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A more severe form is systemic nickel allergy syndrome (SNAS), which is clinically characterized by cutaneous manifestations (such as contact dermatitis, pompholyx, hand dermatitis, dyshydrosis, and urticaria), a long-term course, and systemic symptoms (such as headache, asthenia, itching, and gastrointestinal disorders related to histopathologic alterations of gastrointestinal mucosa, borderline with celiac disease).
Diagnosis of Nickel Allergy. As with any contact allergy, diagnosis is by a patch test. The nickel allergen (usually in the form of nickel sulphate) within the patch is placed on the skin and left in place for up to 72 hours. The area under the patch is usually observed after 48 hours. Because type IV hypersensitivity is a delayed response, the reaction may take 2 to 3 days to become visible.