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Gastrointestinal distress (e.g., nausea, vomiting, diarrhea) and neurological effects were reported in workers who drank water on one shift that was contaminated. PDF | Some heavy metals have bio-importance as trace elements but, the biotoxic exposure, the symptoms of effects include nausea, vomi-. PDF | Nicotinamide adenine dinucleotide phosphate (NADP) is an essential biomolecule that cromatografia de afinidade com níquel. A.

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Níquel Náusea

It may not only cause contact dermatitis, but also asthma, nasal septum perforation, pneumonia, and nasal and lung cancer. Usually primary sensitization occurs from nonoccupational sources and work exposure aggravates the dermatitis, but occasionally primary sensitization occurs in the workplace, mainly from wet works with nickel contact.

Workers develop chronic hand eczema, as many work tools release large amounts of the metal which can also penetrate through rubber gloves. Besides, cross-reactivity requires chemical similarities that are not present in such cases. Cross-challenge experiments carried out in guinea pigs to clarify simultaneous patch-test reactivity and possible cross-reactivity to metals nickel sulfate-cobalt chloride; nickel sulfate-potassium dichromate, nickel sulfate-palladium chloride , show that cross-reactivity is possibly involved in reactions to nickel sulfate-palladium chloride but not in reactions to nickel sulfate-cobalt chloride and nickel sulfate-potassium dichromate.

Lammintausta performed a study in guinea pigs sensitized to nickel and found that they could be more easily sensitized to cobalt. Approximately 18.

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Key search terms included: nickel contact dermatitis, nickel contact allergy, nickel sensitization, nickel, children contact dermatitis, and metal contact dermatitis. In addition, references of relevant articles and reviews were manually searched for additional sources.

Bibliographies of retrieved publications were reviewed to identify sources not obtained in our search. A summary of the evidence and proposed recommendations were then generated. Approach to patients with nickel ACD Management of nickel contact dermatitis include early diagnosis and preventive and therapeutic strategies.

Diagnosis History and clinical examination A detailed history should investigate possible source of exposure, including daily activities, environmental conditions, past and current occupations and manipulation of products. In children, it is important to examine and question their parents and careers. Clinical features include localized primary eruptions or generalized secondary eruptions, which can be eczematous or not.

Primary eruptions are characterized by recurrent eczematous lesions on the sites of direct contact with the items that release nickel, such as earlobes use of earrings , wrists use of watches , neck use of necklaces and umbilical region jeans button. The maculopapular exanthema with flexural involvement presents as a symmetrical eruption of the neck, face, eyelids, elbow flexures and forearms, hands, inner thighs, anogenital regions, and may be generalized.

The name denotes a characteristic clinical picture reminiscent of the red gluteal region of a baboon. The flexural predilection of the eruption is unclear, and it could be only partially explained by local occlusion and sweating.

As this test measures only whether the individual is sensitized or not, a positive test reaction is not necessarily an indicator of clinical disease. Clinical relevance of patch test results should always be established.

There is a high degree of concordance between history of nickel exposure and outcome of patching testing. Positive reactions are usually strong. False-positive reactions may occur in atopics, where follicular irritative reactions are common. Weak true-positive reactions can also show a follicular pattern. False-negative reactions can also occur. Since patch tests are often performed by different specialists including allergologists, dermatologists, pediatricians, and general physicians, special training is essential to correctly judge and interpret the test in order to distinguish allergic from irritative reactions and establish patch test relevance.

Patch testing is considered safe in children, but positive reactions should be assessed with caution. Some limitations include the small patch test surface, hyper mobility which may result in loss of patch test materials , particularly in younger children, and the hesitation of some parents to allow patch testing.

Some authors recommend the same patch test concentration as in adults, but others recommend lower allergen concentration. Dimethylgloxime DMG spot-test This test identifies metallic objects that contain high nickel concentrations at least 1:10,000 and can be useful to screen personal items in individuals allergic to nickel. An object that gives a negative result is unlikely to induce the dermatitis.

There are two methods to perform the test. A modification of this technique was proposed by Shore who suggests applying a few drops of DMG and then a few drops of ammonium hydroxide on a cotton-tipped applicator that is then rubbed against the object. A pink-red precipitate on the applicator tip detects a positive reaction.

Experimental oral provocation This technique is not routinely recommended, but it is a possibility in patients with pompholyx when a possible role of nickel is suspected. Nickel dietary intake varies from 0. The lymphocyte proliferation test This test can be useful in the diagnosis of nickel sensitivity.

Duarte showed that lymphocyte proliferation was higher in patients allergic to nickel 17 patients than in controls 25 patients for all the nickel concentrations tested.

Intradermic test Intradermic test is almost never used on clinical practice, but it may be utilized in case of doubtful patch test reactions, either to identify false-positive reactions or to confirm a clinical suspicion of nickel dermatitis in patients with negative patch tests.

It has been documented that this strategy results in a statistically significant decrease in the frequency of hand eczema in nickel-sensitive individuals.

Cosmetics often contain nickel and some products such as mascara and eye shadows might cause or aggravate ACD, particularly in patients with eyelid involvement.

Antiperspirants The use of antiperspirants in order to decrease sweating can sometimes prevent nickel ACD, as sweating induces release of nickel ions from metallic items. Symptomatic treatments Since pruritus is an important complaint sedating oral antihistamines might be indicated.

Topical antihistamines on the other hand must be discouraged, as they are possible sensitizers. Oral doxepin 10—25 mg at night in adults can be considered if other oral antihistamines are not helpful. Topical or oral antibiotics must be prescribed in case of secondary bacterial infection. Emollients in creams are useful to relief itching and dry skin.

Steroids Topical steroids are very useful and represent the first-line treatment. Potency should be chosen according to the body sites, as low potency steroids are recommended for face and flexural areas and high potency agents might be used for other sites as palms and soles.

Oral steroids act as immunosuppressive agents and might be indicated for short-term treatment of severe dermatitis. In adults prednisone in a single morning dose of 40 to 60 mg can be prescribed and tapered over 2 to 3 weeks, as symptoms resolve. Calcineurin inhibitors Calcineurin inhibitors are currently approved for the treatment of atopic dermatitis but not ACD. Advantages over topical corticosteroids include that they do not cause cutaneous atrophy or glaucoma or cataracts when applied near the eye.

Pimecrolimus cream might be used for the face and tacrolimus 0. Kalimo treated with PUVA 5 female patients with longstanding hand dermatitis with complete resolution after 1 year. However sensitivity of blood lymphocytes to nickel after treatment was approximately the same or increased which provides no evidence to indicate that systemic, nickel-specific suppressive immune regulative mechanisms would have been activated by the treatment.

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It is also important to inform the patients that they cannot drink alcohol during treatment. Adult dose is 500 mg PO qd and 125 to 500 mg PO qd for maintenance. The preparation with diphenylglyomime was shown to have a positive effect. Low-nickel diet Food is important source of nickel and daily ingestion depends both on the type of food and on the production environment. Foods with high nickel content include wholegrain flour, oats, soybeans, legumes, shellfish, nuts, licorice and chocolate.

However, it has been shown that some patients might benefit from a nickel free or a low nickel diet. Nickel hyposensitization Since nickel sensitization is a hapten-specific immunological process, it is possible to induce immune tolerance to this metal.

As already discussed in this article, it had been shown that oral exposure to nickel through dental braces prior to ear piercing reduces the risk of developing nickel allergy. However, occupational ACD usually but not always improves on weekends and during holidays. Nickel occupational ACD presents most commonly as hand eczema, as hands are constantly exposed to work tools that release nickel.

The condition can lead to inability to work, as the hands are necessary in the majority of work tasks. It has been shown by several studies that nickel exposure can be quantified by nickel content in nails and skin.

Such measurements provide an objective evaluation of occupational exposure in nickel-sensitized individuals with hand dermatitis, but are not available in daily practice. Depending on sensitization degree and clinical presentation it might be necessary to temporarily remove the worker from his tasks. Sometimes it might be necessary to rehabilitate the worker in another function where there is no contact with nickel.

Besides the preventive and therapeutical strategies generally recommended for nickel-sensitized individuals, already discussed in this article, there is the necessity to improve the workplace environment by eliminating and substituting metallic tools.

Good occupational hygiene is mandatory, especially for workers in contact with platters and batteries, which release a considerable amount of nickel salts that can contaminate gloves and clothing. Use of personal protective equipment, particularly gloves made of polyvinyl chloride PVC , is important.

Early diagnosis and proper management are fundamental. If the individual can prevent contact with items that release this metal, the prognosis is often good. Factors associated with a bad prognosis include continuous nickel exposure, involvement of the hands, secondary bacterial infection, history of atopy, and multiple contact allergies. Conclusion Nickel is the most common sensitizing agent worldwide.

Allergic contact dermatitis due to this metal represents great morbidity, as well as cases of systemic allergic contact dermatitis, which can be misdiagnosed as adverse drug reactions, delaying the correct diagnosis and leading to inappropriate treatment. Studies in work adaptability and quality of life are needed, as no data have been published in this field.

Footnotes None of the authors declare conflicts of interest. References 1. The International Nickel Company.Topical antihistamines on the other hand must be discouraged, as they are possible sensitizers. False-positive reactions may occur in atopics, where follicular irritative reactions are common.

Depending on sensitization degree and clinical presentation it might be necessary to temporarily remove the worker from his tasks.

Emollients in creams are useful to relief itching and dry skin. The presence of certain metals i. Nausea sartre online pdf - WordPress. Duarte showed that lymphocyte proliferation was higher in patients allergic to nickel 17 patients than in controls 25 patients for all the nickel concentrations tested.

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