In our department, gold sodium thiosulfate has become the 2nd most common allergen in routinely patch tested dermatitis patients, with a rate around 10%. Test reactions to this compound often appear late, sometimes so late that active sensitization may be suspected. This study was performed to study the time course of the allergic reaction to gold sodium thiosulfate and to elucidate whether late test reactions mean active sensitization. 10 patients with contact allergy to gold sodium thiosulfate (0.5% pet.) were retested epicutaneously (e.c.) and intracutaneously (i.c.) with dilution series. The clinical course was followed for 2 months with initially short intervals, later more extended. During the entire study, 26 positive e.c. reactions were diagnosed. Within the 1st week, 17 (65%) were recorded. 12 reactions (46% of 26) were noted at the ordinary reading, 3 days after test application. After 10 days, another 9 reactions (35%) appeared. The patients with the latter reactions also had positive test reactions within the 1st week. After 2 months, 9 reactions remained. Out of 30 i.c. tests applied, 25 became positive within 1 week. 19 (76%) of these reactions changed in morphology from thin infiltrates to deep nodules. Another 4 nodules appeared in patients with previous negative i.c. tests. All 23 nodules remained after 2 months. E.c. and i.c. test reactions to gold sodium thiosulfate are long-lasting. Positive patch test reactions emerging after 10 days do not automatically imply active sensitization. To diagnose contact allergy to gold sodium thiosulfate, the ordinary reading at day 3 is insufficient; even reading at 1 week is insufficient and must be supplemented by a reading at 3 weeks. All the i.c. test reactions, however, appeared within 1 week and, in several, a dermal nodule was formed.

When gold sodium thiosulfate was added to the patch test standard series, positive reactions were obtained in 8.6% of 823 consecutive patients with suspect contact allergy. The test reactions were clinically of an allergic type and, in several cases, long-lasting. There was no correlation with other allergens in the standard series. In a special study on 38 patients with contact allergy to gold sodium thiosulfate, the following principal findings were obtained: positive patch tests to the compound itself in dilute concentration; positive patch tests to potassium dicyanoaurate; negative patch tests to gold sodium thiomalate, sodium thiosulfate, and metallic gold; positive intradermal tests to gold sodium thiosulfate. Our findings make gold sodium thiosulfate the 2nd most common contact allergen after nickel sulfate. It is suggested that a positive skin test to gold sodium thiosulfate represents gold allergy.

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Background: Metallic implants, stents, are increasingly being used especially in patients with stenosis of the cardiac vessels. Ten to thirty per cent of the patients suffer from restenosis regardless of aetiology. We have shown increased frequency of contact allergy to stent metals in stented patients.Objectives: To we evaluate whether contact allergy to stent material is a risk factor for restenosis.Methods: Patients with stainless steel stents, with or without gold plating, were epicutaneously tested and answered a questionnaire. The restenosis rate was evaluated.Results: We found a correlation between contact allergy to gold, gold stent, and restenosis (OR 2.3, CI 1.0-5.1, P ¼ 0.04). The risk for restenosis was threefold increased when the patient was gold allergic and stented with a gold-plated stent. An increased degree of chest pain in gold-allergic patients stented with gold-plated stent was found.Conclusions: We found a correlation between contact allergy to gold, gold-stent, and restenosis. It may be of importance to consider contact allergy when developing new materials for stenting.

Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

To diagnose allergic or irritant contact dermatitis, a clinically relevant contact allergy has to be demonstrated or ruled out, respectively. Although patch testing has been used for 100 years, it remains the method of choice for diagnosing contact allergy. A disadvantage of patch testing is that reading is subjective, based on inspection and palpation of the test area, implying that the assessment is subject to the reader's knowledge and experience. This study was carried out to investigate the accordance in reading patch test reactions between 5 dermatologists. 4 groups, each with 10 patients, participated. Within each group, all 10 were allergic to one and the same sensitizer; nickel, epoxy resin, ethylenediamine, or Kathon CG. The sensitizers were tested in serial dilutions and applied randomly to the back. The tests were read independently by the dermatologists in a blinded fashion. A protocol was used where the dermatologists had to note the presence of the morphological features erythema, infiltration, papules, vesicles, and bullae. In this way, it was possible to allocate the various readings into 4 classification systems, 3 European and one American, although the definition of the various classifications might differ slightly. Based on the readings and classifications, it was possible to calculate the degree of accordance within the 4 systems used. It was also possible to analyze the degree of accordance for the various morphological features. Total accordance for the 5 reading dermatologists for positive and negative test reactions was noted in 36% and 46%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Out of 134 patients patch tested after total hip replacement (metal-toplastic) 13 were sensitive to one or two of the implanted metals. In a prospective series of 112 patients, nine were sensitive to nickel before and another three developed sensitivity to nickel or cobalt after the arthroplasty. In the retrospective as well as in the prospective series the complications could in all cases but one be explained on grounds other than allergy. The incidence of contact allergy to nickel before a planned arthroplasty was 12 per cent in females and 4 per cent i;l males. It is doubtful whether metal sensitivity could be induced by a total hip arthroplasty. However, in cases of a preexisting metal allergy, a certain degree of caution is recommended.

Contact allergy to gold as demonstrated by patch testing is very common among patients with eczematous disease and seems to be even more frequent among patients with complaints from the oral cavity. There is a positive correlation between gold allergy and the presence of dental gold. Gold allergy is often found in patients with non-specific stomatitides as well as in those with lichenoid reactions or with only subjective symptoms from the oral cavity. The therapeutic effect of substituting other dental materials for gold alloys is conspicuous in casuistic reports but less impressive in larger patient materials. The amount of dental gold is correlated qualitatively and quantitatively to the blood level of gold and the effects if any of circulating blood gold are unknown. There is clearly a need for prospective studies in the field and gold sodium thiosulfate is considered an important item in the dental series for patch testing.Key words: contact allergy; dental gold; gold alloy; lichenoid reaction, oral disease; stomatitis. C Blackwell Munksgaard, 2002. Accepted for publication 12 July 2002 DefinitionsThe term dental gold covers alloys containing gold as a component and included in the ISO standards (1, 2). Allergy to gold alloys implies contact allergy, i.e. the T-cell mediated, immunological state which is not expressed as a clinical reaction until a renewed contact with the hapten. A prerequisite for the induction as well as the elicitation of this allergy is dissolution and ionization of the metal followed by penetration of the hapten into the skin or mucous membrane. Dissolution of metallic gold is notoriously difficult but the process is facilitated by the presence of other metals in the alloy -the lower carat, the greater solubility of the gold (3) -but also by metals in the neighbourhood, e.g. amalgam through galvanism (4). Furthermore, dissolution and ionization are promoted by a high pH, an oxidative environment and the presence of amino acids, particularly sulfur-containing ones (3, 5). Diagnosis