Nickel Allergy Masquerading as Irritable Bowel Syndrome- Case Report.

Nickel-allergy is a common cause for contact dermatitis but not a well-known cause for gastrointestinal (GI) symptoms. Dietitians, faced with a patient with multiple nontraditional food intolerances and continued GI distress, worry about declining nutritional health. The prevalence of nickel-allergy is estimated to be about 11.4% in the general population. Many clinicians are unaware systemic nickel allergy syndrome (SNAS) causes symptoms similar to irritable bowel syndrome (IBS). Elimination of nickel in the diet is not possible as it occurs naturally in the environment but reducing exposure is possible. This report describes a woman with dermatological nickel-allergy who has suffered significant GI symptoms with the diagnosis of non-responding IBS. The patient noted that her multiple symptoms both intestinal and extra-intestinal either resolved or were better managed once she started a low-nickel diet. This case demonstrates that clinicians should be aware of nickel-allergy as a potential contributor to non-responding IBS.