Diagnosis and treatment recommendations
Skin patch allergy testing – in which a person’s skin is exposed to nickel – can quickly determine whether a patient with IBS is actually experiencing inflammatory reactions to dietary nickel and would benefit from a low-nickel or no-nickel diet, research shows.
For these patients, Dr. Pashinsky recommends the following:
- Avoiding high-nickel foods.
- Limiting canned foods.
- Using nonstainless cookware, especially for acidic foods.
- Boiling foods for potential nickel reduction, especially grains and vegetables.
- Running the tap before using water to drink or cook with first thing in the morning.
Dr. Pashisky and her team also recommend the following guidelines for doctors:
- Ask patients if symptoms occur immediately after eating certain high-nickel foods or worsen with a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet.
- Determine whether a patient is not responding to typical medical and dietary interventions used to treat IBS.
- Conduct a food/symptom history to identify potential nickel allergy triggers.
- Try a low-nickel dietary intervention to see whether a patient’s symptoms improve in a week or two.
- Refer the patient for additional diagnostic skin-patch testing or treatment.
A multidisciplinary approach
Ms. Finkel said it’s important for doctors, particularly gastroenterologists who treat patients for suspected GI disorders to consider nickel allergy as a cause.
“SNAS is this overlooked condition ... and the research is really in its nascency here,” Ms. Finkel said.
“I would say only give [a low- or no-nickel diet] consideration if the high-nickel foods are a possible trigger,” she said. “It is very specific, looking at their diet history, to have a clear hypothesis based on what their triggers are. It’s not something to try out lightly because it’s a very restrictive diet, so I would never put a patient on a diet that I didn’t think was necessary.”
Ms. Finkel added that treatment of SNAS requires a multidisciplinary approach with a gastroenterologist, an allergist, and a dietitian.
Doctors and dietitians have distinct roles in identifying and treating these patients, Ms. Finkel said.
“If there is a suspicion of IBS symptoms and the patient is not responding to first-line treatments, then it is worth having the input of a dietitian and an allergist,” she said.
A version of this article first appeared on Medscape.com.