Metal allergy

Dotterud LK, Falk ES. 1994. Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy. Contact Dermatitis 31 308-313. 

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. 

The need for preoperative patch-testing for metals is controversial. Enquiry about metal allergy is recommended before endoluminal surgical procedures. 

Carlsson a and Moller H (1989) Implantation of orthopaedic devices in patients with metal allergy. Acta Dermatol Venerol (Stockh) 69 62-66. 

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. 

Fregert S, Sjoborg S (1982) Unexpected lettuce immediate aUergy in a case of delayed metal allergy. Contact Dermatitis 8 265... 

Weast RC (ed) (1989) CRC handbook of chemistry and physics, 70th edn. CRC Press, Boca Raton Yokozeky H, Katayama I, Nishioka K, Kinoshita M, Nishiyama S (1992) The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx. J Dermatol 19 964-967... 

Metal workers are exposed to numerous exogenous factors that play a substantial role in tbe development of allergic as well as irritant contact dermatitis (ICD). Even though nickel is regarded as the most frequent source of all reported metal allergies [i], metal-work fluids (MWFs) are the most important cause of irritant hand dermatitis. Other factors such as metal dust, friction, pressure, heat and humidity also contribute to the irritation of the skin [2]. However, the metal industry is a wide fleld, and exposure may vary widely depending on the kind of job and the type of metal industry. 

The next advance in total hip arthroplasty came with the development of various porous surface treatments which allow bone tissue to grow into the metal porous coating on the femoral stem of the hip implant and on the acetabular component of the total joint replacement. These developments arose because of patients who were not able to tolerate cemented implants because of allergies to the cement, methylmethacrylate. More youthflil patients are better served by a press-fit implant as well. Figure 12 shows the difference between textured and beaded surface-treated orthopedic prostheses. 

Thus the total soil pollution was connected with a respiratory system and a digestive tract. Both systems were also sensitive to such urban pollutants as heavy metals and PAH. For radionuclides the correlation with the given nosologies was not revealed. The asthma morbidity was mostly connected with soil pollution rates. This circumstance, apparently, can be related to nonspecific action of pollutants on a human organism, because the etiology of asthma is connected with the human immune defense system and allergy state (Roite, 1991). The last was shown for pesticides (Nikolaev et al., 1988) and heavy metals (Drouet et al., 1990). The sensitized immune system is, apparently, responsible for chronic toxic effects of other pollutants at low doses (Sidorenko et al., 1991 Novak and Magnussen, 1993). 

In many countries, nickel is the commonest sensitizer in women, causing nickel allergy incidence to be high in a series of reported patch tests [399,400]. Since 1930, the emphasis has shifted from sensitization at work to sensitization in the home by nickel-plated metal and objects made of nickel alloy. The age of onset has altered to teenagers and young women and the source is now cheap metal jewellery and fasteners on clothing such as jeans studs. Also sensitization in infancy has been reported. Nickel-sensitive patients do not... 

Biocompatibility is an important consideration. Again, many unintended consequences are often found, unfortunately after the fact. In the areas of synthetic hip and knee replacement, use of alloys is often called for, yet some patients are found to have long-term allergies to certain metals present in minute amounts that eventually require replacement of the joint material. Thus, extensive testing is required before a new suture becomes commercially available. 

Cavelier C, Foussereau J, Gille P, et al. 1988. Nickel allergy Tolerance to metallic surface-plated samples in nickel-sensitive humans and guinea pigs. Contact Dermatitis 19 358-361. 

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