Metal allergen of the 21st century-a review on exposure, epidemiology and clinical manifestations of palladium allergy

Relationship between internal metal exposure and thyroid cancer incidence: a case-control study simultaneously validated by BKMR and WQS models

The global incidence of thyroid cancer is increasing, attracting great attention. Heavy metals affect human health and cause different diseases through various mechanisms. Several studies have identified heavy metals as risk factors for thyroid cancer and examined the association between heavy metals and the development of thyroid cancer. However, the mixed effects of multiple heavy metals on thyroid cancer are still unknown. In this study, twelve heavy metals including iron (Fe), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), strontium (Sr), cadmium (Cd), cesium (Cs), palladium (Ba), mercury (Hg), and lead (Pb), in urine from thyroid cancer patients and healthy adults, were measured. The results revealed that the levels of Fe, Ni, and Cu were significantly higher in the case group than in the control group. Weighted quantile sum (WQS) and Bayesian kernel-machine regression (BKMR) analyses consistently showed that heavy metal mixtures in urine were positively associated with the risk of thyroid cancer, with metals such as Fe and Ni being the main contributors. Further epidemiological surveys are needed in the future to investigate the effects of individual or multiple heavy metals on thyroid disease.

Correlation between pierced earrings and the prevalence of metal allergies at Tokushima university hospital: a 15-year retrospective analysis

In Japan, metal allergies are becoming increasingly prevalent, raising concerns for public health. This study examined metal allergy characteristics, patient histories, and clinical signs associated with patch test results over a 15-year period at the Dental Metal Allergy Clinic of Tokushima University Hospital. A retrospective analysis of 1085 patients revealed that 65.4% tested positive for at least one metal allergen, with palladium chloride, nickel sulfate, potassium dichromate, and cobalt chloride identified as the most common allergens. Female patients were disproportionately affected, accounting for 78.4% of the study population. Notably, there was a substantial increase in patients reporting inflammation due to pierced earrings, increasing from 5.0% in 2005 to 43.2% in 2020, particularly among females. Patients with a history of inflammation from earrings had an 81.3% prevalence of metal allergies, which was significantly higher than the 60.4% reported in those without such a history (chi-square test, p < 0.001). These findings suggest a strong link between earrings and metal allergies, underscoring the need for improved education, early detection, and preventive strategies to address the growing impact of metal allergies on public health.

The Thermomechanical, Functional and Biocompatibility Properties of a Au-Pt-Ge Alloy for PFM Dental Restorations

A high-noble Au-Pt-Ge porcelain-fused-to-metal (PFM) dental alloy without the known adverse metallic elements and with the addition of germanium (Ge) was produced as a more cost-effective alternative to other precious alloying metals, with investigations for determining the functionality and clinical use of this alloy. The thermomechanical, biocompatibility, durability, workability and economic characteristics of the produced dental alloy were investigated. These properties were investigated with in vitro biocompatibility testing on human gingival fibroblasts (HGFs); static immersion testing for metal ion release; DSC analysis; hardness, tensile testing, density and coefficient of thermal expansion (CTE) measurements; metallographic and SEM/EDX microstructure investigations; and finally with the production of a test PFM dental bridge. The results of the thermomechanical testing showed alloy properties suitable for dental restorations and clinical use, with somewhat lower mechanical properties, making the alloy not suitable for extensive multiunit fixed restorations. The microstructure investigations showed segregations of Ge in the homogeneous alloy matrix, which reduce the alloy's mechanical properties. The produced PFM dental bridge showed excellent workability of the alloy in a dental laboratory setting, as well as a high standard of the final dental restoration. The ion release was negligible, well below any harmful quantities, while the cell viability examination showed significantly higher viability ratings on polished alloy samples as compared to as-cast samples. The results showed that a dental substructure in direct contact with oral tissue and fluids should be highly polished. The performed investigations showed that the produced PFM dental alloy is suitable for clinical use in producing high-quality dental restorations with high biocompatibility for patients prone to metal allergies.

Contact allergies to dental materials in patients

BACKGROUND

Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy.

OBJECTIVES

To analyse current sensitization patterns to dental materials in patients with suspected contact allergy.

METHODS

This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series.

RESULTS

A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%).

CONCLUSIONS

Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

Isatin-Schiff base functionalized graphene oxide as a highly selective turn-on fluorescent probe for the detection of Pd(II) via photoinduced electron transfer pathway

We investigated the use of isatin-Schiff base functionalized graphene oxide (ISBGO) as a selective fluorescent chemosensor for the detection of palladium ions. Selectivity tests indicated that over 23 metal ions tested, ISBGO (λex = 340 nm, λem = 504 nm) showed the highest affinity for Pd(II), displaying a 10.1-fold enhancement. Also, interference tests proved that in the presence of both Pd(II) and other metal ions, there was still high fluorescence intensity and no considerable quenching occurred. According to DFT and TD-DFT calculations, photo-induced electron transfer (PET) is responsible for the turn-on response produced by the chemosensor. Coordination of Pd(II) with ISBGO in fact blocks PET from imine nitrogen of 3-iminoindolin-2-one moiety to the benzene ring, which in turn leads to a turn-on response. In addition, Job's plot analysis and Benesi-Hildebrand approach suggest that ISBGO preferably forms a 1:1 complex with Pd(II) with an association constant of 1.020 × 105 M-1. Moreover, FT-IR spectroscopy and DFT study showed that amide oxygen and imine nitrogen of 3-iminoindolin-2-one moiety acted as binding sites of ISBGO. High sensitivity, fast response, great degree of sensitivity, short life time, low detection limit of 32 nM combined with high association constant (Kf) of 1.020 × 105 M-1 and increased fluorescence quantum yield (Φf) of roughly 1.5-fold in the presence of Pd (II), highlight the role of ISBGO as an excellent probe for sensing Pd(II) in aqueous solution.

Systemic allergic contact dermatitis to palladium, platinum, and titanium: mechanisms, clinical manifestations, prevalence, and therapeutic approaches

Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T-cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work-related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.

Radiopaque properties of polyetheretherketone crown at laboratory study

OBJECTIVES

There have been no reports on the radiopaque properties of new polyetheretherketone (PEEK) crowns for locating crowns during accidental ingestion or aspiration and detection of secondary caries, which is essential information for clinical application. This study aimed to investigate whether the radiopaque properties of PEEK crowns could be used to identify the site of accidental ingestion or aspiration and detect secondary caries.

METHODS

Four types of crowns were fabricated: three non-metal crowns (PEEK, hybrid resin, and zirconia) and one full metal cast crown (gold-silver-palladium alloy). Initially, the images for these crowns were compared using intraoral radiography, chest radiography, cone-beam computed tomography (CBCT), and multi-detector computed tomography (MDCT); computed tomography (CT) values were calculated. Subsequently, the images for the crowns placed on the secondary caries model with two artificial cavities were compared using intraoral radiography.

RESULTS

The PEEK crowns displayed the lowest radiopaque properties on radiography and very few artifacts were observed on CBCT and MDCT. On the other hand, the CT values of the PEEK crowns were a little lower than those of the hybrid resin crowns and considerably lower than the zirconia and full metal cast crowns. The cavity could be detected in the PEEK crown-placed secondary caries model through intraoral radiography.

CONCLUSIONS

This simulated study of radiopaque properties with four types of crowns suggested that a radiographic imaging system can be used to identify the site of accidental ingestion and aspiration of PEEK crowns and to detect secondary caries of the abutment tooth within a PEEK crown.

Colorimetric Paper-Based Analytical Devices (PADs) Backed by Chemometrics for Pd(II) Detection

This paper presents the development of cheap and selective Paper-based Analytical Devices (PADs) for selective Pd(II) determination from very acidic aqueous solutions. The PADs were obtained by impregnating two cm-side squares of filter paper with an azoic ligand, (2-(tetrazolylazo)-1,8 dihydroxy naphthalene-3,6,-disulphonic acid), termed TazoC. The so-obtained orange TazoC-PADs interact quickly with Pd(II) in aqueous solutions by forming a complex purple-blue-colored already at pH lower than 2. The dye complexes no other metal ions at such an acidic media, making TazoC-PADs highly selective to Pd(II) detection. Besides, at higher pH values, other cations, for example, Cu(II) and Ni(II), can interact with TazoC through the formation of stable and pink-magenta-colored complexes; however, it is possible to quantify Pd(II) in the presence of other cations using a multivariate approach. To this end, UV-vis spectra of the TazoC-PADs after equilibration with the metal ions solutions were registered in the 300-800 nm wavelength range. By applying Partial Least Square regression (PLS), the whole UV-vis spectra of the TazoC-PADs were related to the Pd(II) concentrations both when present alone in solution and also in the presence of Cu(II) and Ni(II). Tailored PLS models obtained with matrix-matched standard solutions correctly predicted Pd(II) concentrations in unknown samples and tap water spiked with the metal cation, making the method promising for quick and economical sensing of Pd(II).

A Piperazine Linked Rhodamine-BODIPY FRET-based Fluorescent Sensor for Highly Selective Pd2+ and Biothiol Detection

A class of rhodamine-based fluorescent sensors for the selective and sensitive detection of Pd2+ metal ions in aqueous media has been developed. A rhodamine-based sensor PMS and a rhodamine-BODIPY Förster resonance energy transfer (FRET)-pair sensor PRS have been incorporated with a piperazine linker and an O-N-S-N podand ligand for specific recognition of Pd2+ ion. Both probes displayed colorimetric and fluorescent ratiometric changes when exposed to Pd2+ , due to their spirolactam rings opening and restoring rhodamine conjugation. PRS is highly selective to Pd2+ over 22 other metal ions, showing a 0.6-fold ratiometric difference at I600nm /I515nm . Additionally, the lactam ring in Pd2+ coordinated PRS-Pd could be switched back to the closed form in the presence of various thiols, providing a "red-green traffic light" detection mechanism between red and green emission. Furthermore, PRS showed excellent cell viability and was successfully employed to image Pd2+ and the PRS-Pd complex ensemble could interchangeably detect biothiols including glutathione (GSH) in A549 human lung cancer cells.

Heavy metals in contact dermatitis: A review

Contact dermatitis is an inflammatory skin reaction caused by direct contact with chemical substances in the environment and can either be irritant or allergic in nature. The clinical symptoms of contact dermatitis, include local skin rash, itching, redness, swelling, and lesions. Nowadays, 15-20% of people have some degree of contact dermatitis, which can be more or less severe. Immune responses in allergic contact dermatitis (ACD) are due to the effects of cytokines and allergen-specific CD4⁺ and CD8⁺ T cells on the skin. Acids and alkalis such as drain cleaners, plants such as poinsettias, hair colors, and nail polish remover, are all prominent causes of irritant contact dermatitis (ICDs). Heavy metals are metallic elements with a high atomic weight that are hazardous in low quantities and are known to cause dermatitis after systemic or local exposure. Nickel (Ni), chromium (Cr), lead (Pb), and copper (Cu) are among the most common heavy metals used in various industries. Metal allergies may cause ACD and also systemic contact dermatitis (SCD). Contact dermatitis is detected by laboratory tests such as patch testing, lymphocyte stimulation test (LST), and evaluation of cytokine production by primary cultures of peripheral blood mononuclear cells. This article presents an update on the epidemiological and clinical characteristics of ACD and SCD caused by three heavy metals (Cr, Cu, and Pb). Ni is not discussed due to recent coverage. Furthermore, the effects of contact sensitivity to some other heavy metals, such as gold (Au), cobalt (Co), palladium (Pd), and mercury (Hg) are discussed.

Cross-Reactivity of Intraoral Allergic Contact Mucositis in the Nickel-Sensitized Ear Model of Metal Allergy

Cross-reactivity of metal allergies can make metal allergy treatment complicated because the background of immune response in cross-reactions remains unknown. In clinical settings, cross-reactivity among several metals has been suspected. However, the precise mechanism of immune response in cross-reactivity is unclear. Two sensitizations with nickel, palladium, and chromium plus lipopolysaccharide solution into the postauricular skin were followed by a single nickel, palladium, and chromium challenge of the oral mucosa to generate the intraoral metal contact allergy mouse model. Results showed that the infiltrating T cells in nickel-sensitized, palladium- or chromium-challenged mice expressed CD8+ cells, cytotoxic granules, and inflammation-related cytokines. Thus, nickel ear sensitization can cause cross-reactive intraoral metal allergy.

Type IVb Hypersensitivity Reaction in the Novel Murine Model of Palladium-Induced Intraoral Allergic Contact Mucositis

Palladium (Pd) is a component of several alloy types that are widely used in our environment, including several dental alloy types that cause adverse reactions such as hypersensitivity in the oral mucosa. However, the pathological mechanism of intraoral Pd allergies remains unclear because its animal model in the oral mucosa has not been established. In this study, we established a novel murine model of Pd-induced allergies in the oral mucosa, and explored the immune response of cytokine profiles and T cell diversity in terms of the T cell receptor. The Pd-induced allergy mouse was generated by two sensitizations with PdCl₂, plus a lipopolysaccharide solution into the postauricular skin followed by a single Pd challenge of the buccal mucosa. Significant swelling and pathological features were histologically evident at five days after the challenge, and CD4-positive T cells producing high levels of T helper 2 type cytokines had accumulated in the allergic oral mucosa. Characterization of the T cell receptor repertoire in Palladium allergic mice indicated that Pd-specific T cell populations were limited in V and J genes but were diverse at the clonal level. Our model demonstrated that a Pd-specific T cell population with Th2 type response tendencies may be involved in the Pd-induced intraoral metal contact allergy.

Unique and common TCR repertoire features of Ni2+ -, Co2+ -, and Pd2+ -specific human CD154 + CD4+ T cells

BACKGROUND

Apart from Ni²⁺ , Co²⁺ , and Pd²⁺ ions commonly trigger T cell-mediated allergic contact dermatitis. However, in vitro frequencies of metal-specific T cells and the mechanisms of antigen recognition remain unclear.

METHODS

Here, we utilized a CD154 upregulation assay to quantify Ni²⁺ -, Co²⁺ -, and Pd²⁺ -specific CD4+ T cells in peripheral blood mononuclear cells (PBMC). Involved αβ T cell receptor (TCR) repertoires were analyzed by high-throughput sequencing.

RESULTS

Peripheral blood mononuclear cells incubation with NiSO₄ , CoCl₂ , and PdCl₂ increased frequencies of CD154 + CD4+ memory T cells that peaked at ~400 μM. Activation was TCR-mediated as shown by the metal-specific restimulation of T cell clones. Most abundant were Pd²⁺ -specific T cells (mean 3.5%, n = 19), followed by Co²⁺ - and Ni²⁺ -specific cells (0.6%, n = 18 and 0.3%, n = 20) in both allergic and non-allergic individuals. A strong overrepresentation of the gene segment TRAV9-2 was unique for Ni²⁺ -specific TCR (28% of TCR) while Co²⁺ and Pd²⁺ -specific TCR favorably expressed TRAV2 (8%) and the TRBV4 gene segment family (21%), respectively. As a second, independent mechanism of metal ion recognition, all analyzed metal-specific TCR showed a common overrepresentation of a histidine in the complementarity determining region 3 (CDR3; 15% of α-chains, 34% of β-chains). The positions of the CDR3 histidine among metal-specific TCR mirrored those in random repertoires and were conserved among cross-reactive clonotypes.

CONCLUSIONS

Induced CD154 expression allows a fast and comprehensive detection of Ni²⁺ -, Co²⁺ -, and Pd²⁺ -specific CD4+ T cells. Distinct TCR repertoire features underlie the frequent activation and cross-reactivity of human metal-specific T cells.

Palladium nanoparticles as emerging pollutants from motor vehicles: An in-depth review on distribution, uptake and toxicological effects in occupational and living environment

Palladium nanoparticles (PdNPs) play an integral role in motor vehicles as the primary vehicle exhaust catalyst (VEC) for tackling environmental pollution. Automobiles equipped with Pd-based catalytic converters were introduced in the mid-1970s and ever since the demand for Pd has steadily increased due to stringent emission standards imposed in many developed and developing countries. However, at the same time, the increasing usage of Pd in VECs has led to the release of nano-sized Pd particles in the environment, thus, emerging as a new source of environmental pollution. The present reports in the literature have shown gradual increasing levels of Pd particles in different urban environmental compartments and internalization of Pd particles in living organisms such as plants, aquatic species and animals. Occupational workers and the general population living in urban areas and near major highways are the most vulnerable as they may be chronically exposed to PdNPs. Risk assessment studies have shown acute and chronic toxicity exerted by PdNPs in both in-vitro and in-vivo models but the underlying mechanism of PdNPs toxicity is still not fully understood. The review intends to provide readers with an in-depth account on the demand and supply of Pd, global distribution of PdNPs in various environmental matrices, their migration and uptake by living species and lastly, their health risks, so as to serve as a useful reference to facilitate further research and development for safe and sustainable technology.

Dental material allergies and oral soft tissue reactions

Dental materials can cause reactions to the oral mucosa and present to the general dental practitioner. These are often referred to as 'allergies' but are frequently lichenoid reactions. Most of these are related to dental amalgam restorations and can be remedied by replacing the restoration with another suitable material. Other metals, including gold, palladium, nickel and chrome, have also been reported to trigger mucosal changes. Less commonly, issues arise from other restorative materials, including denture acrylics, composites and glass polyalkenoates. Reactions are also reported due to endodontic and sealing materials. It is unclear what role skin 'patch' testing has in managing dental material allergies. This article aims to give the practitioner a clearer picture of dental material allergy issues and how they should be approached in primary dental practice.

Fatigue Resistance of Cast-on Implant Abutment Fabricated with Three Different Alloys

OBJECTIVES

 This study aimed to evaluate fatigue resistance of cast-on implant abutment using three alloys.

MATERIALS AND METHODS

 Forty specimens of implant-supported crowns were prepared; Group 1 (TA) stock titanium abutments, Group 2 (GS) abutment cast with 40% gold alloy, Group 3 (GP) abutment cast with palladium alloy, and Group 4 (CN) abutment cast with nickel-chromium alloy. Specimens were cyclic loaded at 20 Hz, starting from 200 N (5,000 cycles), followed by stepwise loading of 400, 600, 800, 1,000, 1,200, 1,400, 1,600, and 1,800 N (30,000 cycles/step). Specimens were loaded until failure or reached 245,000 cycles.

STATISTICAL ANALYSIS

 The withstand cycles were analyzed using one-way analysis of variance and Weibull survival analysis. Fracture surfaces were examined using scanning electron microscopy.

RESULTS

 The results of withstand cycles were TA (189,883 ± 22,734), GS (195,028 ± 22,371), GP (187,662 ± 22,555), and CN (200,350 ± 30,851). The statistical analysis showed no significant difference between the groups (p = 0.673).

CONCLUSION

 Although CN has higher Weibull characteristic strength which means greater durability, its lower Weibull modulus demonstrated less structural reliability. Consistent failures at implant fixture level were also found in CN group.

Immunological Mechanisms of Metal Allergies and the Nickel-Specific TCR-pMHC Interface

Besides having physiological functions and general toxic effects, many metal ions can cause allergic reactions in humans. We here review the immune events involved in the mediation of metal allergies. We focus on nickel (Ni), cobalt (Co) and palladium (Pd), because these allergens are among the most prevalent sensitizers (Ni, Co) and immediate neighbors in the periodic table of the chemical elements. Co-sensitization between Ni and the other two metals is frequent while the knowledge on a possible immunological cross-reactivity using in vivo and in vitro approaches remains limited. At the center of an allergic reaction lies the capability of a metal allergen to form T cell epitopes that are recognized by specific T cell receptors (TCR). Technological advances such as activation-induced marker assays and TCR high-throughput sequencing recently provided new insights into the interaction of Ni2+ with the αβ TCR-peptide-major histocompatibility complex (pMHC) interface. Ni2+ functionally binds to the TCR gene segment TRAV9-2 or a histidine in the complementarity determining region 3 (CDR3), the main antigen binding region. Thus, we overview known, newly identified and hypothesized mechanisms of metal-specific T cell activation and discuss current knowledge on cross-reactivity.

Overview of intentionally used food contact chemicals and their hazards

Food contact materials (FCMs) are used to make food contact articles (FCAs) that come into contact with food and beverages during, e.g., processing, storing, packaging, or consumption. FCMs/FCAs can cause chemical contamination of food when migration of their chemical constituents (known as food contact chemicals, FCCs) occurs. Some FCCs are known to be hazardous. However, the total extent of exposure to FCCs, as well as their health and environmental effects, remain unknown, because information on chemical structures, use patterns, migration potential, and health effects of FCCs is often absent or scattered across multiple sources. Therefore, we initiated a research project to systematically collect, analyze, and publicly share information on FCCs. As a first step, we compiled a database of intentionally added food contact chemicals (FCCdb), presented here. The FCCdb lists 12'285 substances that could possibly be used worldwide to make FCMs/FCAs, identified based on 67 FCC lists from publicly available sources, such as regulatory lists and industry inventories. We further explored FCCdb chemicals' hazards using several authoritative sources of hazard information, including (i) classifications for health and environmental hazards under the globally harmonized system for classification and labeling of chemicals (GHS), (ii) the identification of chemicals of concern due to endocrine disruption or persistence related hazards, and (iii) the inclusion on selected EU- or US-relevant regulatory lists of hazardous chemicals. This analysis prioritized 608 hazardous FCCs for further assessment and substitution in FCMs/FCAs. Evaluation based on non-authoritative, predictive hazard data (e.g., by in silico modeling or literature analysis) highlighted an additional 1411 FCCdb substances that could thus present similar levels of concern, but have not been officially classified so far. Lastly, for over a quarter of all FCCdb chemicals no hazard information could be found in the sources consulted, revealing a significant data gap and research need.

Functional, compositional, and regulatory analyses of imported and non-imported single dental crowns

The aims of the study were to investigate functional and esthetic properties, the composition of the alloy, and the content of hazardous elements of single dental crowns with metal skeleton and fired porcelain. Epoxy models made from full mouth impressions taken of a patient with a crown preparation of the right maxillary first permanent molar were used for production of identical polyether impressions, which were distributed to dentists in Norway. The dentists sent the impressions to their regular dental laboratories. All 55 crowns collected were anonymized and examined. Of the crowns received, 35 were made in Norway, 12 were imported, and 8 were of unknown origin. The evaluation of functional properties revealed that 50% of the Norwegian, 42% of the imported, and 25% of the unknown-origin crowns were considered unacceptable. The composition of the alloy was not in accordance with that stated by the manufacturer for 17%, 13% and 20% of the crowns, where this information was provided. The lead content of the alloy exceeded the limit set by the ISO 22674: 2016 for 18% of the crowns in total. The statement that shall follow the work according to EU-regulations was not complete for approximately 75% of the works received.

Usefulness of lymphocyte transformation test and in vitro cytokine release in differentiating between independent and cross-reacting nickel/palladium allergy

BACKGROUND

Often concomitant patch test (PT) reactivity to palladium (Pd) and nickel (Ni) is found.

OBJECTIVES

To determine whether lymphocyte transformation test (LTT) could be useful in discrimination between cross-reacting or distinct PT results, and to compare the results with in vitro cytokine production upon Pd or Ni stimulation.

MATERIALS AND METHODS

The study population consisted of two groups: 13 individuals with Pd PT reactions (10 with concomitant Ni PT reaction, 3 individuals with only Pd PT reactivity) and 10 Ni/Pd PT negative individuals. LTT and assessment of cytokine release (interferon-gamma, interleukin-5 [IL-5], IL-8, IL-17A, tumor necrosis factor alpha) by cytometric bead assay were performed.

RESULTS

All 10 patients with positive PT to Ni and Pd showed positive LTT to Ni (P < .05) as compared with the 10 Pd/Ni PT negative patients-but had no significant LTT reaction to Pd. In all, 9 out of 10 Pd/Ni PT negative patients were also LTT negative to Ni and 10 out of 10 to Pd. In the 3 only Pd PT reactors 2 out of 3 remained LTT negative to Ni and 0 out of 3 to Pd. As a major finding, cytokine production gave clearly enhanced IL-5 response to Ni in Ni PT positive individuals (P < .05), whereas Pd PT reactivity was not linked with such enhanced IL-5 production in vitro to Pd.

CONCLUSIONS

Pd and Ni sensitization are mostly found concomitantly, and cross-reactivity is questioned. By different LTT reactions and particularly IL-5 production in vitro, predominant Ni sensitization becomes more evident.

Patch Testing With an Extended Metal Allergen Series at the Massachusetts General Hospital (2006-2017)

BACKGROUND

Reports of patch test data with an extended metal series that includes rare metals are limited.

OBJECTIVE

The aims of the study were to analyze and report patch testing results from an extended metal series, examine associations with sex and age, and highlight concomitant metal reactions.

METHODS

This study is a retrospective review of 150 patients referred for suspected metal allergy from January 1, 2007, to December 31, 2016.

RESULTS

The most common indications for evaluation referral were those having symptoms after implantation of a metal device (55.3%) and those with a history and concern of metal allergy before implantation of a metal device (22.0%). One or more positive patch test reactions were observed in 87 patients (58.0%). Metals with the highest frequencies were nickel sulfate 2.5% (26.2%), gold sodium thiosulfate 0.5% (23.0%), gold sodium thiosulfate 2.0% (20.7%), palladium chloride 2.0% (19.6%), cobalt chloride 1.0% (12.0%), and manganese chloride 2.0% (10.1%). Of the 45 metals tested, 15 caused no patch test reactions. Female patients were more likely to be sensitized to nickel, gold, and palladium (P < 0.05). Younger patients (≤40 years) had higher reaction rates to nickel, mercury, palladium, and cobalt. Concomitant reactions of the top metals (nickel, palladium, gold, and cobalt) were statistically associated bidirectionally (P < 0.05), except for cobalt and gold.

CONCLUSIONS

Allergy to metals, including those not included in standard series, may be more prevalent than previously suspected. Results may help guide future testing for suspected metal allergy, although future studies are warranted.

Cross-Reactivity of Palladium in a Murine Model of Metal-Induced Allergic Contact Dermatitis

Metal allergy is usually diagnosed by patch testing, however, the results do not necessarily reflect the clinical symptoms because of cross-reactivity between different metals. In this study, we established the novel mouse model of cross-reactive metal allergy, and aimed to elucidate the immune response in terms of T-cell receptor repertoire. This model was classified into two groups: the sensitization to nickel and challenge with palladium group, and the sensitization to chromium and challenge with palladium group. This model developed spongiotic edema with intra- and peri-epithelial infiltration of CD4⁺ T cells in the inflamed skin that resembles human contact dermatitis. Using T cell receptor analysis, we detected a high proportion of T cells bearing Trav8d-1-Traj49 and Trav5-1-Traj37 in the Ni- and Cr-sensitized Pd-challenged mice. Furthermore, mucosal-associated invariant T cells and invariant natural killer T cells were also detected. Our results indicated that T cells bearing Trav8d-1-Traj49 and Trav5-1-Traj37 induced the development of palladium-cross reactive allergy, and that mucosal-associated invariant T and invariant natural killer T cells were also involved in the cross-reactivity between different metals.

Higher Prevalence of Nickel and Palladium Hypersensitivity in Patients with Ulcerative Colitis

BACKGROUND

The etiology of ulcerative colitis (UC) remains elusive even though many genetic and environmental pathogenic factors have been reported. Aberrant inflammatory responses mediated by specific subsets of T cells have been observed in ulcerative lesions of UC patients.

OBJECTIVES

To elucidate the involvement of a delayed-type hypersensitivity reaction in UC, we focused on dental metal hypersensitivity, a T cell-mediated, delayed-type allergic reaction that causes oral contact mucositis and systemic cutaneous inflammation.

METHOD

We recruited 65 Japanese UC patients and 22 healthy controls (HC) and used the in vitro lymphocyte stimulation test to quantify their sensitivity to zinc, gold, nickel, and palladium - the metals that have been widely used in dentistry. All subjects were users of metallic dental implants and/or prostheses containing zinc, gold, nickel, and/or palladium as major constituents.

RESULTS

Sixty percent of the UC patients were hypersensitive to at least one metal species, whereas 32% of the HC were hypersensitive to only a single metal species. The overall incidence of metal hypersensitivity was significantly higher for UC patients than for HC. Furthermore, a significantly greater proportion of UC patients were hypersensitive to nickel or palladium. The severity of the sensitivity to nickel and palladium was also significantly greater for UC patients than for HC.

CONCLUSIONS

This pilot study demonstrates that UC patients have a significantly higher incidence of hypersensitivity to nickel and palladium, suggesting the possible involvement of dental metal hypersensitivity in UC pathogenesis.

Effects of diet on skin sensitization by nickel, poison ivy, and sesquiterpene lactones

Skin contact or exposure to sensitizers often occurs as a consequence of occupational exposures (e.g. poison ivy in forestry), wearing jewelry (e.g. nickel), or use of cosmetics (e.g. fragrances). However, many of the known skin sensitizers or their chemical variants are also consumed orally through foods or other sources. Since oral exposure to antigenic substances can lead to tolerance, consumption of sensitizers may impact the development and potency of skin sensitization, especially if the sensitizer is consumed early in life, prior to the first skin contact. To address this issue, we have reviewed human clinical and epidemiological literature relevant to this subject and evaluated whether early oral exposures to relevant sensitizers, or their chemical variants, are associated with reduced prevalence of skin sensitization to three main allergic sensitizers - nickel, urushiols of poison ivy, and sesquiterpene lactones of chrysanthemum and other plants.

The HR-CS-GF-AAS determination and preconcentration of palladium in contaminated urban areas, especially in lichens

The increasing content of platinum group metal particles emitted into the environment by car traffic is gradually attracting the attention of the scientific community. However, the methods for the determination of platinum group metals in environmental matrices are either costly or suffer from low sensitivity. To facilitate the use of less sensitive, but significantly cheaper, devices, the preconcentration of platinum group metals is employed. For platinum, a multitude of preconcentration approaches have been published. On the contrary, the preconcentration approaches for palladium are still rare. In this work, the development, optimization, and testing of a new approach is described; it is based on a preconcentration of palladium on octadecyl modified silica gel together with the complexing agent dimethylglyoxime, and it is then analyzed with the high-resolution continuum-source atomic absorption spectrometry. For comparison, a newly developed sorbent, QuadraSil™ TA, with a high affinity for platinum group metals was also tested. The preconcentraiton approach was tested on the lichen Hypogymnia physodes, which served as a bioindicator of palladium emissions. The case study site was a mid-sized city in central Europe: Brno, Czech Republic. The dry "bag" monitoring technique was used to collect the palladium near roads with a large span of traffic density. The developed analytical approach confirmed an increasing concentration of palladium with increasing exposure time and intensity of the traffic. Consequently, a simple relationship between the amount of bioaccumulated palladium and traffic density was established.

Metal nanomaterials: Immune effects and implications of physicochemical properties on sensitization, elicitation, and exacerbation of allergic disease

The recent surge in incorporation of metallic and metal oxide nanomaterials into consumer products and their corresponding use in occupational settings have raised concerns over the potential for metals to induce size-specific adverse toxicological effects. Although nano-metals have been shown to induce greater lung injury and inflammation than their larger metal counterparts, their size-related effects on the immune system and allergic disease remain largely unknown. This knowledge gap is particularly concerning since metals are historically recognized as common inducers of allergic contact dermatitis, occupational asthma, and allergic adjuvancy. The investigation into the potential for adverse immune effects following exposure to metal nanomaterials is becoming an area of scientific interest since these characteristically lightweight materials are easily aerosolized and inhaled, and their small size may allow for penetration of the skin, which may promote unique size-specific immune effects with implications for allergic disease. Additionally, alterations in physicochemical properties of metals in the nano-scale greatly influence their interactions with components of biological systems, potentially leading to implications for inducing or exacerbating allergic disease. Although some research has been directed toward addressing these concerns, many aspects of metal nanomaterial-induced immune effects remain unclear. Overall, more scientific knowledge exists in regards to the potential for metal nanomaterials to exacerbate allergic disease than to their potential to induce allergic disease. Furthermore, effects of metal nanomaterial exposure on respiratory allergy have been more thoroughly-characterized than their potential influence on dermal allergy. Current knowledge regarding metal nanomaterials and their potential to induce/exacerbate dermal and respiratory allergy are summarized in this review. In addition, an examination of several remaining knowledge gaps and considerations for future studies is provided.

Impact of Heavy Metals on Host Cells: Special Focus on Nickel-Mediated Pathologies and Novel Interventional Approaches

BACKGROUND

Heavy metals [arsenic, aluminium, cadmium, chromium, cobalt, lead, nickel (Ni), palladium and titanium] are environmental contaminants able to impact with host human cells, thus, leading to severe damage.

OBJECTIVE

In this review, the detrimental effects of several heavy metals on human organs will be discussed and special emphasis will be placed on Ni. In particular, Ni is able to interact with Toll-like receptor-4 on immune and non-immune cells, thus, triggering the cascade of pro-inflammatory cytokines. Then, inflammatory and allergic reactions mediated by Ni will be illustrated within different organs, even including the central nervous system, airways and the gastrointestinal system.

DISCUSSION

Different therapeutic strategies have been adopted to mitigate Ni-induced inflammatoryallergic reactions. In this context, the ability of polyphenols to counteract the inflammatory pathway induced by Ni on peripheral blood leukocytes from Ni-sensitized patients will be outlined. In particular, polyphenols are able to decrease serum levels of interleukin (IL)-17, while increasing levels of IL- 10. These data suggest that the equilibrium between T regulatory cells and T helper 17 cells is recovered with IL-10 acting as an anti-inflammatory cytokine. In the same context, polyphenols reduced elevated serum levels of nitric oxide, thus, expressing their anti-oxidant potential. Finally, the carcinogenic potential of heavy metals, even including Ni, will be highlighted.

CONCLUSION

Heavy metals, particularly Ni, are spread in the environment. Nutritional approaches seem to represent a novel option in the treatment of Ni-induced damage and, among them, polyphenols should be taken into consideration for their anti-oxidant and anti-inflammatory activities.

Prevalence of contact allergy to metals: nickel, palladium, and cobalt in Southern Sweden from 1995-2016

BACKGROUND

In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel.

OBJECTIVES

To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis.

METHODS

A retrospective analysis of patch test results from 1995-2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations.

RESULTS

The prevalence of nickel allergy decreased significantly in the youngest age group (6-30 years) for both female and male patients from 1995-1999 to 2012-2016: females: 33.4% to 19.1% (P < .001); males: 5.9% to 2.1% (P < .05). The concomitant reactions between nickel and palladium and nickel and cobalt among young females, respectively, also decreased significantly. Isolated palladium and cobalt allergy remained stable (1.4% and 2.3%, respectively) during the same time period for both men and women.

CONCLUSIONS

The prevalence of nickel has decreased among young females and males suspected of contact allergy in Southern Sweden after the introduction of the EU nickel directive. There has been no change in isolated palladium or cobalt allergy.

Improved metal allergen reactivity of artificial skin models by integration of Toll-like receptor 4-positive cells

BACKGROUND

Reconstructed human epidermis (RhE) is widely used to replace animal models in order to assess the proinflammatory and allergenic effects of chemicals. Unfortunately, RhE lacks proinflammatory responsiveness for metal haptens, which are the most prevalent human contact allergens, raising concerns about its reliability for predicting skin allergens.

OBJECTIVES

To investigate whether this limitation of RhE might be attributable to a lack of functional expression of Toll-like receptor 4 (TLR4), which governs proinflammatory sensitivity to nickel and cobalt.

MATERIALS AND METHODS

RhE, dendritic cell (DC)-containing RhE and full-thickness skin equivalent (FTSE) were compared regarding their proinflammatory responsiveness to metal allergens.

RESULTS

The incorporation of dermal fibroblasts was sufficient to confer metal sensitivity to RhE. Unlike keratinocytes, normal human fibroblasts expressed high levels of TLR4 mRNA and induced interleukin-8 expression upon stimulation with nickel or cobalt. Consistently, dermal isolates from FTSE expressed considerable amounts of TLR4 mRNA, whereas RhE or epidermis isolated from FTSE, normal human epidermis or inflamed human epidermis failed to express TLR4. Similarly, co-culture with TLR4-positive DCs bestowed RhE with proinflammatory responsiveness to metals.

CONCLUSION

Our data suggest that FTSE or DC/RhE co-culture models can circumvent the shortcomings of RhE assays, and combine the benefits of complex and monoculture-based test systems in a single assay.

Delayed hypersensitivity to palladium dichloride: 15-year retrospective study in a skin allergy unit

BACKGROUND

Metal allergies are the most frequent causes of allergic contact dermatitis. Although the use of palladium is increasing, it is not included in any baseline series.

OBJECTIVE

To assess the prevalence of hypersensitivity to palladium and to describe the clinical and demographic characteristics of patients who are sensitized to palladium dichloride (PdCl₂ ).

METHODS

A single-centre, retrospective study of 15 years of patch testing with the Spanish baseline series supplemented with PdCl₂ 2% pet. was performed. We collected clinical and demographic data and data on co-sensitization among the metals studied, and we compared patients who were sensitized to palladium, with or without co-sensitization to nickel, with the rest of the study population.

RESULTS

Among the 3678 included patients, 730 (19.9%) were sensitized to nickel sulfate. The prevalence of sensitization to PdCl₂ (n = 316, 8.6%) was higher than the prevalence of sensitization to potassium dichromate (n = 240, 6.5%) and similar to the prevalence of sensitization to cobalt chloride (n = 353, 9.6%). Only 26 (8.2%) of the patients sensitized to palladium were not co-sensitized to nickel. The percentage of men and patients aged ≥40 years was higher in this subgroup than in the patients with nickel co-sensitization.

CONCLUSIONS

Given the high prevalence of hypersensitivity to PdCl₂ , this metal salt should be included in the Spanish baseline series, notwithstanding the frequency of co-sensitization to nickel.

Exploring the Incidence, Implications, and Relevance of Metal Allergy to Orthopaedic Surgeons

Introduction:

Allergic reactions to metal implants are increasingly recognized, but its relevance to the orthopaedic surgeon remains unclear. We evaluate the prevalence of metal allergies in a subset of the population and review the significance through a survey of the current literature.

Methods:

Preoperative and postoperative patients referred for metal allergy testing were divided into two groups; those with a history of dermatitis and those without. Patients with a history of dermatitis were offered skin patch testing that included the North American Contact Dermatitis core allergen panels in addition to our metal screening series. Patients without dermatitis were tested to the more limited patch testing metal screening series. Some patients with dermatitis opted for the more limited screening, whereas some patients without dermatitis underwent more extensive testing at their request or at the request of the referring clinician. Patch tests were evaluated at 2 and 4 days after placement.

Results:

Hundred patients were referred for metal allergy testing, 46 of whom were for reasons related to planned orthopaedic surgery. Of those tested, 60 patients had a history of dermatitis and 40 did not. Some patients were nonreactive to all tested allergens, whereas others demonstrated one or more positive skin patch test reactions. The number of positive reactions to each metal in patients with a history of dermatitis was the following: nickel 19, amalgam 10, palladium 10, copper 8, cobalt 5, mercury 5, tin 2, gold 1, titanium 1, and vanadium 1. The number of positive reactions to metals in patients without a history of dermatitis was the following: nickel 4, amalgam 5, palladium 4, mercury 4, cobalt 4, tin 2, copper 2, gold 1, vanadium 1, and molybdenum 1.

Discussion:

Metal allergy was common in the individuals referred for testing, with reactions to nickel and amalgam being the most commonly encountered. Some individuals experience more notable allergic reactions to implanted devices than others. Localized and generalized skin reactions have been reported, along with implant failure and loosening. Surgeons should be aware of the incidence of metal allergies and the potential consequences.

Use of a Polyetheretherketone Clasp Retainer for Removable Partial Denture: A Case Report

Clasp retainers made of metal alloys may be esthetically unappealing or cause allergic reactions. To investigate alternative materials, we used the nonfiller polyetheretherketone (PEEK) to fabricate the clasp retainer of a removable partial denture for the mandibular bilateral distal free-end abutment of an 84-year-old female. Two years later, few color and texture changes of PEEK were found macroscopically. The rest part and the clasp arm fitted well without any deformation. There were no particular occlusal or periodontal problems. Subjective satisfaction was expressed by both the practitioner and the patient.

Metal allergy patient treated by titanium implant denture: A case report with at least 4-year follow-up

Patch testing with metal reagents was positive on female patient with history of metal hypersensitivity after dental treatment. All of the dental restorations with metal components were removed, and subsequent oral rehabilitation utilizing dental implants and metal-free prostheses was carried out. The treatments alleviate the presenting signs and symptoms.

Biosynthesis of palladium nanoparticles using Diospyros kaki leaf extract and determination of antibacterial efficacy

Palladium, the building block of white gold, has been found to exhibit extraordinary properties in nanotechnological products produced in recent years. The most prominent feature of palladium is adsorbing and storing high levels of hydrogen. Therefore, the demand for palladium in the world increased excessively in the 2000s. In the present study, palladium nanoparticles (PdNPs) were biosynthesized by the extract of Diospyros kaki leaves as bio-stimulator. D. kaki, also called persimmon, was collected in a local area in Istanbul Turkey. PdNP formation was screened by analyzing UV-Vis spectrophotometer at 250-550 nm. The nanoparticles were characterized by scanning electron microscope which revealed that the biosynthesized PdNPs were in sizes ranging from 50 to 120 nm. Fourier transform infrared spectroscopy applied on both D. kaki leaf extract and PdNPs was used to decide on the reactive groups managing the reduction of the biosynthesized nanoparticles. Also, the PdNPs showed reasonably proficient antibacterial efficacy for both Escherichia coli and Staphylococcus aureus and the zones of inhibition were found as 18 and 10.5 mm, respectively.

Palladium Nanoparticles: Toxicological Effects and Potential Implications for Occupational Risk Assessment

The increasing technological applications of palladium nanoparticles (Pd-NPs) and their consequent enhancing release into the community and occupational environments, have raised public health concerns regarding possible adverse effects for exposed subjects, and particularly for workers chronically and highly exposed to these materials, whose toxico-kinetic and dynamic behavior remains to be fully understood. Therefore, this review aimed to critically analyze literature data to achieve a more comprehensive knowledge on the toxicological profile of Pd-NPs. Results from available studies demonstrated the potential for these chemicals to affect the ecosystem function, to exert cytotoxic and pro-inflammatory effects in vitro as well as to induce early alterations in different target organs in in vivo models. However, our revision pointed out the need for future studies aimed to clarify the role of the NP physico-chemical properties in determining their toxicological behavior, as well as the importance to carry out investigations focused on environmental and biological monitoring to verify and validate experimental biomarkers of exposure and early effect in real exposure contexts. Overall, this may be helpful to support the definition of suitable strategies for the assessment, communication and management of Pd-NP occupational risks to protect the health and safety of workers.

Delayed-type hypersensitivity to metals in connective tissue diseases and fibromyalgia

Rheumatic diseases include a group of autoimmune disorders with environmental and genetic etiology that are characterized as a subgroup of connective tissue diseases (CTD). Rheumatoid arthritis (RA) often involves the small joints of the hands in a symmetrical fashion that can lead to loss of joint function, and RA, as well as Sjögren's syndrome (SS) and other rheumatic diseases, are often accompanied by sensitivity to metals. Numerous investigations on metal sensitivity were evaluated in this review. A detailed metal exposure history was collected by different evaluation of studies. In all subjects, the main source of metal exposure was nickel, mercury, gold, palladium, titanium, and chromium. All of SLE (systemic lupus erythematosus), RA and SS patients appeared to have an increased frequency of metal delayed-type hypersensitivity (DTH) (Type IV allergy). As dental restorative materials release minor amounts of their metals (including mercury, gold, and nickel), many adults are commonly exposed to these metal ions by vapor or corrosion into saliva. Metal-related DTH in these patients will induce an inflammatory response. Such inflammations are important factors in CTD progress. It is hypothesized that metal-specific T cell reactivity can act as an etiological agent in the propagation and chronification of rheumatic inflammation. The key responses of metal delayed-type hypersensitivity in autoimmunity are precipitating as an appealing challenge for further investigations.