{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T21:49:53Z","timestamp":1779140993733,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sfera Societ\u00e0 Agricola Srl"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>A low-nickel (Ni) diet, a key treatment for Systemic Nickel Allergy Syndrome (SNAS), is difficult in the long term and strongly impacts quality of life (QoL). Hydroponic agriculture could be an alternative to allow the reintroduction of tomato, an essential food in the global diet. In a first interventional, randomized, double-blind, single-center crossover study, we compared the possible effects of eating tomato puree deriving from hydroponic agriculture versus tomato puree from conventional cultivation, collecting data on subjective control of SNAS symptoms, adherence to treatment, and impact on QoL. Thirty subjects were randomly assigned to one of the following treatment groups: (1) a 12-week low-Ni diet plus 100% Italian Datterino tomato puree deriving from hydroponic technology; (2) a 12-week low-Ni diet plus 100% Italian Datterino tomato puree deriving from conventional cultivation. Then, after a 2-week washout period on the low-Ni diet, each patient crossed over to the other treatment. Patients reported lower symptom scores after eating Datterino tomato puree deriving from hydroponic technology; specifically, bloating (p = 0.0111, p = 0.0060), flatulence (p = 0.0090), abdominal cramps (p = 0.0207), constipation (p = 0.0395), and diarrhea (p = 0.0105). Overall, the adherence rate was high for both treatment arms. At baseline, QoL was poor, but significant improvement was observed after two treatments. In our study, precision medicine and precision agriculture merge in a holistic approach to the challenges of food allergies.<\/jats:p>","DOI":"10.3390\/jcm11185459","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T02:06:50Z","timestamp":1663553210000},"page":"5459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Datterino Trial: A Double Blind, Randomized, Controlled, Crossover, Clinical Trial on the Use of Hydroponic Cultivated Tomato Sauce in Systemic Nickel Allergy Syndrome"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-746X","authenticated-orcid":false,"given":"Angela","family":"Rizzi","sequence":"first","affiliation":[{"name":"UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Chini","sequence":"additional","affiliation":[{"name":"UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Porcari","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell\u2019Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Settanni","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell\u2019Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Persichetti","sequence":"additional","affiliation":[{"name":"UOC Nutrizione Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzina","family":"Mora","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell\u2019Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Fanali","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell\u2019Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Leonetti","sequence":"additional","affiliation":[{"name":"UOC Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell\u2019Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1510-2718","authenticated-orcid":false,"given":"Giuseppe","family":"Parrinello","sequence":"additional","affiliation":[{"name":"UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-7201","authenticated-orcid":false,"given":"Franziska","family":"Lohmeyer","sequence":"additional","affiliation":[{"name":"Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2843-9966","authenticated-orcid":false,"given":"Riccardo","family":"Inchingolo","sequence":"additional","affiliation":[{"name":"UOC Pneumologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-7062","authenticated-orcid":false,"given":"Maria","family":"Mele","sequence":"additional","affiliation":[{"name":"UOC Nutrizione Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy"},{"name":"Medicina e Chirurgia Traslazionale, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"Medicina e Chirurgia Traslazionale, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Roma, Italy"},{"name":"UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Nucera","sequence":"additional","affiliation":[{"name":"UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. 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Water Use, CIHEAM\/EU DG Research."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"364","DOI":"10.5958\/2455-7145.2018.00056.5","article-title":"Hydroponics as an Advanced Technique for Vegetable Production: An Overview","volume":"17","author":"Sharma","year":"2018","journal-title":"J. Soil Water Conserv."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Collins, E.J., Bowyer, C., Tsouza, A., and Chopra, M. (2022). Tomatoes: An Extensive Review of the Associated Health Impacts of Tomatoes and Factors That Can Affect Their Cultivation. Biology, 11.","DOI":"10.3390\/biology11020239"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3389\/fnut.2019.00133","article-title":"Nutraceutical Characterization of Anthocyanin-Rich Fruits Produced by \u201cSun Black\u201d Tomato Line","volume":"6","author":"Blando","year":"2019","journal-title":"Front. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109896","DOI":"10.1016\/j.scienta.2021.109896","article-title":"Controlled Comparisons between Soil and Hydroponic Systems Reveal Increased Water Use Efficiency and Higher Lycopene and \u03b2-Carotene Contents in Hydroponically Grown Tomatoes","volume":"279","author":"Verdoliva","year":"2021","journal-title":"Sci. Hortic."},{"key":"ref_9","first-page":"18","article-title":"Do Differences Exist in the Quality between Soilless and Conventionally Produced Tomatoes and Head Lettuce?","volume":"85","author":"Hurter","year":"1994","journal-title":"Mitt. Geb. Lebensm. Hyg."},{"key":"ref_10","first-page":"3","article-title":"Some Qualitative Aspects of Tomatoes Grown on NFT","volume":"3","author":"Benoit","year":"1987","journal-title":"Soil. Cult."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4319","DOI":"10.1021\/jf0602572","article-title":"Changes in Antioxidant Content of Tomato Fruits in Response to Cultivar and Nutrient Solution Composition","volume":"54","author":"Fanasca","year":"2006","journal-title":"J. Agric. Food Chem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jfca.2013.05.014","article-title":"Nutritional Value of Tomatoes (Solanum lycopersicum L.) Grown in Greenhouse by Different Agronomic Techniques","volume":"31","author":"Erba","year":"2013","journal-title":"J. Food Compos. Anal."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/039463201302600314","article-title":"Systemic Nickel Allergy Syndrome: Nosologic Framework and Usefulness of Diet Regimen for Diagnosis","volume":"26","author":"Braga","year":"2013","journal-title":"Int. J. Immunopathol. Pharm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3109\/07853890.2013.861158","article-title":"Nickel Oral Hyposensitization in Patients with Systemic Nickel Allergy Syndrome","volume":"46","author":"Ricciardi","year":"2014","journal-title":"Ann. Med."},{"key":"ref_15","unstructured":"Rizzi, A., Nucera, E., and Schiavino, D. (2018). Metal Allergy, Springer."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/cod.13327","article-title":"Nickel Allergy and Allergic Contact Dermatitis: A Clinical Review of Immunology, Epidemiology, Exposure, and Treatment","volume":"81","author":"Thyssen","year":"2019","journal-title":"Contact Dermat."},{"key":"ref_17","first-page":"135","article-title":"Systemic Nickel Allergy Syndrome (SNAS): A Review","volume":"16","author":"Falagiani","year":"2008","journal-title":"Rev. Port. Imunoalergologia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1159\/000236994","article-title":"Oral Hyposensitization to Nickel Allergy: Preliminary Clinical Results","volume":"107","author":"Panzani","year":"1995","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_19","unstructured":"Nielsen, F.H. (1982). Possible Future Implications of Nickel, Arsenic, Silicon, Vanadium, and Other Ultratrace Elements in Human Nutrition, AR Liss."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5056\/jnm16027","article-title":"Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?","volume":"23","author":"Rizzi","year":"2017","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lombardi, F., Fiasca, F., Minelli, M., Maio, D., Mattei, A., Vergallo, I., Cifone, M.G., Cinque, B., and Minelli, M. (2020). The Effects of Low-Nickel Diet Combined with Oral Administration of Selected Probiotics on Patients with Systemic Nickel Allergy Syndrome (SNAS) and Gut Dysbiosis. Nutrients, 12.","DOI":"10.3390\/nu12041040"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Nucera, E., Rizzi, A., Chini, R., Giangrossi, S., Lohmeyer, F.M., Parrinello, G., Musca, T., Miggiano, G.A.D., Gasbarrini, A., and Inchingolo, R. (2021). Diet Intervention Study through Telemedicine Assistance for Systemic Nickel Allergy Syndrome Patients during the COVID-19 Pandemic. Nutrients, 13.","DOI":"10.3390\/nu13082897"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s12664-020-01090-3","article-title":"The Effect of a Low-Nickel Diet and Nickel Sensitization on Gastroesophageal Reflux Disease: A Pilot Study","volume":"40","author":"Yousaf","year":"2021","journal-title":"Indian J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Borghini, R., De Amicis, N., Bella, A., Greco, N., Donato, G., and Picarelli, A. (2020). Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease. Nutrients, 12.","DOI":"10.3390\/nu12082277"},{"key":"ref_25","first-page":"5","article-title":"Systemic Nickel Hypersensitivity and Diet: Myth or Reality?","volume":"43","author":"Pizzutelli","year":"2011","journal-title":"Eur. Ann. Allergy Clin. Immunol."},{"key":"ref_26","unstructured":"Jones, J.B. (2004). Hydroponics: A Practical Guide for the Soilless Grower, CRC Press. [2nd ed.]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.scienta.2015.09.011","article-title":"Beneficial Bacteria and Fungi in Hydroponic Systems: Types and Characteristics of Hydroponic Food Production Methods","volume":"195","author":"Lee","year":"2015","journal-title":"Sci. Hortic."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1016\/j.ejim.2013.05.013","article-title":"The Brief Visual Analogue Scale for Irritable Bowel Syndrome Questionnaire Can Be Used to Evaluate Psychological Well-Being in Patients with Irritable Bowel Syndrome","volume":"24","author":"Bengtsson","year":"2013","journal-title":"Eur. J. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0895-4356(98)00094-8","article-title":"The Italian SF-36 Health Survey: Translation, Validation and Norming","volume":"51","author":"Apolone","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/1477-7525-4-88","article-title":"Development and Validation of the Short Version of the Psychological General Well-Being Index (PGWB-S)","volume":"4","author":"Grossi","year":"2006","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/0190-9622(93)70281-W","article-title":"Low Nickel Diet: An Open, Prospective Trial","volume":"29","author":"Veien","year":"1993","journal-title":"J. Am. Acad. Derm."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2058738420934629","DOI":"10.1177\/2058738420934629","article-title":"Impact of Nickel Oral Hyposensitization on Quality of Life in Systemic Nickel Allergy Syndrome","volume":"34","author":"Rizzi","year":"2020","journal-title":"Int. J. Immunopathol. Pharm."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Chen, J.K., and Thyssen, J.P. (2018). Metal Allergy: From Dermatitis to Implant and Device Failure, Springer International Publishing.","DOI":"10.1007\/978-3-319-58503-1"},{"key":"ref_34","unstructured":"(2016). Production of Fruit and Vegetables. Apples and Tomatoes Were the Top Fruit and Vegetable Produced in the EU in 2015. Spain, Italy and Poland: Main Producers, Eurostat."},{"key":"ref_35","unstructured":"(2022, May 31). FAOSTAT. Available online: https:\/\/www.fao.org\/faostat\/en\/#home."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5432","DOI":"10.1038\/s41598-022-09107-x","article-title":"Tomato (Solanum lycopersicum L.) Accumulation and Allergenicity in Response to Nickel Stress","volume":"12","author":"Roccotiello","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_37","unstructured":"(1998). Commission Directive 98\/82\/EC of 27 October 1998 Amending the Annexes to Council Directives 86\/362\/EEC, 86\/363\/EEC and 90\/642\/EEC on the Fixing of Maximum Levels for Pesticide Residues in and on Cereals, Foodstuffs of Animal Origin and Certain Products of Plant Origin, Including Fruit and Vegetables Respectively (Text with EEA Relevance), European Union."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Contaminants in the Food Chain (CONTAM), Schrenk, D., Bignami, M., Bodin, L., Chipman, J.K., Del Mazo, J., Grasl-Kraupp, B., Hogstrand, C., Hoogenboom, L.R., and Leblanc, J.-C. (2020). Update of the Risk Assessment of Nickel in Food and Drinking Water. EFSA J., 18, e06268.","DOI":"10.2903\/j.efsa.2020.6268"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1080\/01904169809365553","article-title":"Effect of Nickel Concentration on Tomato Plant Nutrition and Dry Matter Yield","volume":"21","author":"Palacios","year":"1998","journal-title":"J. Plant Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1081\/CSS-120005759","article-title":"Yield Increase in Tomato, Eggplant, and Pepper Using Thermanox Manganese Soil Amendment","volume":"33","author":"Karagiannidis","year":"2002","journal-title":"Commun. Soil Sci. Plant Anal."},{"key":"ref_41","first-page":"286","article-title":"Influence of Nickel on Some Physiological Aspects of Tomato Plants","volume":"1","author":"Gad","year":"2007","journal-title":"Aust. J. Basic Appl. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s10661-018-6658-7","article-title":"Bioaccumulation of Nickel in Tomato Plants: Risks to Human Health and Agro-Environmental Impacts","volume":"190","author":"Correia","year":"2018","journal-title":"Environ. Monit. Assess."},{"key":"ref_43","first-page":"629","article-title":"Hydroponics in vegetable crops: A review","volume":"10","author":"Swain","year":"2021","journal-title":"Pharma Innov. J."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Goddek, S., Joyce, A., Kotzen, B., and Burnell, G.M. (2019). Aquaponics Food Production Systems: Combined Aquaculture and Hydroponic Production Technologies for the Future, Springer International Publishing.","DOI":"10.1007\/978-3-030-15943-6"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1080\/01140671.2004.9514277","article-title":"Rockwool in Horticulture, and Its Importance and Sustainable Use in New Zealand","volume":"32","author":"Bussell","year":"2004","journal-title":"N. Z. J. Crop Hortic. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5459\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:33:13Z","timestamp":1760142793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,16]]},"references-count":45,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11185459"],"URL":"https:\/\/doi.org\/10.3390\/jcm11185459","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,16]]}}}