Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?

Area of Science:

• Cardiology
• Allergy and Immunology
• Biomaterials Science

Background:

• Nickel is a prevalent contact allergen, frequently used in medical devices for cardiac defect closure.
• Nickel hypersensitivity following atrial septal defect (ASD) and patent foramen ovale (PFO) device occlusion is infrequently reported compared to typical sensitization.
• The existence and incidence of this
• device syndrome,

Purpose of the Study:

• To explore the clinical entity of nickel hypersensitivity developing after percutaneous PFO/ASD device closure.
• To review the associated symptoms, diagnostic challenges, and current management strategies.
• To highlight the need for further research into the pathophysiology and diagnostic methods for device-related nickel hypersensitivity.

Main Methods:

• Literature review of reported cases of nickel hypersensitivity after PFO/ASD device closure.
• Analysis of clinical manifestations, diagnostic approaches (including skin patch tests), and treatment outcomes.
• Discussion of the diagnostic challenges and the empirical nature of current management.

Main Results:

• Nickel hypersensitivity after PFO/ASD occlusion is a rare but recognized complication.
• Associated symptoms can be diverse, including chest pain, migraines, palpitations, and dyspnea.
• Diagnosis is often by exclusion, lacking specific criteria, and management is empirical, ranging from medication to device explantation.

Conclusions:

• Endocardiac device-related nickel hypersensitivity, or "device syndrome," warrants further investigation.
• There is a critical need for research to elucidate the underlying mechanisms.
• Development of reliable prognostic tests and preventative strategies for high-risk patients is essential.