Eczematous Dermatitis From Nickel

Barranco, Vincent P.; Soloman, Herman

doi:10.1001/jama.1972.03200090066016

Cited by 84 publications

(16 citation statements)

References 7 publications

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“…This method of exposure is quite different from the actual in-service environment of a metal implant, where there is typically weeks to months of constant exposure prior to emergence of skin reactions, such as eczema. 8,[20][21][22][23][24] Additionally, the haptenic potential of metals in dermal contact testing (in which dermal Langerhans cells are the primary hypersensitivity effector cells) is likely different in the periprosthetic milieu than on the surface of the epidermis. 38,39 Furthermore, the diagnostic utility of patch testing may be affected by possible immunologic tolerance (i.e., suppression of dermal response to implants), 40,41 impaired host immune response, 42,43 and the possible induction of hypersensitivity in a previously insensitive patient.…”

Section: Discussionmentioning

confidence: 99%

“…1,57,58 It is clear from previous reports that some patients experience sensitivity reactions directly associated with implanted metallic materials. 8,[20][21][22][23][24] Standard, easily quantifiable, user-independent and more comprehensive immunologic testing methodologies are paramount to the clear assessment of hypersensitivity responses in longterm implant efficacy. The triple-assay methods (proliferation, inflammatory cytokine release, and migration inhibition) used here to test lymphocyte/monocyte mediated activation are put forward as improved methods to facilitate such assessment through use in multi-center studies of DTH type responses to metallic biomaterials.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,12,[17][18][19] Many case studies of implant-associated hypersensitivity responses have implicated delayed type hypersensitivity (type IV or DTH) as the principle immunologic mechanism associated with metallic biomaterials leading to specific responses such as severe dermatitis, urticaria, and/or vasculitis. 8,[20][21][22][23][24][25][26][27][28][29][30][31][32] Degradation products as moieties in haptenic complexes most likely mediate these responses.…”

Section: Introductionmentioning

confidence: 99%

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A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty

Hallab

Mikecz

Jacobs

2000

J. Biomed. Mater. Res.

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The determination of biocompatibility has been dominated historically by the characterization of candidate materials based upon the observation of adverse host responses. However, some adverse responses are subtle in clinical settings and continue to foster debate and investigation. One of these responses is "metal allergy" or hypersensitivity to metallic biomaterials. Current methods used to diagnose hypersensitivity reactions, such as dermal patch testing and migration inhibition assays, are not well accepted in orthopedic practice as a means for the characterization of hypersensitivity to metallic joint-replacement components. An increasing need to resolve whether metal sensitivity may be a significant and/or predisposing factor for eliciting an over-aggressive immune response in patients with metallic implant components requires improved and standardized widespread study. Here we present three in vitro methodologies: (1) a proliferation assay, (2) cytokine analysis using ELISA, and (3) a migration inhibition assay. When in conjunction with one another, these assays may be used to more comprehensively quantify metal-induced hypersensitivity responses. Therefore, these methodologies are detailed with the intent of facilitating multi-center large-scale studies. In the following cases, a multi-assay approach for measuring the prevalence of delayed-type hypersensitivity in orthopedic patients shows the propensity to yield a more comprehensive and, therefore, more conclusive determination than currently employed patch testing or single assay techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty

Hallab

Mikecz

Jacobs

2000

J. Biomed. Mater. Res.

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“…Although hypersensitivity to metallic implants is well documented in case reports1–8 and group studies,9–22 it remains a relatively unpredictable and poorly understood phenomenon 13, 23, 24. All metals in contact with biological systems corrode,25, 26 and the released ions, while not sensitizers on their own, can activate the immune system by forming complexes with native proteins 27–29.…”

Section: Introductionmentioning

confidence: 99%

In vitro reactivity to implant metals demonstrates a person‐dependent association with both T‐cell and B‐cell activation

Hallab

Caicedo

Epstein

et al. 2009

J Biomedical Materials Res

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Hypersensitivity to metallic implants remains relatively unpredictable and poorly understood. We initially hypothesized that metal-induced lymphocyte proliferation responses to soluble metal challenge (ions) are mediated exclusively by early T-cell activation (not B-cells), typical of a Delayed-Type-Hypersensitivity response. We tested this by comparing proliferation (6-days) of primary lymphocytes with early T-cell and B-cell activation (48-hours) in three groups of subjects likely to demonstrate elevated metal-reactivity: Group 1(n=12) history of metal-sensitivity with no implant; Group 2a(n=6) well performing metal-on-metal THRs, and Group 2b(n=20) subjects with poorly performing metal-on-polymer total joint arthroplasties (TJA). Group 1 showed 100%(12/12) metal reactivity (Stimulation Index>2) to Ni. Group 2a&2b were 83%(5/6) and 75%(15/22) metal reactive (to Co, Cr or Ni) respectively. Of the n=32 metal reactive subjects to Co, Cr or Ni (SI>2), n=22/32 demonstrated >2-fold elevations in % of T-cell or B-cell activation (CD25+,CD69+) to metal challenge compared to untreated control. 18/22 metal-activated subjects demonstrated an exclusively T-cell or B-cell activation response to metal challenge, where 6/18 demonstrated exclusively B-cell activation and 12/18 demonstrated a T-cell only response, as measured by surface activation markers CD25+ and CD69+. However, there was no direct correlation (R 2 <0.1) between lymphocyte proliferation and % T-cell or B-cell activation (CD25+:CD69+). Proliferation assays (LTT) showed greater ability to detect metal reactivity than did subject-dependent results of flow-cytometry analysis of T-cell or B-cell activation. The high incidence of lymphocyte reactivity and activation, indicate that more complex than initially hypothesized immune responses may contribute to the etiology of debris induced osteolysis in metal-sensitive individuals.

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“…This can result in allergic contact dermatitis in skin overlying implants, 10,11 with urticaria and vasculitis as other possible occurrences. 15,16 Whether metal allergies cause device failure or device failure results in an increase serum concentration of degradation products and causes metal allergies is unclear. Up to 25% of patients with well-functioning hip arthroplasties may be hypersensitive to metal testing, and upward of 60% of patients with failed or problematic implants may have hypersensitivity.…”

mentioning

confidence: 99%