Oral intake of nickel (Ni) is capable of causing the onset of systemic disorders in patients with Systemic Allergy to Nickel Syndrome (SNAS), an emerging allergic condition. Given its ubiquitous age, it is not possible to completely eliminate Ni and, therefore, it is necessary to plan a low-content diet. However, due to various factors (such as variability of Ni concentration in the soil, individual foods, variability of dietary habits and daily menus, different intake of Ni contained in the water, different intake of kitchen utensils, simultaneous intake of other substances), a restrictive diet is difficult and socially discriminating with a strongly negative impact on the quality of life of these patients. Hydroponic agriculture in a completely controlled, aseptic, artificial, soilless environment could be an alternative for patients suffering from SNAS with known and lower concentrations of metals than those deriving from conventional agricultural techniques, which are affected by the soil of origin and practices cultivation. The primary outcome of the study is to evaluate the possible effects of taking tomato puree deriving from hydroponic agriculture compared to tomato puree from conventional cultivation in the subjective control of SNAS symptoms, in patients following a low-diet diet. This is an interventional, randomized, double-blind, single-center crossover study involving a cohort of SNAS patients following a low-nickel diet for at least 4-6 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
30
Daily intake of minimum 100ml - maximum 200ml of 100% Italian datterino tomato puree deriving from hydroponic technology (soilless), contained in a 720ml bottle.
Daily intake of at least 100ml - maximum 200ml of 100% Italian datterino tomato puree deriving from conventional cultivation, contained in a 720 ml bottle.
UOSD Allergologia e Immunologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS
Roma, Italy
Change of gastrointestinal symptoms control
Average values of the scores relating to the individual SNAS symptoms as reported in the visual analogue scale (VAS) - Systemic Nickel Allergy Syndrome (SNAS) scale before and after taking each type of tomato sauce (hydroponic vs conventional). This scale includes values from a minimum of zero to a maximum of ten. Higher scores indicate a worse outcome.
Time frame: Immediately after the intervention
Change of impact on quality of life - SF-36
Difference in mean scores on quality of life questionnaire Short Form 36 Items Health Survey (SF-36) before and after each planned dietary treatment (hydroponic vs conventional tomato). Each patient answers SF-36v2 (Italian version) questionnaire. It comprises 36-items measuring 8 dimensions of general QoL. Each question's score is coded, summed up, and transformed to a scale of 0 (worst possible health state measured by the questionnaire) to 100 (best possible health state).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of impact on quality of life - PGWBI
Difference in mean scores on quality of life questionnaire Psychological General Well Being Index (PGWBI) before and after each planned dietary treatment (hydroponic vs conventional tomato). PGWBI consists of 22 questions, which deal with 6 factors (anxiety, depression, vitality, general health,self-control and well-being) constituting a global assessment. The response format is graded 1-6. This index includes values from a minimum of 0 to a maximum of 110. Higher scores indicate a better outcome.
Time frame: Change from baseline index at 12 and 26 weeks.
Change of intestinal permeability
Difference in mean values of serum zonulin (a biomarker of intestinal permeability) before and after each planned dietary treatment (hydroponic vs conventional tomato puree).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of beta-carotene
Difference in the average values of beta-carotene \[microg/dl\] before and after each planned dietary treatment (hydroponic vs conventional tomato puree).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of Vitamin D
Difference in the average values of Vitamin D \[ng/ml\] before and after each planned dietary treatment (hydroponic vs conventional tomato puree).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of hemoglobin
Difference in the average values of hemoglobin \[g/dl\] before and after each planned dietary treatment (hydroponic vs conventional tomato puree).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of ferritin
Difference in the average values of ferritin \[ng/ml\] before and after each planned dietary treatment (hydroponic vs conventional tomato puree).
Time frame: Change from baseline index at 12 and 26 weeks.
Change of adherence
Cross-comparison between the percentages of weekly intake \[average number of days per week\] of tomato puree (hydroponic tomato puree before and conventional after versus conventional tomato puree before and hydroponic after).
Time frame: After 12 weeks, after 26 weeks.
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