Systemic (gastrointestinal and skin) reactions to ingestion of nickel rich foods 
in patients with nickel allergic contact dermatitis characterize Systemic Nickel 
Allergy Syndrome (SNAS). The objective of the study was to describe the 
nosologic framework of the syndrome and to compare sensibility and specificity 
for SNAS diagnosis between two different low nickel diets - BraMa-Ni and the 
usually prescribed list of forbidden foods - along with patient adherence to 
diet. One hundred forty-five patients with suspected SNAS (by history and 
benefit from nickel dietary restrictions) were selected and orally challenged 
with nickel for a definite diagnosis. Specificity and sensibility of the diets 
were calculated in relation to the results of nickel challenges. The nosologic 
framework of SNAS was deduced from the clinical pictures of 98 patients with 
positive nickel challenge and characterized essentially by skin and 
gastrointestinal symptoms, whereas all other symptoms (dizziness, headache etc.) 
were never elicited by the oral nickel challenge. The specificity and 
sensibility of BraMa-Ni in detecting SNAS were significantly higher than the 
forbidden food list diet, with an excellent patient adherence. Therefore, 
BraMa-Ni diet can be prescribed for the treatment of the syndrome other than for 
the diagnosis, the gold standard of which remains the oral nickel challenge.