Comparison of personal history with patch test results in metal allergy

Nickel Sensitivity in Rosacea Patients: A Prospective Case Control Study

Background:

Rosacea is a frequently seen chronic disease. Certain allergens, some foods and beverages are known to trigger symptoms of rosacea.

Objective:

We aimed to assess if nickel sensitivity is more common in rosacea patients than the normal population.

Method:

Fourty patients with rosacea and 40 healthy age and sex-matched volunteers were included in the study. From European standard patch test series, test units with nickel were applied on the skin of the upper back. According to the scheme of the International Contact Dermatitis Research Group (ICDRG), test results were evaluated at 48th, 72th and 96th hours. Seven days later, reevaluation was done for late reactions. Statistical analyses were done by using Statistics package for Social Sciences (SPSS) 17 package program and p<0.05 was accepted as statistically significant.

Results:

Female/male ratio was 34/6 in patient group and 32/8 in control group. Mean age of the patient group and the control group were 39.97±12.65 (18-65 years), 40.82±11.79 (19-68 years), respectively. Age and sex distributions were found to be statistically similar. Nickel allergy in the patient and control group was found to be 52.5%, 22.5% respectively and the difference between groups was statistically significant (p=0. 006).

Conclusion:

Our results showed that there may be an association between nickel sensitivity and rosacea. Nickel sensitivity may be one of the underlying pathology or a triggering factor of the rosacea. Nickel restricted diet and avoiding the use of nickel-containing jewellery and piercings may extend the remission periods.

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

BACKGROUND

Hypersensitivity to metals as a cause of implant-related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest.

OBJECTIVE

To evaluate sensitization to implant materials in patients with implant-related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause.

METHODS

Patients with implant-related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed.

RESULTS

In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant-related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant-related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal.

CONCLUSION

Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant-related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.

Nickel sensitivity in patients with gastroesophageal reflux disease

OBJECTIVE

Various foods play important role in the pathogenesis of gastroesophageal reflux disease (GERD). These foods are shown to increase gastroesophageal reflux symptoms via various mechanisms and majority of these foods also contain nickel. The purpose of this study is to evaluate the relationship between Nickel sensitivity and GERD.

MATERIAL AND METHODS

Fifty-four patients diagnosed with GERD and 50 healthy volunteers who were admitted to our gastroenterology outpatient clinic were took part in the study. European standard patch test series, nickel-containing test units and corticosteroids were applied to the patient body; upper back. Evaluation was performed according to the scheme of the International Contact Dermatitis Research Group (ICDRG). The positive and negative reactions were recorded at the hours of 48, 72 and 96. Following the test implementations, 7 days later, the tests were reevaluated for late reactions. Statistics package for Social Sciences (SPSS) 17 package program was used for statistical evaluation and results of tests were compared between groups with the Chi-squared test. p < 0.05 was considered statistically significant.

RESULTS

Individuals in both groups were statistically similar in terms of age and gender. Nickel sensitivity was found to be positive in 48.2 and %22 of the GERD patients and control group, respectively. Difference between groups was statistically significant (p = 0.008).

CONCLUSIONS

Nickel sensitivity was significantly higher in GERD patients compared to the control group. In addition to imbalance between defensive and aggressive forces of the esophagus, there seems to be an association between nickel sensitivity and GERD.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Prospective analysis of human leukocyte functional tests reveals metal sensitivity in patients with hip implant

Background

The aim of the study was to examine the reactivity of peripheral human leukocytes to various metal ions prior and following hip replacement in order to investigate implant-induced metal sensitivity.

Methods

Three patient groups were set up: (1) individuals without implants and no history of metal allergy (7 cases), (2) individuals without implants and known history of metal allergy (7 cases), and (3) patients undergoing cementless hip replacement (40 cases). Blood samples were taken in groups 1 and 2 at three different occasions; in group 3, prior and 3, 6, 12, 24, and 36 months after surgery. Peripheral leukocytes were separated and left either untreated or challenged with Ti, NiCl₂, CoCl₂, CrCl₃, and phytohemagglutinin. Cell proliferation, cytokine release, and leukocyte migration inhibition assays were performed. Metal-induced reactivity was considered when all three assays showed significant change. Skin patch tests were also carried out.

Results

Both skin patch tests and leukocyte functional tests were negative in group 1, and both were positive in group 2. In group 3, after 6 months, 12% of the patients showed reactivity to the tested metals except for NiCl₂. Following the 36-month period, 18% of group three became sensitive to metals (including all the earlier 12%). In contrast, patch tests were negative at each time point in group 3.

Conclusions

Orthopedic implant material may induce metal reactivity after implantation in a manner where susceptibility is yet to be elucidated. Leukocyte triple assay technique might be a useful tool to test implant material-related sensitivity.

Audit of primary and secondary care as a source of patch test clinic referrals

BACKGROUND

Referral for patch testing is important in managing patients with eczema/dermatitis. These referrals come from many different sources.

OBJECTIVES

To assess the appropriateness of referrals from general practitioners (GPs) to a dedicated patch test clinic.

METHODS

Referral sources were recorded for patch testing in a dedicated contact dermatitis unit for a 4-month period between November 2002 and February 2003.

RESULTS

Of 217 referrals reviewed, 45 (21%) were received from GPs. There was no significant difference in the percentages of positive patch test results and of relevant positive patch test results obtained from GP referrals compared with those received from other sources, including dermatology departmental referrals.

CONCLUSIONS

Referrals from GPs, if selected appropriately, can be seen directly in the patch test clinic without prior assessment in a general dermatology clinic.

Preferential usage of TCR-Vbeta17 by peripheral and cutaneous T cells in nickel-induced contact dermatitis

Nickel (Ni) is one of the most common contact sensitizers in man, and Ni-induced contact dermatitis is considered as a model of hapten-induced delayed type hypersensitivity. Previous studies indicated that Ni-reactive T cells derived from Ni-allergic individuals preferentially express distinct TCR-Vbeta chains. However, data on the TCR-Vbeta repertoire of Ni-responsive T cells are not consistent. Therefore, the aim of this study was to identify the TCR-Vbeta receptors of Ni-responsive peripheral and cutaneous T cells in a cohort of 17 donors with Ni-induced contact dermatitis in comparison with those of 6 healthy controls. Peripheral NiSO(4)-responsive T lymphocytes showed a significant overexpression of TCR-Vbeta17 and the frequency of TCR-Vbeta17(+) T cells correlated significantly with the in vitro reactivity of PBMC to NiSO(4). In addition, the cutaneous infiltrate of Ni-induced patch test reactions consisted primarily of Vbeta17(+) T cells. The majority of patch test-derived NiSO(4)-responsive T cells of three allergic donors were TCR-Vbeta17(+), whereas patch test-derived NiSO(4) unresponsive T cells of four additional donors did not express TCR-Vbeta17. Skin-derived Ni-responsive T cell lines from three donors uniformly secreted the Th2 cytokine, IL-5, but no IFN-gamma or IL-10. These in vitro and in vivo findings strongly suggest that T cells with a restricted TCR-Vbeta repertoire, i.e., Vbeta17, predominate in NiSO(4)-induced contact dermatitis and may be crucial in the effector phase of Ni hypersensitivity.