Thomas Peter, Geier Johannes, Dickel Heinrich, Diepgen Thomas, Hillen Uwe, Kreft Burkhard, Schnuch Axel, Szliska Christiane, Mahler Vera
Department of Dermatology and Allergology of the Ludwig-Maximilians, University Munich, Germany.
Information Network of Departments of Dermatology (IVDK), Institute at the University of Göttingen, Germany.
J Dtsch Dermatol Ges. 2015 Oct;13(10):1001-4. doi: 10.1111/ddg.12773.
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.
对金属植入物的不耐受反应可能由金属过敏引起。然而，在植入前，不应进行“预测性”/预防性斑贴试验。植入前斑贴试验仅应用于有相应病史的患者以验证或排除金属过敏。在出现与植入物相关的并发症时，尤其是在关节置换术后，如疼痛、积液、皮肤病变、活动范围减小或植入物松动，应首先排除骨科原因。然后应使用包括镍、钴和铬制剂的DKG标准系列对疑似金属植入物过敏进行检查。各种评估金属合金盘用于斑贴试验有效性的研究表明，这种特殊方法在提供有关金属过敏的可靠信息方面无效。此类试验中的任何阳性反应都不能归因于合金中所含的特定金属。此外，存在广泛且不加区分地使用这些容易获得的盘的风险。因此，鉴于与使用标准化金属盐制剂进行斑贴试验相比缺乏额外益处，我们不建议使用金属合金盘进行斑贴试验。
