Reply to: Update on systemic nickel allergy syndrome and diet.

I am glad to reply to Goldenberg and Jacob’s observations, whom I thank for the kind attention given to my article. As a preliminary consideration, I wish to reiterate that my paper discussed exclusively the exposure to nickel via food; it didn’t discuss the other routes of systemic exposure. It distinguished allergic contact dermatitis (ACD) from systemic nickel allergy syndrome (SNAS) and, within the SNAS, systemic contact dermatitis (SCD, which has only cutaneous signs and symptoms) from extra-cutaneous (i.e. gastrointestinal, respiratory, neurological, etc.) signs and symptoms (see table 1) (1). In what follows, I will discuss: diagnostic steps for nickel pathology (Section 1); and some possible differences in the management of the three forms of nickel pathology discussed (Section 2).