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Gergovska M, Darlenski R, Kazandjieva J. Nickel Allergy of the Skin and Beyond. Endocr Metab Immune Disord Drug Targets 2021; 20:1003-1009. [PMID: 32108006 DOI: 10.2174/1871530320666200228124453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/25/2020] [Accepted: 03/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema. OBJECTIVE The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented. METHODS Electronic databases on this topic was carried out using PubMed-Medline. RESULTS The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared. CONCLUSION The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.
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Affiliation(s)
- Malena Gergovska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Pleven, Bulgaria
| | - Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Jana Kazandjieva
- Department of Dermatology and Venereology, Faculty of Medicine, Sofia, Bulgaria
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Thomas P, Summer B, Thyssen JP. Hypersensitivity Reactions to Orthopedic Implants. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neuropathy Caused by Metal Hypersensitivity after Placement of Stainless Steel Plate. Case Rep Orthop 2020; 2020:9789021. [PMID: 32015923 PMCID: PMC6988665 DOI: 10.1155/2020/9789021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/24/2019] [Indexed: 11/18/2022] Open
Abstract
Metal hypersensitivity is a rare complication for implants especially with neuropathy involvement. There was not any previous report suggesting metal hypersensitivity manifested in the form of neuropathy or tendinopathy from metal plate implantation. Here, we present a case of a 42-year-old female with chronic ulnar wrist pain and unremarkable physical and radiological findings. Ulna shortening osteotomy with small stainless steel-made DCP and screw fixation was done. On the third day postoperative, the patient developed pain, swelling, ulnar neuropathy, and flexor tendon contracture. Severe adhesion was found around the implant and the ulnar nerve. Minimal skin patch testing reaction and pathological study suggest a cell-mediated delayed type IV hypersensitivity reaction. A titanium-made LCP was later implanted in place of the stainless steel-made DCP. The patient's clinical status significantly improved after the operation. Metal hypersensitivity in this patient was unprecedented and unique. The severity of the reaction and its location close to the ulnar nerve may predispose to the intensity of the reaction.
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Thomas P, Summer B, Thyssen JP. Orthopedic Implants. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_80-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas P, Summer B, Thyssen JP. Hypersensitivity Reactions to Orthopedic Implants. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_80-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
There are very few reports of eczema and other prosthetic-related allergic skin complications following arthroplasty. We aimed to assess the risk of eczema after joint replacement.We performed a retrospective population-based cohort study in 2024 joint replacement patients using the Longitudinal Health Insurance Database. For comparison, 8096 controls were selected, with 4 control subjects for each joint replacement patient matched for age, sex, and index year, to assess eczema risk. We examined 14-year cumulative eczema incidence associated with age, sex, immunity, disease history, and joint replacement location.Eczema rates in the joint replacement patients were 38% higher than in the control group (57.90 vs 41.84 per 1000 person-years, respectively). Compared with the control group, joint replacement patients showed a 1.35-fold increased risk of eczema according to the multivariable Cox model (95% Confidence interval [CI] = 1.23-1.49). Knee replacement patients had higher eczema risk compared with the control group (Hazard ratio [HR] = 1.45, 95% CI = 1.33-1.70). Stratified by study period, the joint replacement cohort had a higher eczema risk after the 3-month follow-up.Our study revealed that joint arthroplasty increased risk of eczema in this 14-year follow-up study, and this was not related to personal atopic history or gender.
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Affiliation(s)
- Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital
- School of Medicine, China Medical University
| | | | - Chun-Hao Tsai
- School of Medicine, China Medical University
- Department of Orthopedics, China Medical University Hospital
- Department of Sports Medicine/School of Medicine, China Medical University, Taichung, Taiwan
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Abstract
Routine implant removal is frequently performed although evidence-based guidelines are lacking. But routinely planned implant removal has significant economic implications and shows considerable complication rates. In general, clinical outcome seems to improve but pain relief after operation is often unpredictable. Even in patients reporting implant-related pain, implant removal does not guarantee relief and may be associated with further complications. The intra- and postoperative complication rate remains very high. Implant removal demonstrates a significant learning curve and unsupervised junior surgeons tend to cause more complications. The need for implant removal may be questioned. Even with the implant in place, contact activities can be resumed. However, a new adequate trauma can create a new fracture independently if there is an implant in-situ or not. It is important to understand the complications and outcomes to be expected with hardware removal to carefully evaluate its indication.
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Affiliation(s)
- Yves P Acklin
- Universitätsspital Basel, Department of Orthopaedics and Traumatology, Basel, Switzerland.
| | - Andreas Bircher
- University Hospital Basel, Department of Infectiology and Allergology, Basel, Switzerland
| | - Mario Morgenstern
- Universitätsspital Basel, Department of Orthopaedics and Traumatology, Basel, Switzerland
| | | | - Christoph Sommer
- Kantonsspital Graubünden, Department of Traumatology, Chur, Switzerland
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Mu Y, Godar DE, Merrill SJ. A perspective on the challenges and issues in developing biomarkers for human allergic risk assessments. Biomark Med 2017; 11:523-526. [PMID: 28700260 DOI: 10.2217/bmm-2017-0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ying Mu
- Center for Devices & Radiological Health, U.S. Food & Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - Dianne E Godar
- Center for Devices & Radiological Health, U.S. Food & Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, USA
| | - Stephen J Merrill
- Department of Mathematics, Statistics & Computer Science, Marquette University, Milwaukee, WI 53201-1881, USA
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Unverträglichkeitsreaktionen auf implantierbare Herzschrittmacher und Defibrillatoren. Hautarzt 2016; 67:352-8. [DOI: 10.1007/s00105-016-3775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thomas P, Summer B. Diagnosis and management of patients with allergy to metal implants. Expert Rev Clin Immunol 2015; 11:501-9. [DOI: 10.1586/1744666x.2015.1016501] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Thomas P. Clinical and diagnostic challenges of metal implant allergy using the example of orthopaedic surgical implants: Part 15 of the Series Molecular Allergology. ACTA ACUST UNITED AC 2014; 23:179-185. [PMID: 26120529 PMCID: PMC4479460 DOI: 10.1007/s40629-014-0023-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/29/2014] [Indexed: 11/25/2022]
Abstract
The focus of this review are allergic reactions to orthopaedic-surgical metal implants. The spectrum of metal implant associated potential allergic reactions encompasses eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Despite the growing number of respective publications the topic „metal implant allergy“ remains a diagnostic challenge. Initially, differential diagnoses should always be excluded in cooperation with surgery collegues. It is recommended to perform a combined evaluation of medical history, clinical findings, patch testing and histology. The lymphocyte transformation test (LTT) can indicate metal sensitization, but it needs careful interpretation. Allergists can provide a substantial contribution to this interdisciplinary topic.
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Affiliation(s)
- Peter Thomas
- Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Frauenlobstraße 9-11, 80337 Munich, Germany
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Thomas P. Klinische und diagnostische Herausforderungen der Metallimplantatallergie am Beispiel orthopädisch-chirurgischer Implantate. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
In a representative survey among members of the working group for joint replacement (AE) in Germany (86.7% response) it was found that 0.6% of patients with total knee arthroplasty (TKA) and 1.2% of patients with total hip arthroplasty (THA) may have a problem due to hypersensitivity to nickel or cobalt after implantation. Only one third of them may need revision surgery. Although patients with hypersensitivity are rare 84% of surgeons would prefer to use a specially coated allergy implant for knee arthroplasty patients. However, no long term results and few data on the topic of allergies and joint arthroplasty are available for these implants so that this has to be critically discussed with patients. Before a revision is performed it is recommended to perform knee arthroscopy to obtain tissue for microbiological and histopathological investigations. The second part of this questionnaire will look at the special question of how to deal with allergy patients based on constructed case examples.
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Mystery Solved: Contact Dermatitis and Medical Implants. J Cutan Med Surg 2013; 17:147-50. [DOI: 10.1177/120347541301700301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Hypersensitivity reactions to nickel are one of the most common in the modern world. Nickel allergy prevalence is constantly growing in many countries and represents a major health and socioeconomic issue. Herein the current understanding on nickel allergy is summarized with a practical approach to the dermatologist, allergist, and general practitioner. The personal experience with some practical clinical cases of nickel dermatitis is shared. A special emphasis is put on the possible strategies for treatment and prevention of the disease.
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Meyer H, Krüger A, Roessner A, Lohmann CH. [Allergic reactions as differential diagnosis for periprosthetic infection]. DER ORTHOPADE 2012; 41:26-31. [PMID: 22273704 DOI: 10.1007/s00132-011-1838-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metallic orthopedic devices are composed of elements known to be skin sensitizers in the general population and metal-on-metal hip prostheses in particular have the theoretical advantage of producing less abrasive wear than metal-on-polyethylene prostheses. However, there is concern about the possibility of hypersensitivity reactions with typical elicitors, such as nickel, chromium or cobalt. These materials are also used for total knee arthroplasty (TKA) and may elicit an immune response the role of which is still unclear in the outcome of arthroplasty. The immune response is dominated by perivascular T and B lymphocyte tissue infiltration around the hip replacement. The infiltrates are mostly surrounded by so-called high endothelial venules. This reaction is associated with periprosthetic osteolysis and aseptic loosening of the prostheses. The differentiation of hypersensitivity and low-grade infection is initially a diagnosis by exclusion using aspiration cultures. The final diagnosis is only resolved by histological investigation of synovial tissue. A close cooperation between orthopedic surgeons, pathologists and microbiologists is necessary to diagnose specific cellular differences in hypersensitivity and infection in tissue investigations.
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Affiliation(s)
- H Meyer
- Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120 Magdeburg, Deutschland.
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[Approach to painful hip resurfacing]. DER ORTHOPADE 2011; 40:481-90. [PMID: 21614600 DOI: 10.1007/s00132-011-1757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hip resurfacing in young patients has been increasingly performed within the last decade. In comparison to standard total hip arthroplasty the failure rate remains high. Age and implant size have a significant effect on the risk of revision for primary total resurfacing and the risk of revision increases with increasing age. At 7 years the cumulative revision rate for patients is 5% and females have more than twice the cumulative revision rate as males. Even in hip resurfacing arthroplasty which has been performed in a perfect manner, a certain percentage of patients suffer from persistent pain for various reasons, such as neck fracture, iliopsoas tendinopathy, metal hypersensitivity, such as aseptic lymphocytic vasculitis associated lesions (ALVAL) and aseptic loosening. Diagnostic work-up of the painful hip resurfacing is challenging even for experienced surgeons. Recommendations for the diagnostic procedure are described.
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