From the *Department of Dermatology, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA; and †National Allergy Research Centre, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Dermatitis. 2013 Nov-Dec;24(6):313-20. doi: 10.1097/DER.0b013e3182a67d90.
Cutaneous metal hypersensitivity reactions (MHR) are common but rare with implanted devices.
This study aimed to characterize the opinions of dermatologists who are actively evaluating/advising patients with MHR.
A questionnaire was distributed to all individuals who attended the European Society of Contact Dermatitis (ESCD) 2012 and the American Contact Dermatitis Society 2013 meetings.
A total of 119 individuals responded with a participation rates of 10% (ESCD) and 32% (American Contact Dermatitis Society). Ninety-six percent of the respondents evaluate MHR and 91% were attending physicians. Orthopedic and dental devices were common problems compared with cardiovascular devices. Patch testing is the top choice for evaluating MHR. Lymphocyte transformation and intradermal tests are rarely used. Eighty-two percent of the respondents evaluate plastic/glue components in symptomatic patients postimplant. Most dermatologists use a tray specifically for joint allergy or a history-based custom array of allergens. Those patients with a strong clinical history of metal allergy should be evaluated before metal implantation (54%), whereas others forgo evaluation and recommend a titanium implant based on history alone (38%). Diagnostic criteria for postimplant reactions were evaluated. Eight percent of the respondents felt that no evaluation was necessary, with ESCD respondents being significantly more likely to not recommend evaluation (P = 0.001).
Metal hypersensitivity reactions consultation requests are common for preimplant and postimplant issues. Patch testing is currently the best test for MHR.
皮肤金属过敏反应（MHR）在植入装置中很常见，但很少见。
本研究旨在描述积极评估/建议 MHR 患者的皮肤科医生的意见。
向参加 2012 年欧洲接触性皮炎学会（ESCD）和 2013 年美国接触性皮炎学会会议的所有人员分发问卷。
共有 119 人回复，参与率为 10%（ESCD）和 32%（美国接触性皮炎学会）。96%的受访者评估 MHR，91%为主治医生。与心血管装置相比，骨科和牙科装置是常见的问题。斑贴试验是评估 MHR 的首选方法。淋巴细胞转化和皮内试验很少使用。82%的受访者评估有症状患者植入后塑料/胶水成分。大多数皮肤科医生使用专门用于关节过敏的托盘或基于病史的定制过敏原阵列。对于有强烈金属过敏病史的患者，应在植入金属前进行评估（54%），而其他患者则仅根据病史放弃评估并建议植入钛金属（38%）。评估了植入后反应的诊断标准。8%的受访者认为无需进行评估，ESCD 受访者更有可能不建议进行评估（P = 0.001）。
金属过敏反应咨询请求在植入前和植入后都很常见。斑贴试验是目前评估 MHR 的最佳方法。
