Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants

Richards, Logan J; Streifel, Alexandra M.; Rodrigues, J.

doi:10.7759/cureus.5761

Cited by 21 publications

(42 citation statements)

References 46 publications

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“… 10 , 11 It is thought that jewelry is the most common cause of exposure, but patients can be exposed to metal in various ways. 12 This can occur through the skin in the form of cell-phones, clothing fasteners, and leather.…”

Section: Potential Causesmentioning

confidence: 99%

“…Skin patch testing is, however, simple with a low cost and an excellent initial test for patients with a metal sensitivity and has a low risk to the patient. 5 , 12 Potential disadvantages include different mechanisms of reactivity than that seen in deep tissues, the cost and time associated with the test, the difficulty to report quantifiable and standardized results, and the process of in vivo patch testing that could induce sensitization in a previously nonsensitized patient, leading to failure due to MH. 5 , 9 In contrast to skin patch testing, lymphocyte transformation test is more sensitive and cannot induce HS, with testing seeing that it is done in vitro.…”

Section: Testing Modalities Availablementioning

confidence: 99%

“…The erythematous reactions to the allergen are then rated at 48, 72, and 96 hours or more after placement. 3 , 12 The reactions are categorized as 1+, 2+, or 3+. Patch test reactions rated 2+ or 3+ are more likely to cause implant reactions than 1+ patch testing.…”

Section: Testing Modalities Availablementioning

confidence: 99%

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Metal Hypersensitivity in Joint Arthroplasty

Merwe¹

2021

JAAOS Glob Res Rev

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Metal hypersensitivity in joint arthroplasty is a very controversial topic with limited evidence. With increasing numbers of joint replacements being done annually, a clear understanding of the pathogenesis, clinical picture, preimplant screening, postimplant workup, and treatment plan is crucial. This review article looked at all the available evidence regarding metal hypersensitivity and summarized the key findings. An algorithm was also proposed for preimplant screening, postimplant workup, and management.

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Section: Potential Causesmentioning

confidence: 99%

Section: Testing Modalities Availablementioning

confidence: 99%

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Metal Hypersensitivity in Joint Arthroplasty

Merwe¹

2021

JAAOS Glob Res Rev

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“…For the detection of metal hypersensitivity in patients with implants lymphocyte transformation testing is also used. The test uses the measurement of lymphocytes in peripheral blood that are produced in the span of 7 days following allergen exposure [ 18 ]. The ratio of lymphocyte proliferation after allergen challenge to proliferation without the allergen is expressed as a stimulation index [ 16 , 17 ].…”

Section: Mechanismmentioning

confidence: 99%

“…Currently, there is still a debate concerning the need of pre-implant testing in orthopaedic surgery as testing has not consistently been shown to change patient outcomes [ 18 ].…”

Section: The Research On Allergy To Metalmentioning

confidence: 99%

Metal allergy after the Nuss procedure for pectus excavatum: a review

Gałązka¹,

Leis²,

Kroczek³

et al. 2020

pdia

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Minimally invasive repair of pectus excavatum (MIRPE) technique (the Nuss procedure) is a minimally-invasive method that is commonly used in the treatment of pectus excavatum. An allergic reaction to the metal alloy bar that is implanted in the thorax during the procedure is a reported complication. We briefly review current literature concerning epidemiology, mechanisms and research results of allergic reactions after Nuss bar implantation. This allergic reaction occurs in approximately 2.7% of patients and is caused by metals used in the medical implant. The most common symptoms include fever and skin lesions such as allergic dermatitis. Elevated levels of C-reactive protein is a frequent finding in laboratory tests. In order to minimize the risk of such complications, taking a detailed allergy-based medical history and conducting allergy tests, i.e. patch test are required. Allergic reactions can be managed with conservative treatment such as general or topical glucocorticosteroid therapy and antihistamine agents. Severe allergic reactions can be addressed by implant revision, replacement of the steel bar with a titanium substitute or removal of the stabilization at all. Although the risk of an allergic reaction to titanium is smaller it still exists, the titanium substitute is not routinely used due to its higher cost and lesser plasticity which has a negative impact on matching a stabilizing bar during the surgery. Surgeons treating pectus excavatum should remember about the possible allergic reactions after implantation of the metal bar and be familiar with methods of diagnosis and treatment of those complications.

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Allergic reaction and metal hypersensitivity after shoulder joint replacement

et al. 2021

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Purpose Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. Methods Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. Results At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. Conclusions Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. Levels of evidence Level II.

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Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants

Cited by 21 publications

References 46 publications

Metal Hypersensitivity in Joint Arthroplasty

Metal Hypersensitivity in Joint Arthroplasty

Metal allergy after the Nuss procedure for pectus excavatum: a review

Allergic reaction and metal hypersensitivity after shoulder joint replacement

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