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

Heitmiller, Kerry; French, Andrea J; Alaish, Samuel M.; Goldner, R. B.; Gaspari, Anthony A.

doi:10.1097/der.0000000000000149

Cited by 13 publications

(14 citation statements)

References 22 publications

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“…The previous method was found not to be adequately sensitive in preoperative screening (specifically looking for nickel allergy). It was found that patch tests using metal in petrolatum was a more sensitive and accurate means of preoperative nickel allergy testing [12]. Hypersensitivity to the skin test manifests most often within 48-96 h from exposure, but in some cases it may take up to 168 h. The results of preoperative testing may be influenced by drugs, other allergens, active neoplastic disease, age, or inborn histamine intolerance [12,13].…”

Section: Mechanismmentioning

confidence: 99%

Metal allergy after the Nuss procedure for pectus excavatum: a review

Gałązka¹,

Leis²,

Kroczek³

et al. 2020

pdia

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Minimally invasive repair of pectus excavatum (MIRPE) technique (the Nuss procedure) is a minimally-invasive method that is commonly used in the treatment of pectus excavatum. An allergic reaction to the metal alloy bar that is implanted in the thorax during the procedure is a reported complication. We briefly review current literature concerning epidemiology, mechanisms and research results of allergic reactions after Nuss bar implantation. This allergic reaction occurs in approximately 2.7% of patients and is caused by metals used in the medical implant. The most common symptoms include fever and skin lesions such as allergic dermatitis. Elevated levels of C-reactive protein is a frequent finding in laboratory tests. In order to minimize the risk of such complications, taking a detailed allergy-based medical history and conducting allergy tests, i.e. patch test are required. Allergic reactions can be managed with conservative treatment such as general or topical glucocorticosteroid therapy and antihistamine agents. Severe allergic reactions can be addressed by implant revision, replacement of the steel bar with a titanium substitute or removal of the stabilization at all. Although the risk of an allergic reaction to titanium is smaller it still exists, the titanium substitute is not routinely used due to its higher cost and lesser plasticity which has a negative impact on matching a stabilizing bar during the surgery. Surgeons treating pectus excavatum should remember about the possible allergic reactions after implantation of the metal bar and be familiar with methods of diagnosis and treatment of those complications.

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Section: Mechanismmentioning

confidence: 99%

Metal allergy after the Nuss procedure for pectus excavatum: a review

Gałązka¹,

Leis²,

Kroczek³

et al. 2020

pdia

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“…The positive skin test to the disc and the resolution of signs and symptoms after removal suggest that the titanium allergy was relevant to the patient's favorable outcome. Testing with metal discs has been discouraged because of concerns about false negative patch testing (22). Despite these concerns, this patient exhibited a type IV hypersensitivity reaction to the disc, which was the basis for implant removal.…”

Section: Casementioning

confidence: 99%

Diagnostic dilemmas of Titanium hypersensitivity in patients with medical implants: a case series

Heitmiller

Innes

Zollo

et al. 2021

Eur Ann Allergy Clin Immunol

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“…Implant failure in Nuss patients is much less likely due to the short amount of time they are left implanted (minimum of two years) [23]. It has been estimated that metal allergy in Nuss patients may have an incidence of about 2.2%, with some evidence of this being up to 6.4% [14,23-24]. A study examining the metal disc offered by the Nuss bar manufacturer for preoperative metal allergy evaluation of pectus excavatum patients found that it was not adequately sensitive in preoperative screening (specifically looking for nickel allergy).…”

Section: Reviewmentioning

confidence: 99%

“…A study examining the metal disc offered by the Nuss bar manufacturer for preoperative metal allergy evaluation of pectus excavatum patients found that it was not adequately sensitive in preoperative screening (specifically looking for nickel allergy). However, it was found that PT using metal in petrolatum was a more sensitive and accurate means of preoperative nickel allergy testing [24]. Due to the morbidity of allergic reactions in patients undergoing Nuss procedure as well as a means of potentially avoiding revision surgery, it has been suggested that PT be used on all patients prior to the Nuss procedure [23-24].…”

Section: Reviewmentioning

confidence: 99%

“…However, it was found that PT using metal in petrolatum was a more sensitive and accurate means of preoperative nickel allergy testing [24]. Due to the morbidity of allergic reactions in patients undergoing Nuss procedure as well as a means of potentially avoiding revision surgery, it has been suggested that PT be used on all patients prior to the Nuss procedure [23-24]. Moreover, it has also been suggested that if metal allergy testing proves to be positive to metals such as nickel, a titanium Nuss bar should be used instead [14].…”

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants

Richards¹,

Streifel²,

Rodrigues³

2019

Cureus

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Total joint arthroplasties are increasingly common orthopedic procedures performed throughout the United States. Implant failure after these procedures occurs due to a number of causes such as infection or mechanical problems, with metal hypersensitivity being an area of growing interest. The nature and mechanism of a causative relationship between metal hypersensitivity and implant failure have been unclear as it is not known whether implant failure occurs due to a previous metal allergy or metal allergy results from secondary sensitization via metal exposure in existing failing implants. Overall, there appears to be growing support and evidence for metal-hypersensitive patients having worse outcomes with regard to total hip and knee arthroplasties. However, there are conflicting recommendations (outside of Nuss procedures) for pre-implant testing for metal hypersensitivity as testing has not consistently been shown to change patient outcomes.

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

Abstract: The metal disc may not be adequately sensitive to determine nickel allergy before the Nuss procedure. Patch testing alone with standard formulations of nickel sulfate in petrolatum may be more sensitive in diagnosing nickel allergy.

Cited by 13 publications

References 22 publications

Metal allergy after the Nuss procedure for pectus excavatum: a review

Metal allergy after the Nuss procedure for pectus excavatum: a review

Diagnostic dilemmas of Titanium hypersensitivity in patients with medical implants: a case series

Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants

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