D2.58 - Nickel Sensitization and Reversible Airway Dysfunction: Evidence from Pulmonary Function Response to Nickel Avoidance

Environmental nickel exposure is increasingly recognized as an emerging contributor to allergic disease beyond its classical cutaneous manifestations. Systemic effects of nickel sensitization may involve respiratory pathways through inflammatory cell activation and neuro-immune interactions. As the global burden of allergy and asthma continues to rise, identifying reversible environmental triggers is essential for prevention and long-term disease control.

A cross-sectional observational study was conducted among adults with confirmed nickel sensitization. Participants underwent standardized pulmonary function testing before (nickel-associated reaction, Ni²⁺AR) and after a structured period of environmental nickel avoidance (nickel-avoidance response, Ni²⁺AvR). Spirometric parameters included forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF), and mid-expiratory flows (FEF25%, FEF50%). Subgroup analyses evaluated the influence of body mass index (normal-weight vs overweight) and smoking status.

Nickel avoidance resulted in consistent and clinically relevant improvements across all measured pulmonary function parameters. Post-avoidance values of FVC, FEV₁, PEF, FEF25%, and FEF50% increase compared with pre-avoidance measurements, demonstrating reversible airflow limitation associated with environmental nickel exposure. Normal-weight individuals showed higher spirometric performance than overweight participants, while non-smokers exhibited superior expiratory flows compared with smokers, indicating that tobacco exposure amplifies respiratory compromise in nickel-sensitized subjects.

Nickel sensitization may represent an underrecognized environmental factor contributing to reversible airway dysfunction. Improvements observed after nickel avoidance highlight a modifiable risk element with relevance for reducing the long-term burden of respiratory allergy and asthma. Integrating assessment of contact allergens into respiratory and occupational allergy diagnostics may enhance early detection and support personalized prevention strategies aligned with the EAACI vision of a future free from allergy and asthma burden.