DKG statement on the use of metal alloy discs for patch testing in suspected intolerance to metal implants.

Abstract

Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, 'prophetic'/prophylactic patch testing should not be performed. Pre-implant patch testing should only be done to verify or exclude metal allergy in patients with a corresponding history. In case of implant-related complications - in particular following replacement arthroplasty - such as pain, effusion, skin lesions, reduced range of motion or implant loosening, orthopedic causes should be ruled out first. Workup of suspected metal implant allergy should then be done using the DKG standard series, which includes nickel, cobalt, and chromium preparations. Various studies assessing the usefulness of metal alloy discs for patch testing have shown this particular approach to be ineffective with respect to providing reliable information on metal allergy. Any positive reaction in such tests cannot be assigned to a specific metal contained within the alloy. Furthermore, there is a risk of broad and indiscriminate use of these readily available discs. Accordingly, given the lack of additional benefit compared to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.

• Authors: Peter Thomas, Johannes Geier, Heinrich Dickel, Thomas Diepgen, Uwe Hillen, Burkhard Kreft, Axel Schnuch, Christiane Szliska, Vera Mahler
• Journal: Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (J Dtsch Dermatol Ges) Vol. 13 Issue 10 Pg. 1001-4 (Oct 2015) ISSN: 1610-0387 [Electronic] Germany
• PMID: 26408461 (Publication Type: Journal Article, Review)
• Copyright: © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Chemical References

• Alloys
• Metals

Topics

• Alloys
• Dermatitis, Allergic Contact (diagnosis, etiology)
• Dermatology (standards)
• Evidence-Based Medicine
• Germany
• Humans
• Metals (adverse effects)
• Patch Tests (standards)
• Practice Guidelines as Topic
• Prostheses and Implants (adverse effects)