High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing

Shah, Bhairav; Cohee, Amy; Deyerle, Ashley; Kelly, Cynthia S.; Frantz, Frazier W.; Kelly, Robert E.; Kuhn, M. Ann; Lombardo, Michele; Obermeyer, Robert J.; Goretsky, Michael J.

doi:10.1016/j.jpedsurg.2013.07.014

Cited by 42 publications

(41 citation statements)

References 13 publications

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“…6,7 Shah et al 7 2014 reported a rise in after implantation metal hypersensitivity reactions despite preoperative patch testing those with a history of metal hypersensitivity. The study found that a family history of metal allergy and preoperative history of metal sensitivity correlated with metal allergy after implantation.…”

Section: Discussionmentioning

confidence: 99%

“…The study found that a family history of metal allergy and preoperative history of metal sensitivity correlated with metal allergy after implantation. 7 Patients who did not report a history of hypersensitivity experienced after implantation hypersensitivity-related complications and were found to be metal allergic upon postoperative patch testing. This, therefore, suggests the value in broader preoperative patch testing for patients before Nuss bar implantation to prevent postoperative complications associated with metal allergy.…”

Section: Discussionmentioning

confidence: 99%

“…In the context of the Nuss procedure for patients with pectus excavatum (PE), preoperative patch testing for patients with a known metal allergy or history of atopy seems to be an accepted practice. 6,7 The Nuss procedure is a minimally invasive surgical procedure, during which a convex stainless steel bar, also known as the Nuss bar, is placed behind the sternum and left in place for approximately 2 years to allow for thoracic remodeling. 8,9 The Nuss bar manufacturer, Biomet Microfixation (Warsaw, Ind), now offers a metal disc to be purchased separately by the surgeon performing the Nuss bar insertion for preoperative assessment of metal sensitivity.…”

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Patch Testing for Metal Allergy With Manufacturer-Supplied Materials Before Nuss Bar Insertion

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Patch Testing for Metal Allergy With Manufacturer-Supplied Materials Before Nuss Bar Insertion

et al. 2015

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“…The role of the LTT remains unclear, but seems to be gaining support for use in conjunction with the patch test and potentially coupled with peri-implant histopathology [60, 67, 75, 76]. Protocols for patch testing have been proposed based on implant type and surgical location [60, 77, 78].…”

Section: The Debate Surrounding Appropriate Testingmentioning

confidence: 99%

Metal Hypersensitivity Reactions to Orthopedic Implants

Teo

Schalock

2016

Dermatol Ther (Heidelb)

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Total hip and knee replacement surgery using metal alloy devices is common. Type IV allergic reactions to these implants occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected individual—including aseptic loosening, pseudotumor formation and frank device failure. It is challenging to predict who will have these reactions, even in those with established pre-implant metal allergy. At this time, the scientific literature clearly supports few conclusions. Despite this, we believe several conclusions can be made: routine pre-implant testing in asymptomatic individuals is not indicated; listen to patient’s concerns about metal allergy if the concern arises; patch testing is probably the best pre- and post-implant screening test; post-implantation testing is controversial and even positive LTT or patch test does not definitively diagnose morbidity from a metal allergy; and complete recovery following revision placement of an immunologically inert device is diagnostic. More research is needed to scientifically approach this issue.

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“…In addition, the rapid decay of T cells means that samples must be processed quickly [211]. Therefore, patch testing appears to be the best available approach for potential metal hypersensitivity reactions, both before and after implantation, while the role of LTT in clinical practice remains unclear [204,[211][212][213]. Schalock et al [184,211] recommended a protocol for patch testing using a baseline series and an adjunctive metal series based on implant type [214].…”

Section: Which Test?mentioning

confidence: 99%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing

Cited by 42 publications

References 13 publications

Patch Testing for Metal Allergy With Manufacturer-Supplied Materials Before Nuss Bar Insertion

Patch Testing for Metal Allergy With Manufacturer-Supplied Materials Before Nuss Bar Insertion

Metal Hypersensitivity Reactions to Orthopedic Implants

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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