creating a desired effect or look such as rose, red, or white gold, or sterling silver, increasing scratch resistance or durability, or lowering production and purchasing costs.
Alloys in metals often act as contact sensitizers, causing an allergic reaction through contact. Unknown alloys and impurities may lead people to believe they are allergic to the wrong metal. Unknown metals can also hide in products and devices such as tattoo inks, leather, cosmetics products, soaps, as well as some contact lens solutions.
The prevalence of chromium allergies affects about 1% of the U.S. population and is used widely by a variety of industries. Chromium is known by several names including:
- Chromium salt;
- Chromium sulfate;
- Potassium dichromate.
Chromium is a hard metal that is silver in color and often takes on a high mirror-like polish. Stainless steel is an alloy that must have a minimum of 10.5 chromium, which lends its properties of resistance to corrosion, so any jewelry, cookware, or other products made of stainless steel containing chromium. Chromium may also be found in:
- Anti-rust primer in yellow or green paint;
- Automobile primer paints;
- Dental and orthopedic implants;
- Many tanned leather goods including shoes and gloves;
- Radiator coolants;
- Yellow or green cosmetics or tattoo inks.
Workers that often come in contact with irritant contact-sensitivities include artificial flower makers, woodworkers, cement workers, and those that work in photographic or pottery industries.
Cobalt is a natural metal found in soil, seawater, and dust. In a pure form, cobalt is silvery blue or gray. Cobalt has a long history of uses including ceramics, pottery, and glass blowing. It can often be found as an alloy in jewelry, commonly with tungsten for its natural hardness and scratch resistance, though there are tungsten rings that do not contain cobalt. Cobalt may also be found in:
- Automobile exhaust;
- Blue pigments for colored glass, porcelain, ceramics, pottery, and enamels;
- Blue and green watercolors and crayons;
- Dental plates;
- Hair dyes;
- Metal alloys for machine parts such as cutting tools and drills;
- Metal-plated buckles, buttons, snaps, and zippers;
- Metal prosthesis;
- Vitamin B12.
Workers that often come in contact with cobalt are those that manufacture polyester resins, that work in the cement industry or with certain paints or varnishes, as well as those in the pottery industry.
Nickel is a common metal, silver-white in color and lustrous, with a slight golden tinge. Nickel allergies are considered the most metal common allergy, frequently affecting women more so than men. The allergy may appear at any age of a person’s life. The most common cause of contact allergic dermatitis from nickel is jewelry, but nickel can also be found in:
- Cell phones;
- Clothing fasteners and zippers;
- Glasses frames;
- Paper clips;
- Stainless steel cooking equipment;
Most jewelry contains nickel alloys, or at least trace amounts of nickel — aside from pieces made from stainless steel, 18-24 carat gold, sterling silver, or pure platinum. For this reason, many people often mistake nickel allergies for allergies associated with other metals, including gold and silver.
Those with severe allergies may also have to carefully read labels and be cautious about what they eat, as some foods contain nickel. Foods to be aware of may include:
- Asparagus, broccoli, Brussels sprouts, sprouts, and spinach;
- Black tea;
- Bananas and pears;
- Canned, preserved, and processed foods;
- Cocoa-powder and chocolate;
- Legumes, including beans, chickpeas, lentils, peas, and peanuts, and soy;
- Multi-grain bread and cereals;
- Oats, buckwheat, whole wheat, wheat germ;
- Soy milk;
- Various seeds and nuts.
Workers that often come in contact with, or who are highly likely to develop allergies to nickel include; hairdressers, nurses, caterers, people who handle cash and coins regularly, as well as people who work directly with metals including welders and smiths. It is also important to inform a doctor of any nickel allergies before surgery.
Metal Allergy Symptoms
There are a variety of symptoms that can arise from allergic reactions to metal. Symptoms may include:
- Blistering of the skin;
- Chronic fatigue and inflammation;
- Cognitive impairment;
- Joint pain;
- Muscle pain;
- Reddening or discoloration of the skin;
The symptoms of an allergic reaction may range from mild to severe. They may also be specific to the location of contact with the irritant or may migrate to other parts of the body — especially when sweating, or if the irritant is internal such as a prosthetic.
Chromium Allergy Symptoms
The symptoms of sensitivity to chromium usually manifest as contact dermatitis, a triggered irritation on the skin from an allergen. The affected area may become itchy, red, and blistered, ranging in intensity from mild to severe. Acute dermatitis may also occur, bringing on a rapidly evolving rash that could swell and blister, sometimes even resulting in a thickening of the skin.
For some who have undergone surgery or prosthetic replacements, symptoms such as eczema may occur over the prosthesis site. Symptoms may also vary from tenderness and swelling to urticarial or vasculitic reactions. Hip replacements may also suffer from long-term complications of a chromium allergy that may result in the loosening of the implant.
Cobalt Allergy Symptoms
Cobalt allergies often manifest as contact dermatitis, a skin rash that occurs through contact. However, irritant dermatitis — a reaction when the skin is repeatedly exposed to an irritant over time — is also frequent. Cobalt allergies are often found in tandem with nickel allergies.
Airborne cobalt particles may cause erythema multiforme — a reaction triggered by an infection resulting in a skin eruption or lesion. Less frequently the administration of B12 injections may cause redness, itching, and tenderness at the site. There are also reported occurrences of chronic resistant eczema or asthmatic symptoms after the ingestion of the oral administration of vitamin B12.
Nickel Allergy Symptoms
Nickel allergy symptoms often arise after 24-48 hours of coming into contact with items containing nickel. The symptoms often include rash and bumps, itch, redness or changes in skin color, dry patches, and blisters in very severe cases. These responses are typically localized to the area that came into contact with nickel.
Immune responses can also occur after eating foods that contain small amounts of nickel. This can trigger symptoms such as severe itching, scaly, raw, dry, discolored, or thickened skin, feelings of tenderness or excess warmth in the skin, or fluid-filled blisters. These symptoms may last two to four weeks.
In more rare occurrences, nickel allergies can result in respiratory problems that may manifest as nasal inflammation, runny nose, sneezing, or asthma. These reactions indicate that preventative measures should be sought immediately.
Metal Allergy Treatments
The best way to treat an allergy depends on the allergic reaction source. There are a variety of topical creams used for skin irritation from contact dermatitis, though some allergic reactions require oral antihistamine or corticosteroids provided by a doctor. Severe cases of an allergic reaction may result in anaphylaxis and should be addressed by a medical professional — if you are experiencing these symptoms you should call 911 immediately. Symptoms of severe allergic reactions include:
- Breathing problems;
- Chest tightness;
- Hives all over the body;
- Nausea and vomiting;
- Swelling of the eyes;
- Swelling of the mouth and throat which can result in the closure of the airway;
- Tingling of the palms, hands, feet, or lips.
Seeing an allergist may help prevent allergic reactions before they happen. Diagnosis of metal allergies is often performed through exposure and open application testing to determine the threshold for sensitization.
Chromium Allergy Treatment
There is no cure for a chromium allergy. Treatment of allergic reactions to chromium are often used to soothe contact dermatitis with localized measures including topical creams and oral antihistamines or corticosteroids that reduce inflammation. Further treatment may be necessary for a secondary infection.
Prevention of further contact dermatitis often results in a reduction, avoidance, or elimination of exposure. This can result in no longer wearing jewelry or irritants, using vinyl or rubber gloves, wearing protective clothing, utilizing wooden or rubber handles for metal objects, or coating small objects such as clothing fasteners with clear nail polish.
Cobalt Allergy Treatment
There is no cure for a cobalt allergy. Treatment of allergic reactions to cobalt typically utilizes topical creams and corticosteroids, as well as oral corticosteroids and antihistamines to suppress allergic reactions. If secondary infections occur, further treatment may be needed.
To prevent further allergic reactions, avoidance of all sources of cobalt is important. This can be done with the use of vinyl or rubber gloves, and utilizing wood, plastic, or other hypoallergenic handles for metal instruments. Painting clothing fasteners and small objects with clear nail polish may also help to alleviate symptoms, though the best prevention methods are no-touch techniques.
Nickel Allergy Treatment
There is no cure for a nickel allergy. Treatment of allergic reactions to nickel may include topical creams, corticosteroid creams, and/or oral corticosteroids or antihistamines. Moisturizers and lotions may also soothe contact dermatitis areas, as well as calamine lotion and wet compresses. Secondary infections may require further medical attention and may need to be treated with antibiotics.
To prevent further allergic reactions of nickel allergies, all objects and food containing nickel should be avoided. People with allergic reactions to nickel should also avoid stainless steel as well as jewelry that is not hypoallergenic. Doctors, dentists, and optometrists should be told of nickel allergies before any surgical procedures, orthodontic braces or fillings, or eyeglass frames are offered.
Metals to Avoid If You Have Sensitive Skin
Those with sensitive skin should be aware of the metal alloys that may act as sensitizers. Metals that should be avoided if you have sensitive skin include:
- Brass is an alloy of copper and zinc, meaning that allergies to brass may be relatable to allergies with copper.
- Rose gold;
- Rose gold a gold and copper alloy, causing allergic reactions to those with copper allergies.
- White gold;
- White gold is typically a gold and nickel alloy, causing those with nickel allergies to have allergic reactions.
- Plated metals;
- Plating is not always a perfect barrier to allergies. It is important to consider what the object has been plated with, as well as what the base object may be.
- Stainless steel;
- Stainless steel contains trace amounts of nickel and iron and may cause reactions to those with nickel allergies.
Sensitive-skinned individuals may have difficulty finding hypoallergenic wedding bands and other jewelry that they can wear comfortably and confidently. However, there are several hypoallergenic metals that are great alternatives to traditional metals. Hypoallergenic metals may include:
- Ceramic – Ceramic wedding bands and tools are made of a non-metal substance that is hypoallergenic for those with metal allergies
- Gold – Gold is categorized by a variety of carat counts. 24-carat gold is pure gold without the use of an alloy. 20-carat gold and below may reduce the likelihood of allergic reactions, but it is important to discover what alloys were used to consider if there are chances for an allergic reaction.
- Niobium – Niobium is often used in medical implants, and it does not contain additives or nickel or lead alloys making it safe for those with metal allergies.
- Platinum – Platinum is often considered a hypoallergenic metal that is corrosion-resistant. It is often alloyed with gold but can be alloyed with other metals. It is important for those with sensitive skin to ensure that the platinum they intend to use has not been alloyed with cobalt
- Silver – It is important to know the grade of silver you intend to wear/use as most silver is made with an alloy. Sterling silver must be 92.5% pure silver, but it is consequential to ensure that it is nickel-free sterling silver, or hypoallergenic silver.
- Stainless steel – Stainless steel may have a nickel content that is too high for some to wear or use consistently, but it is resistant to corrosives and will not rust, making it a valuable metal for surgical instruments. Steel that has less than 1% nickel content may be suitable for those with sensitive skin.
- Titanium – Titanium is considered biocompatible and is often used for implants. It is non-toxic and long-lasting. Titanium is graded; titanium grades 1-4 are considered pure, with grades 5 or higher being an alloy. It is important to consider using purer forms of titanium if metal sensitivity is an issue.
- Tungsten – Pure tungsten is an allergen-free metal that can be used for jewelry or hypoallergenic tungsten wedding bands. It is important to make sure that the tungsten you plan on wearing/using has not been alloyed with nickel.