If someone is allergic to certain metal jewellery, what are the chances of having a deep tissue allergy? What is the most accurate way of testing someone for a deep tissue allergy?

It is estimated that approximately 10% of the population shows skin (cutaneous) allergy to metal products like costume jewellery. In terms of deep tissue allergy the leading authorities agree that, ‘clinically important metal hypersensitivity in patients with metal-on-metal bearings appears to be low’. In our series only 0.3% of patients required a revision for presumed metal debris reaction. It is not clear if these cases represent a true allergic response or an expected response to excess debris. There is no proven way of testing for deep tissue allergy. Cutaneous testing works through a different mechanism to deep tissue allergy, and therefore is not of much benefit. Lymphocyte transformation testing is described as one of the ways of testing potential deep tissue allergy but is not proven.

"Allergy after artificial joints is an interesting issue. One must keep in mind that the co-cr-mo alloy has been in clinical use for 45 yrs and is present in 99% of all hip and knee replacement surgery. Even if a component is titanium the articulating part would be always co-cr-mo. Therefore metal sensitivity is not exclusive to metal on metal joints. It is a factor in every joint replacement surgery and therefore has been used in millions of patients. Skin allergy is quite different from deep tissue allergy which is mediated by different mechanisms of immune response by the body. Thus skin testing is of no value when trying to gauge deep tissue hypersensitivity. There have been reports of hundreds of patients who had skin sensitivity but went on to have very successful resurfacing. Only one thing can be said about deep tissue sensitivity at this point in time --- it is very very rare.

with best regards

vijay bose chennai
 

Dr. De Smet writes that although very rare, a reaction can occur after a BHR hip replacement. The following is a story about a problem that Dr. De Smet thinks is associated with a metal sensitivity in a BHR.

November 08, 2007
Metal allergy - an OS writes


While metal allergies are indeed rare, they can be (or have the effect of being) all too real.....

My wife is 31 yrs old and had her right hip resurfaced 2 years ago by Dr. De Smet (she originally broke her hip around 10 years, developed AVN, had an osteotomy 7 years ago, developed arthritis, which ultimately led us to Ghent - can't say enough about the experience there).

Around a month ago she started experiencing terrible hip pain. X-rays (and a CT Scan) show that the bone just below the bottom end of the femoral cap is essentially dissolving (osteolysis).

Blood tests were performed and, while it is not an exact science, there does appear to be sensitivity to both chromium and nickel - chromium being one of the main by-products of the resurfacing components.

While there certainly could be other factors at play (e.g. improper load bearing due to prior surgeries/injuries or decay of the cement used in the femoral cap [which, according to one prominent surgeon I spoke to, can happen, particularly in cases where the femoral head has already been significantly damaged]), I don't believe it. Both of those factors can, I believe, be worked through with exceptional surgical technique - and I have the utmost confidence in De Smet.

According to De Smet, around 1 out of every 500 patients has this type of reaction to the metal. To quote De Smet, "That indeed is a possibility. Metal sensitivity is a risk of 1/500 in my series. A lot of people do not believe it and say it is non existing or very rare. If [metal] is the problem......she has really bad luck".
We are now looking at a THR (which will most likely happen in the next week or so) and, while there is no way to know for certain whether a "metal allergy" is causing the problem, at this point, we certainly can't risk having a MoM THR - ceramic is the only option.

Joel Feldman (Meg: De Smet - Sept 05)