Hypersensitivity reactions to metallic implants - diagnostic algorithm and suggested patch test series for clinical...

Area of Science:

• Allergy and Immunology
• Biomaterials Science
• Dermatology

Background:

• Cutaneous and systemic hypersensitivity reactions to implanted metals present diagnostic and therapeutic challenges.
• While uncommon, these reactions necessitate thorough evaluation and management.
• A comprehensive understanding of diagnostic tools is crucial for affected patients.

Purpose of the Study:

• To review evidence on evaluation tools for hypersensitivity reactions to implanted metal devices.
• To provide guidance on patch testing and lymphocyte transformation tests.
• To offer a diagnostic algorithm for symptomatic patients with suspected metal hypersensitivity.

Main Methods:

• Review of existing evidence on diagnostic tools for metal hypersensitivity.
• Focus on patch testing as the gold standard and lymphocyte transformation tests.
• Consideration of various implanted devices including orthopaedic, cardiovascular, and dental.

Main Results:

• Patch testing is the gold standard for metal hypersensitivity, though results can be subjective.
• Pre-implant testing is recommended for patients with a history of metal dermatitis.
• Post-implant testing and a diagnostic algorithm are provided for symptomatic patients.

Conclusions:

• Appropriate evaluation, including patch testing, is essential for suspected metal hypersensitivity.
• Management strategies should be tailored based on diagnostic findings and patient history.
• This review serves as a reference for evaluating and managing metal hypersensitivity reactions to implants.