Saturday, April 2, 2011

Allergy testing for the Depuy Hip Implant patients?

I thought I would share this study with you as it was just published in March as a collaborative effort between a number of instituions including Harvard and the Clevland Clinic foundation on the possiblity of doing allergy testing for metal sensitivity if a patient is having a problem with the metal implant.  Its interesting because my toxicoligist recommended considering the possiblity of this testing....something I had not considered before.  While this study suggests refraining from "patch testing" unless issues have occured from a prior surgery, the concept is interesting. I will publish another  set of tests which you can look into with your physcian if your doctor wants to consider this option. (apparently, patch testing is not test that most orthopedic professionals buy into but there are other options for testing metal allergies.)
Br J Dermatol. 2011 Mar;164(3):473-8. doi: 10.1111/j.1365-2133.2010.10144.x. Epub 2011 Jan 28.

Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery.

Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark Department of Dermatology, Harvard Medical School, Boston, MA, U.S.A. Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH, U.S.A. Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, U.S.A.


Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery, and as surgeons may refer patients with complications following total joint arthroplasty for diagnostic work-up, there is a continuous need for updated guidelines. This review presents published evidence for patch testing prior to surgery and proposes tentative diagnostic criteria which clinicians can rely on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk of complications caused by a delayed-type hypersensitivity reaction. At present, we do not know how to identify the subgroups of metal contact allergic patients with a potentially increased risk of complications following insertion of a metal implant. We recommend that clinicians should refrain from routine patch testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having an allergic reaction to a metal implant should include patch testing and possibly in vitro testing. We propose diagnostic criteria for allergic dermatitis reactions as well as noneczematous complications caused by metal implants.
© 2011 The Authors. BJD © 2011 British Association of Dermatologists.

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