Case Report: Inflammatory Bowel Disease, Iron Deficiency Anemia and Systemic Nickel Allergy Syndrome: What is the Significance of the Low Nickel Diet and Chronic H. Pylori Infection?



A 33-year-old Caucasian female, previously diagnosed with ulcerative colitis (UC), presented with a five-year long history of severe gastrointestinal and extra-gastrointestinal manifestations, including iron deficiency anemia (IDA). She turned to clinical functional nutrition counseling after a series of conventional medical interventions failed to provide benefit. Recommendations for extensive laboratory evaluation were suggested (testing to identify heavy metal toxicity and environmental and/or food allergies/ sensitivities), of which the patient opted to have food allergy/sensitivity testing. Laboratory testing revealed sensitivity to nickel-rich foods, which prompted a referral to an allergist and a diagnosis of systemic nickel allergy syndrome (SNAS). Additionally, a history of chronic, untreated H. pylori infection was revealed following a severe food poisoning approximately four years prior to the official UC diagnosis. The UC diagnosis was preceded by proctitis and pancolitis. Medical nutrition therapy included a low nickel diet, iron supplementation, and lifestyle recommendations. Within one week of initiating dietary interventions, there were improvements in gastrointestinal symptomatology. Due to patient’s adverse reaction to IDA therapy, specifically iron supplementation, the extragastrointestinal manifestation, namely the IDA persists.