High frequency of contact allergy to implant and bone cement components, in particular gentamicin, in cemented arthroplasty with complications: usefulness of late patch test reading

Abstract

SummaryBackgroundArthroplasty patients with complications may be sensitized to implant components.ObjectivesTo quantify patch test reactions to implant materials in aseptic cemented arthroplasty patients with complications, and to evaluate the benefit of late patch test reading at D6.MethodsAnalyses of patch test reactions to baseline series and bone cement components and of the questionnaire‐aided histories of 250 consecutive patients with suspected implant allergy were performed. Patch tests were read at D2, D3, and D6.ResultsThere were 187 positive reactions to the 29 allergens of the baseline series, and 52 to the seven allergens of the bone cement series. Forty‐nine of 250 patients reacted to the bone cement series. In contrast to ‘early allergens’ such as fragrance mix, late reading at D6 increased the number of positive reactions by 11/32 for nickel, 1/5 for cobalt, and 2/4 for chromium. With bone cement components, most reactions were to gentamicin (25 of 250 patients), and 17 of 25 appeared only at D6.ConclusionLate reading is useful for patch tests with metals and bone cement components. With only D2/D3 readings, 32 reactions to nickel, cobalt, chromium and bone cement components would have been missed. This underlines the utility of late reading in general and in complicated cemented arthroplasty patients, given the unexpectedly high number of gentamicin reactions.

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

“…We recently reported a gain of 34% positive Ni patch test reactions in 250 patients (i.e. 21/250 versus 32/250) by use of an additional D6 reading . Accordingly, some limitations apply to the data presented here.…”

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

“…Bone cement components have been discussed as causing relevant hypersensitivity reactions . Several case reports have suggested an association with benzoyl peroxide and the antibiotic gentamicin .…”

“…66 Although all cement components were tested, almost all of our positive reactions (13%) were to benzoyl peroxide, which is clearly a higher rate than in other studies. 64,66 The validity of patch test results for benzoyl peroxide has been discussed for years. For example, Ockenfels et al mentioned the frequent difficulty of differentiating between irritant and allergic reactions, and therefore the uncertainty about the validity of results.…”

Systemic allergic dermatitis due to gentamicin

“…5 Rare cases of systemic allergic dermatitis due to gentamicin are also described: all these cases were due to intravenous administration or related to gentamicin-loaded arthroplasty implants. [6][7][8] Although numerous cases of contact dermatitis due to gentamicin arise from crosssensitivity to neomycin, in this case the patient appears to have been sensitized only to gentamicin. Broken skin and multiple, occlusive application for several days could have favored drug absorption, accumulation in the skin, and sensitization.…”

“…Most cases of allergic contact dermatitis due to gentamicin reported in the literature are related to its topical use . Rare cases of systemic allergic dermatitis due to gentamicin are also described: all these cases were due to intravenous administration or related to gentamicin‐loaded arthroplasty implants . Although numerous cases of contact dermatitis due to gentamicin arise from cross‐sensitivity to neomycin, in this case the patient appears to have been sensitized only to gentamicin.…”