Detection of nickel and palladium contact hypersensitivity by a flow cytometric lymphocyte proliferation test

Spoerri, I.; Scherer, Kathrin; Michel, Susanne; Bircher, Andreas J.; Heijnen, Ingmar

doi:10.1111/all.12553

Cited by 14 publications

(25 citation statements)

References 17 publications

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“…In contrast to the findings of Muris et al, in both groups sodium tetrachloropalladate was more often positive than nickel sulfate. As mentioned above, we noticed similar characteristics in former studies from our department . A reason might be the use of a 3% concentration, as some studies showed a significantly higher number of irritant reactions than with a 2% concentration of tetrachloropalladate …”

Section: Discussionsupporting

confidence: 84%

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Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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Background Hypersensitivity to metals as a cause of implant‐related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest. Objective To evaluate sensitization to implant materials in patients with implant‐related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause. Methods Patients with implant‐related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed. Results In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant‐related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant‐related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal. Conclusion Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant‐related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.

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Section: Discussionsupporting

confidence: 84%

“…However, Pd is not included in the baseline series, making a comparison difficult. The high number of positive test reactions to Pd can partly be explained by cross‐reactivity to Ni, a high proportion of which has been observed in previous studies in our clinic …”

Section: Discussionsupporting

confidence: 55%

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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“…We found that optimized culture conditions and reference to two Ni stimulatory concentrations (NiSO 4 1 × 10 −5 m and 2.5 × 10 −5 m ) showed the best concordance between patch test and LTT reactivity (88%), with the lowest proportion of non‐specific reactions being seen in patch test‐negative/history‐negative individuals (specificity of 96%). A similar test evaluation against the patch test was reported both by Spoerri et al , using a non‐radioactive flow cytometry assay including patch test‐negative controls, and by Pacheco et al , who introduced a peak SI in controls for calibration. Our approach differs in two respects.…”

Section: Discussionmentioning

confidence: 61%

Evaluation of lymphocyte transformation tests as compared with patch tests in nickel allergy diagnosis

et al. 2017

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In the patch tests, 2 of 50 controls and 18 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to Ni. In the LTTs, 2 of 50 controls and 26 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to NiSO 2.5 × 10 m, and 2 of 50 controls and 17 of 50 patients with self-reported suspicion of Ni allergy showed positive reactions to NiSO 1 × 10 m. Sixteen of the 18 history-positive and patch test-positive patients (i.e. 88% sensitivity) were also LTT-positive, in contrast to only 2 positive LTT reactors within the 48 PT and history negative individuals (i.e. 96% specificity). [Correction added on 16 February 2017, after first online publication: The preceding sentence has been edited for language and this has been amended in this version.] CONCLUSION: Performing the LTT with optimized stimulating conditions might be a useful additional tool for the diagnosis of Ni allergy if non-sensitized controls are included.

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“…The flow cytometric LPT was performed as previously described, with Candida albicans and toxoid from Clostridium tetani as positive antigens. Cell proliferation in wells without antigen provided baseline proliferation values.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, in the classic LPT, proliferation of uncharacterized lymphocytes is measured by the amount of [ 3 H]thymidine incorporation. To avoid the risk of working with radioactivity and to allow immunophenotypic characterization of proliferating cells, we have recently developed and evaluated a flow cytometric LPT with carboxyfluorescein succinimidyl ester labelling and specific staining of T cell markers for the detection of nickel and palladium sensitization …”

Section: Introductionmentioning

confidence: 99%

Delayed‐type allergy to cobalt—comparison of a flow cytometric lymphocyte proliferation test with patch testing

et al. 2018

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Background The patch test is the standard procedure for diagnosing delayed‐type sensitization. If a patch test is not possible, the flow cytometric lymphocyte proliferation test (LPT), which determines the number and type of cells responding to a specific antigen in vitro, might be considered as an alternative. Objectives Our aim was to establish a flow cytometric LPT for the detection of delayed‐type allergic responses to cobalt, and to determine the correlation between stimulation indices (SIs) in LPT and the grade of patch test reactions. With the patch test as a diagnostic reference, we also assessed the sensitivity and specificity of the LPT. Methods Fifty‐four patients patch tested with the baseline series including cobalt (CoCl2) were additionally tested with the flow cytometric LPT with CoCl2. Results There was a significant correlation between the results of both tests: rs = 0.43; P = .001. The LPT with CoCl2 showed a sensitivity of 52.6% and a specificity of 85.7%. Corresponding to the low sensitivity of the LPT, high likelihood ratios for a positive patch test reaction were reached only in cases of strong lymphocyte proliferation (SI ≥ 10). Conclusions In cases of clearly increased SIs, the flow cytometric LPT with CoCl2 gives relevant diagnostic information, and represents a valuable alternative to patch testing.

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Detection of nickel and palladium contact hypersensitivity by a flow cytometric lymphocyte proliferation test

Cited by 14 publications

References 17 publications

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

Evaluation of lymphocyte transformation tests as compared with patch tests in nickel allergy diagnosis

Delayed‐type allergy to cobalt—comparison of a flow cytometric lymphocyte proliferation test with patch testing

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