Metal allergy is a late-type allergic reaction in which the immune system gives up chemical substances such as metals. In the 20th century, industrialization and modern life led to an excessive skin sensitivity to metals, and thus to an increase in metal allergy. There is a general focus on nickel, cobalt and chromium because these metals are the most common. In the surrounding area, metals such as nickel, cobalt and chromium are existing everywhere.
In the first half of the 20th century, nickel allergies and contact dermatitis began to be more common among people working in metal and coating industries. Nickel allergy, which is most frequently encountered is mostly explained by exposure to nickel-containing consumer products.
It is estimated that metal allergy is high in the general population, 17% of women and 3% of men are estimated to have nickel allergies. Cobalt and chromium allergy can also be seen in 1-3%. New metals such as titanium have also been shown to be in close proximity to allergies. This rate is higher in patients with dermatitis complaints.
WHAT IS THE MOST COMMON METAL ALLERGENTS?
Metal materials and chemical substances, which are increasing day by day in modern life alongside with industrialization, lead to the development of new allergic reactions.
Nickel, cobalt and chromium are the most prevalent metals because they are the most widely used metals.
Allergic complaints about titanium, which have started to be used more recently in recent years, have started to be published. Titanium allergies are likely to increase with the use of titanium, especially in implants.
Titanium
Titanium allergy is often unknown, but about 4% of all patients reported being allergic. Symptoms can be very different and variable in people with titanium allergy. These can range from simple skin rashes to contact dermatitis or muscle pain and chronic fatigue.
Titanium (Ti) exposure in implants and titanium as a nanoparticle (NP) from personal care products are the most common causes of titanium allergy.
Titanium dioxide (TiO2) is widely used in consumer products because it is non-toxic, although it triggers allergies in some people. It is known as “pearl agent” for making paper and paint bright and white. Titanium dioxide can be in the form of foodstuffs, pills and cosmetics, especially titanium-containing products
Orthopedic and surgical implants.
Dentistry: In dental implants and as colored pigment in composites.
Sunscreen: fine titanium dioxide, prevents sunlight from harmful ultraviolet rays.
Candy: Makes candy look brighter and can be found, for example, on chewing gums.
Cosmetics: makeup is used to illuminate and intensify the color. Eye is regularly found in flax, blush, nail polish, lotions, lipstick and dust.
Toothpaste: Used as a pigment to make Toothpaste whiter.
Paint: TiO 2 improves the durability of coatings and gives white color.
Plastic carrier bags: increase durability and give a white color.
Medical pills and vitamin supplements can also take white coating from titanium dioxide.
Piercing and Jewelery: watches and body piercing can be found in any product.
It is seen that the exposure of many people to Titanium is predominantly from dental and medical implants, personal care products and food. Titanium, especially in dental implants, is likely to be released in biological fluids and tissues under certain conditions, although it is not thought that Ti is highly biocompatible compared to other metals.
In most of the studies, titanium does not penetrate the skin barrier in the form of nanoparticles such as pure Ti, alloy or Ti oxide. However, the indication of the Ti penetration in the oral mucosa was seen.
The patch test with existing Ti preparations for the detection of type IV hypersensitivity is already insufficient for Ti. Although several other methods have been proposed for detection of contact allergy including lymphocyte stimulation tests, they have not yet been generally accepted and the diagnosis of Ti allergy is based primarily on clinical evaluation.
The diagnosis of Ti allergy is based primarily on clinical evaluation. Reports on clinical allergies and adverse events are rarely published. This is due to the fact that the possible reactions to this metal are not recognized, and the difficulties in the detection methods or the fact that the metal is actually considered relatively safe.
WHICH DISEASES METALIC ALLERGY CAN CAUSE?
Metal allergies can be seen as contact dermatitis and allergic contact, as well as common systemic allergic contact dermatitis. The most important problem in metal allergies is the rejection of implants and stents used in orthopedic, dental or cardiovascular diseases leading to implant failure.
1.Metal allergy induced allergic contact dermatitis.
The mechanism required for the development of allergic contact dermatitis consists of two different phases.The first phase is the induction phase and the other phase is the emergence phase. The induction phase usually develops from a few days to several weeks and involves events that occur in the immune system following first skin contact with metal. In this phase, antigen-specific T cells develop and the individual becomes susceptible.
Activation of antigen-specific T cells results in dermatitis in the skin area where the allergen contacts.
At the clinical level, the induction phase is called contact sensitivity or contact allergy, while the following phase is called allergic contact dermatitis. Contact allergy is a chronic, lifelong condition.
Allergic contact dermatitis can occur anywhere in the entire body. Nickel and cobalated dermatitis is typically found in the face (ear lobes), the body (in jewelry and piercing areas) and the hands, while chromium dermatitis is present in hands and feet. The clinical picture varies depending on the permanent theme.
While characterized by acute dermatitis, erythema, edema, papules, vesicles and swollen wounds, chronic dermatitis scaly, rash and dry and fissures are characterized by deep clefts.
Studies have shown that the prognosis of dermatitis is particularly low in chromium allergic patients, whereas the prognosis of nickel dermatitis is better in patients with limited or restricted nickel exposure.
Systemic allergic dermatitis due to metal allergy
Systemic allergic dermatitis is defined as a skin rash that occurs after systemic exposure to allergens that cause allergies, that is, by oral or intravenous exposure.
Taking into account the possible mechanisms of systemic allergic dermatitis, for example, in a study of systemic nickel allergy, it has been shown that there is a relationship between nickel intake and dermatitis exacerbation. A dose relationship has been shown between the amount of nickel and systemic allergic dermatitis. Diets containing low nickel or drugs that bind nickel can cause dermatitis to heal or heal in patients with nickel allergy.
Systemic exposure to chromium, cobalt, and gold can cause systemic allergic dermatitis.
Allergic dermatitis and diseases caused by implants attached to metal allergy
With regard to today’s heavily used metal implants, very little is known about the relationship between metal oscillation, metal allergy, and device failure that occurs in metal devices.
When implants used in the body are in contact with body fluids, most of these metals are corroded and the released metal ions can bind to the surrounding proteins and activate T cells, resulting in late type allergic reactions on the immune system.
These late-onset allergic reactions can sometimes manifest themselves in the form of a deep allergic contact dermatitis above the implants, or can lead to the failure of the implanted implant.
The majority of intracoronary stents used in heart diseases are made of stainless steel containing nickel, chromium and molybdenum. In some studies, coronary stent restenosis has been shown to be associated with nickel allergy, and it has been shown that nickel allergy, especially in recurrent restenosis, may be a factor leading to vascular occlusion.
Gold allergy has also been associated with restenosis in patients with gold-plated stents, and gold use has therefore been largely abandoned.
Prosthetics used by orthopedists are typically performed using cobalt-chromium-molybdenum-containing materials. Studies showing that there is a possible relationship between metal allergy, which has increased rapidly in recent years, and implant failure are leading to increased concerns. In studies on metal allergy in patients with hip arthroplasty, the prevalence of metal allergy is around 60% among patients with failed or poorly performing implants.
Allergic reactions were mainly observed against cobalt, chromium, nickel and molybdenum. Apart from complications such as impaired dysfunction due to an allergic reaction, it has sometimes been shown to cause serious clinical reactions, such as aseptic lymphocytic vasculitic lesions or pseudotumors, at a low number. In such cases, the implants can be replaced with titanium-based endoprostheses. However, hypersensitivity reactions have been described after the placement of titanium implants, but titanium allergy is extremely rare.
In general, the allergic risk of titanium is lower than that of other metal materials. However, it is advisable to test for pre-implant disease, hypersensitivity reactions to metals, and to perform a disease patch test that has experienced these reactions.
HOW TO DO THE DIAGNOSIS METAL ALERGY’S?
Is it possible to clinically determine metal sensitivity responses?
Approved methods for the diagnosis of metal allergy are in vitro blood tests involving skin test (patch test) and lymphocyte transformation test (LTT).
Since commercial kits used for patch testing exist for a variety of common metals, there are questions about the applicability of skin testing for diagnosis, as they present problems with the generation of immune responses of orthopedic implants.
One of the most important tests for metal allergy is canine-looking lymphocyte transformation test. This test is based on measuring the change in lymphocytes after the chemical substances that the patient is sensitive to have contacted the immune system cells in the blood. Kanda can be used to verify patch tests in these tests.
Other tests that can be performed include lymphocyte migration inhibition test and lymphocyte immunostimulation assay (MELISA®), a newly developed form of LTT. Flow cytometric measurements can be used for all of these. But despite all this, there is not a single test to diagnose allergic contact dermatitis.
It is appropriate to have these tests done by allergy specialists and, if necessary, confirm with blood tests in case of doubt.
HOW TO TREAT METAL ALLERGY ?
Metal allergies appear to be confronted with many different clinics. It is important to investigate metal allergies especially in patients with dermatitis complaints. Since metal allergies can lead to failure of the prosthesis and implants in particular, it is appropriate to identify patients with complaints before such procedures. Prosthesis and implants should be selected from non-allergic agents.
Since allergens and reactions leading to Metal Allergies can be very different from person to person, the treatment of metal hypersensitivity must be done individually according to the allergies contacted by the patient.
The main treatment in metal allergies can be solved by not using the substance that causes skin hypersensitivity. In the metal allergy reaction, dermatitis may also suggest corticosteroid creams and ointments to reduce local inflammation in the anterior plenteous. They may also prescribe oral antihistamines to reduce the allergic reaction.
Oral corticosteroids may also be used if there are more reactions in metal allergies, but they can cause side effects for extended periods of time.
Systemic reactions may be more difficult to treat. Because it is usually caused by implants. Removal of the implant may require the use of an implant, sometimes non-metallic. However, allergic artificial knee or hip prosthesis is rarely changed to a non-metal option, although the difficulty of changing if caused by prosthesis is present. For these cases, treatment is usually topical and oral medicines to reduce the allergic reaction. In patients with systemic complaints it is absolutely necessary to remove them if the reactions can not be stopped.
If there is systemic nickel allergy due to nickel, desensitization treatments with nickel are performed. Despite successful results with this treatment, a complete procedure has not been established.
Because of the difficulty of treating systemic metal allergies, doctors sometimes recommend performing a hypersensitivity test before choosing an implant. The selection of the implant or prosthesis to be selected after the tests is extremely beneficial for the patient.
AS A RESULT
Metal allergy is a late-type allergic reaction in which the immune system gives up chemical substances such as metals. In the 20th century, industrialization and modern life led to an excessive skin sensitivity to metals, and thus to an increase in metal allergy.
Nickel allergy, which is most frequently encountered when metal allergy is mentioned today, is mostly explained by exposure to nickel-containing consumer products.
It is estimated that metal allergy is high in the general population, and 17% of women are estimated to have nickel allergies in 3% of men.
Titanium allergy is generally unknown, although about 4% of all patients reported being allergic.
In general, the allergic risk of titanium is lower than that of other metal materials. However, it is advisable to test for pre-implant disease, hypersensitivity reactions to metals, and to perform a disease patch test that has experienced these reactions.
Metal allergies can be seen as contact dermatitis where the allergen comes in contact, as well as common systemic allergic contact dermatitis. The most important problem in metal allergies is the rejection of implants and stents used in orthopedic, dental or cardiovascular diseases leading to implant failure.
Approved methods for the diagnosis of metal allergy are in vitro blood tests involving skin test (patch test) and lymphocyte transformation test (LTT).
Once metal has been found causing metal allergies, it is necessary that the patient be removed from the metal causing the allergic reaction. It is therefore useful for the patient to select the most appropriate prosthesis or implant after allergy specialists have seen the prosthesis and implant in patients with metal allergies and after the tests have been performed and allergy has been detected.
