Contact sensitization to iron: A potentially underestimated metal allergen and elicitor of complications in patients with metal implants

Abstract

Background: Little is known about sensitization to iron (Fe) in private, occupational, and medical settings, particulary implantology.Objectives: To investigate sensitization to metals, particularly to Fe, both in preimplant individuals with presumed metal allergy and in patients with suspected metal implant allergy. To further characterize Fe-sensitized individuals.Methods: Analysis of patch test reactions to an Fe (II) sulfate-containing metal series in 183 consecutive patients (41 pre-implant, 142 metal implant bearers). Test readings were on day (D)2, D3, and D6. Evaluation of questionnaire-aided history of metal reactivity patterns and demographics of Fe reactors.Results: Metal reactivity in pre-implant/implant/total group was: to nickel 39%/30%/32%; to cobalt 17%/15%/15%; and to chromium 7%/13%/11%.Co-sensitizations cobalt/nickel (19/58) and cobalt/chromium (11/21) were significant at P < .001; co-sensitizations Fe/nickel (4/10) and chromium/knee arthroplasty (11/73) at P = .03. Ten of 183 (5.5%) reacted to Fe (2 of 41 pre-implant patients, 8 of 142 implant bearers), with 10 reacting only on D6. Fe reactivity was highest in complicated knee arthroplasty (7/73). Further peculiarities of Fe reactors included frequent isolated Fe reactivity (6/10), occupational metal exposure (7/10), previous (par)enteral Fe substitution (6/10).Conclusions: The 5.5% prevalence of Fe reactions suggests a potentially underestimated role of this metal allergen in general and in implant bearers. The latter also shows a distinct metal sensitization pattern.

Metal‐free laparoscopic distal pancreatectomy using transpancreatic mattress suture with polyglycolic acid sheet and fibrin glue: A case report

“…And the risk of POPF has been reported to be increased in patients with a hard pancreas or one thicker than 16 mm 2 . In addition, nickel and chromium, which are used in staplers, pose a risk of allergic reactions to the metal left in the abdominal cavity 6 . Because the present patient had a metal allergy and a thick pancreas, we planned a metal‐free LDP.…”

“…2 In addition, nickel and chromium, which are used in staplers, pose a risk of allergic reactions to the metal left in the abdominal cavity. 6 Because the present patient had a metal allergy and a thick F I G U R E 1 Single pancreastransfixing suture used as a stay suture (white arrow).…”

Hypersensitivity to permanent tattoos: Literature summary and comprehensive review of patch tested tattoo patients 1997–2022

“…Recent research on PT patients with ACD to implants, a non-epidermal application with systemic exposure to metals and therefore to some degree similar to tattoos, points out possibly relevant PT reactions to iron(II) sulphate in implant patients that became positive on D6 and which were probably missed in the past. 183 We encourage more research on this matter and obligatory inclusion of late readings.…”

Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants

“…After stopping using them, there was no recurrence of symptoms [ 42 ]. Iron (Fe) can be a relevant sensitizer, especially in complicated knee arthroscopy [ 43 ]. Aluminum (Al) salts are adjuvants found in many vaccines.…”