An increasingly common and effective method for the treatment of atherosclerotic disease in the coronary arteries is percutaneous transluminal coronary angioplasty (PTCA) and stenting. The stents are made of different metals. An increased rate of restenosis when using gold-plated stents has been shown. Contact allergy to gold is common in many countries. Recently, a study has shown an increased rate of contact allergy to nickel among patients with restenosis and a nickel-containing stent. The aims of our study were to investigate whether there was an increased rate of contact allergy to gold among patients with gold-plated stents and if this increased the risk of restenosis. 22 patients who had received a gold-plated stent were patch tested. An age- and sex-matched population of 88 patients, previously patch tested because of a suspected contact dermatitis, served as controls. In the stent group, 10/22 (45.5%) had a contact allergy to gold, in the control group 18/88 (20.5%); the difference is statistically significant (P = 0.04). There was no significant difference regarding frequency of restenosis. Our study indicates that there is a risk of sensitizing the patient when implanting a gold-plated stent. Further studies are needed to confirm these results and to evaluate whether there is an increased risk of restenosis.
Contact allergy to gold in patients with gold-plated intracoronary stentsDear Sir, We appreciate the comments made on this intriguing issue. All in all, we seem to share views, but on our part, we would still like to make a few comments. In our pilot study (1), the two aims were to establish whether there was an increased frequency of gold allergy in a population with endovascular devices coated with gold and whether there was a connection between gold allergy and restenosis when patients were stented with gold-plated stents. In order to answer the first question, it is necessary to have a control population of non-stented patients; of course preferably this should have been a population with cardiac disease but without stent. For ethical and practical reasons, we chose an ageand sex-matched population from the dermatology department to serve as controls, as it can be presumed that contact allergies as such should be at least as common as in a population with cardiac disease. The patients in the study were divided into two groups -patients with and without restenosis -and the two groups were actually matched for other risk factors which are stated in the article (1). It would, of course, have been of interest to investigate other possible metal allergies, but this was not the aim of our limited pilot study. The patients were however tested with the European standard series and thus with nickel sulfate. 3 (2 women) positive patients were seen, and the difference with regard to the frequency in the control material was not significant.We agree that optimally, each patient should be tested before and after stent deployment in order to recognize gold-plated stents as potential sensitizer. However, in this study, there were initially no suspicions that a metal allergy might be induced by stenting and therefore,
There is a low risk of eczema in palladium-allergic and nickel-allergic individuals when they wear jewellery coated with pure palladium, but further studies are needed to determine whether palladium, when present in alloys, could cause allergic reactions. PdCl2 , like NiSO4 .6H2 O, shows variability in patch test reactivity over time. Furthermore, Na2 PdCl4 seems to be a more sensitive test substance than PdCl2 for the detection of palladium allergy.
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