Cobalt allergy

Since the early 1940s, it has been known that there is a genetic predisposition to allergic contact dermatitis, a skin condition that is one of the most common maladies caused by workplace exposure to xenobiotics and to cosmetics (see Section 9.3). A study published in 1993 revealed that some individuals have a genetic predisposition to produce human leukocyte (white blood cell) antigen, resulting in allergy to nickel, chromium, and cobalt.4... 

Attempts continue to predict metal sensitivity in the individual patient so that the choice of material can be made accordingly. In vitro tests for metal allergies have been developed on the basis of lymphokine (MIF) release from sensitized T lymphocytes exposed to metal-protein complexes (11). About 6% of patients without a previous metal implant had positive reactions to nickel, chromium, or cobalt. However, it is still not clear whether such a positive reaction is a reliable predictor of clinical problems. In practice few patients have either local or systemic reactions when symptoms occur and other causes are ruled out, the implant should be removed. Some workers recommend removal of an implant whenever there is both a positive MIF test and a positive skin test, even in the current absence of a serious reaction. Allergic dermatitis will clear up as soon as the metal has begun to be cleared from the tissue. The type of metal and the amount released into the tissue will affect the time taken for the disappearance of toxic dermatological phenomena. 

Nickel plays a major role in sensitization of patients. Even the small amount present in cobalt chrome alloys often suffices to elicit allergic reactions. Reactions to cobalt are more generally toxic in nature (3). An increased rate of allergy to cobalt and nickel has been found in those patients bearing metallic implants who have developed bone infection in the surroundings of osteosynthesis material. 

Cobalt is an essential element. Its deficiency can result in pernicious anemia. It is present in vitamin B12. Excessive intake of this element may result in polycythemia or overproduction of erythrocytes and heart lesions. Exposure to its dusts can produce cough and respiratory irritation. Chronic inhalation of its dusts or fumes can decrease pulmonary functions and may cause diffuse nodular fibrosis and other pulmonary diseases. Skin contact may induce dermal hypersensitivity reactions, producing an allergy-type dermatitis. 

Toxicology Exposure is by inhalation. Cobalt causes skin allergies and irritation, and its dust causes occupational asthma. The lARC decided that cobalt metal powder and cobaltous oxide are A3 confirmed carcinogenics in animals, and they are possible human carcinogens [20]. 

Van Ketel WG (1977) Allergy to idoxuridine eyedrops. Contact Dermatitis 3 106 Veien NK, Svejgaard E (1978) Lymphocyte transformation in patients with cobalt dermatitis. Br J Dermatol 99 191-196... 

Eye protection should be worn. Students known to have skin allergies should wear nitrile gloves when using cobalt chloride paper. Hands should be washed after their use. 

Brown, G.C., Lockshin, M.D., Salvati, E.A. et al, (1977) Sensitivity to metal as a possible cause of sterile loosening after cobalt-chromium total hip-replacement arthroplasty, J. Bone Joint Surg., 59A(2), 164-168 Denies existence of metal allergy in orthopaedics. Complete misinterpretation of data. Uses negative results of an invalid test to draw conclusions. Limited patient population deliberately selected to prove lack of allergy. 

Shirakawa, T., Kusaka, Y. and Morimoto, K. (1992) Specific IgE antibodies to nickel in workers with known reactivity to cobalt. Clin. Exp. Allergy, 22 (2), 213-218 Measuring IgE and nickel cobalt interactions. 

Manufacturers of nitinol products are known to electropolish the surface of the nitinol wire to produce an oxidized surface layer that contains only titanium and oxygen. This reduces the potential for nickel allergy and toxicity problems. The alloy MP35N used in the CS/SF device is a quaternary of cobalt, nickel, chromium, and molybdenum, and is known to have high strength and corrosion resistance. Additionally, this metal has been found to be biocompatible and MR compatible. These are all desirable properties for an implantable device, but its nickel content should be noted and considered when dealing with patients who are allergic to nickel. 

Guameri F, Guameri C, Cannavo SP. Nail-art and cobalt allergy. Contact Dermatitis 2010 62(5) 320-1. 

Evans EJ, Schmidt RJ (1980) Plants and plant products that induce contact dermatitis. Planta Medica 38 289-316 Fischer T, Rystedt I (1983) Cobalt allergy in hard metal workers. Contact Dermatitis 9 115-121... 

A case report of ashy dermatosis associated with cobalt allergy in a plumber should also be taken as an example of occupational pigmented contact dermatitis... 

Testud F, Descotes J, Evreux JC (1994) Pathologie professionnelle due aux medicaments. Arch Mai Prof 55 279-286 Tuomi ML, Rasanen L (1995) Contact allergy to tylosin and cobalt in a pig-farmer. Contact Dermatitis 33 285 Valsecchi R, Cassina P, Cainelli T (1987) Contact toxic epidermal necrolysis. Contact Dermatitis 16 277 Valsecchi R, Rohrich 0, Cainelli T (1989) Contact allergy to cistoran, an intermediate in ranitidine synthesis. Contact Dermatitis 20 396-397... 

Construction workers risk occupational contact dermatitis from exposure to irritants, chromate, cobalt, rubber and epoxy. Nickel allergy, however, is not often discussed in relation to construction work (Coenraads et al. 1984). In construction workers it is often found together with allergy to chromate and/or cobalt, and nickel in cement has been proposed as a cause. However, nickel in cement exists mainly as insoluble salts (Wahlberg et al. 1977 Goh et al. 1986). 

Goh CL, Kwok SF, Gan SL (1986) Cobalt and nickel content of Asian cements. Contact Dermatitis 15 169-172 GoUhausen R, Ring J (1991) Allergy to coined money. J Am Acad Dermatol 25 365-369... 

Three common contact allergens diagnosed by standard patch testing - chromium, cobalt, and nickel - head every list of metal contact sensitivity (Chaps. 66-68). Concerning some of the metals reviewed below, cases of occupational contact dermatitis are rarely seen today or are at least not reported. The reason is probably due to extensive preventive measures, including reduced exposure and automation (Chap. 52). However, even if a contact allergy is acquired non-occupationally, there is always a risk of relapses at renewed exposure in an occupational setting. 

Results from patch tests performed with impure preparations and with an insufficient number of controls for irritancy imply that some anecdotal reports on contact allergy to metals, such as antimony, iron, lead, silver, manganese, and zinc, may be questioned. Scientifically, as well as from a clinical point of view, it is somewhat challenging that nickel, chromium, and cobalt are so dominant, while the other metals in the periodic table of elements play such a minor role. 

Contact allergy to cobalt is common and is often associated with concomitant allergy to nickel or chromate (Chaps. 66, 67). This is interpreted as simultaneous sensitization due to combined exposure, because nickel is often contaminated with cobalt, and cement contains chromium as well as cobalt. Solitary cobalt allergy is seen mainly among hard-metal workers (Chap. 68) and in the glass and pottery industries. 

Cases of contact allergy to rhodium salts among workers in the precious-metal industry and among goldsmiths have been reported (Bedello et al. 1987 de la Cuadra and Massanes 1991). The patients were also patch-test positive to cobalt and cross-reactivity may exist. In a guinea-pig model, rhodium chloride was a potent sensitizer and, at cross-challenge, the animals also reacted to cobalt but not to nickel or palladium (Liden et al. 1995). 

Nickel is a contaminant of cement in the form of insoluble NiO which, in contrast to the cobalt oxides, is not allergenic (Wahlberg et al. 1977). In a study using multivariate regression analysis, no statistically significant association between nickel allergy and cement eczema was found (Avnstorp 1983, 1989). 

Fregert S, Rorsman H (1966) Allergy to chromium, nickel and cobalt. Acta Derm Venereol 46 114-118 Fregert S, Gruvberger B, Sandahl E (1979) Reduction of chromate in cement by iron sulfate. Contact Dermatitis 5 39-42 Fullerton A, Gammelgaard B, Avnstorp C, Menne T (1993) Chromium content in human skin after in vitro application of ordinary cement and ferrous-sulfate-reduced cement. Contact Dermatitis 29 133-137... 

Kanerva L, Jolanki R, Estlander T (1996c) Offset printer s occupational allergic contact dermatitis caused by cobalt-2-ethylhexoate. Contact Dermatitis 34 67-68 Kanerva L, Hyry H, Jolanki R, Hytdnen M, Estlander T (1997) Delayed and immediate occupational allergy caused by methylhexahydrophthalic anhydride. Contact Dermatitis 36 34-38... 

Tosti A, Guerra L (1988) Protein contact dermatitis in food handlers. Contact Dermatitis 19 149-150 Valero A, Lluch M, Amat P, Serra E, Malet A (1996) Occupational egg allergy in confectionary workers. Allergy 51 588-589 van der Meeren HL (1987) Dodecyl gallate, permitted in food, is a strong sensitizer. Contact Dermatitis 16 260-262 van Ketel WG (1984) Simultaneous sensitization to gum arabic and cobalt. Contact Dermatitis 10 180 Vincenzi C, Stinchi C, Ricci C, Tosti A (1995) Contact dermatitis due to an emulsifying agent in a baker. Contact Dermatitis... 

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