Allergic reactions to metal implants

Abstract

Upon surgery only transient inflammatory response may be observed in contrast to some developing immune response to metal implants as result of material characteristics or individual reagibility. This is predominantly a macrophage-driven foreign body like response to particulate debris. Metal implant allergy may develop as result of preexisting allergy or upon newly induced lymphocyte sensitisation. Clinical manifestations encompass eczema, recurrent swelling, seroma formation and impaired wound healing. Allergydependent implant loosening is also suspected. We discuss more detailed clinical-allergological testing, the analysis of periimplantar immune reaction and report about an interdisciplinary data collection (metal implant allergy register).Key words: Allergy -implant -metal -lymphocyteWährend eine operationsbedingte Entzündungsantwort meist in Tagen abklingt, kann bei individuell erhöhter Reaktionsbereitschaft und in Abhängigkeit von Materialeigenschaften eine Immunantwort auf Metallimplantate entstehen. Am häufigsten sind Makrophagen-dominierte Fremdkörperreaktionen auf Abriebpartikel. Besteht eine Metallkontaktallergie oder bildet sich eine spezifische Lymphozytensensibilisierung neu aus, so kann dies zu Metallimplantatallergie führen. Klinische Korrelate sind Ekzeme, rezidivierende Schwellung, Ergußbildung und Wundheilungsstörungen. Allergie-bedingte Implantat-Lockerung wird ebenfalls vermutet. Eine Erweiterung der klinisch-allergologischen Diagnostik, Analysemöglichkeiten der periimplantären Immunreaktion und eine begonnene interdisziplinäre epidemiologische Datenerfassung (Metallimplantatallergie-Register) werden vorgestellt.

The in vitro response of human osteoblasts to polyetheretherketone (PEEK) substrates compared to commercially pure titanium

“…There are concerns regarding potential metal ion release and subsequent osteolysis [14] or allergenicity [15]. Potential corrosion of metals and poor compatibility with modern imaging techniques such as magnetic resonance imaging (MRI) are also issues.…”

Titanium allergy or not? "Impurity" of titanium implant materials

“…An immunological response to metals [partly as an exaggerated allergic reaction] is discussed to be the cause of impaired wound healing or the delayed healing of fractures [19]. Allergic reactions to orthopedic implants can thus also necessitate the removal of the implant [24]. Lymphocyte infiltration was discovered in the peri-prosthetic tissue, indicating T-lymphocyte-related inflammation components [25][26][27][28].…”

“…The average sensitization ratio in the general population lies between 2 percent and 12 percent, depending on age, gender and living conditions. In addition to the typical findings, such as hand eczeme, uncommon manifestations, such as pseudo-lymphomas or implantassociated intolerance reactions, are also known to occur [24]. Many aspects of skin allergies have already been analyzed, such as thresholds above which allergens, such as nickel, chrome or cobalt trigger skin reactions, the use of standardized provocation testing for the detection of an allergy [patch test], [immuno-] histological characteristics of such reactions, tracking elements, such as CLA [cutaneous leukocyte antigen], which allow sensitized T-cells to migrate into the skin, and the diminishing reactivity following the avoidance of the allergens for many years which leads to problems only after repeated fresh contact with the respective allergen [booster], e.g.…”

“…Nickel, cobalt and chrome are the classic contact allergens [1,2,11,[29][30][31][32]. However, in contrast to the sensitization ratio of up to 12 percent of the general population to nickel and of up to 5 percent to cobalt and chrome [24,32], only a few cases of allergies to implant materials have been documented. Precise details on the frequency of such reactions are presently not available.…”

“…For example, inflammatory infiltrations of the peri-implant region displaying characteristics of late-type allergic reactions were found in a number of patients undergoing revision operations related to complications [2]. Thomas [24] and Willert [27] published cases of endoprosthesis loosening with accompanying T-lymphocyte-dominated immune reactions in the peri-implant region. In the 1970s, obvious allergic reactions to the cobalt-chrome alloy components of the McKee-Farrar prosthesis underwent scrutiny for the first time [3,11].…”