First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
First Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, Andreas Suggros Hospital, Athens, Greece.
Clin Rev Allergy Immunol. 2022 Jun;62(3):476-483. doi: 10.1007/s12016-021-08867-0. Epub 2021 Jun 15.
Nickel is one of the most common contact allergens worldwide; it is used as the main component of the devices used for atrial septal defects (ASDs) and patent foramen ovale (PFO) closure. Developing nickel hypersensitivity after PFO/ASD occlusion is significantly rarer described in medical literature than typical nickel contact sensitization. The exact pathophysiological mechanism of this "device syndrome" remains unknown, and many question the real incidence or even the existence of this clinical entity. Nevertheless, it has been associated with a wide spectrum of symptoms, including chest pain, migraines, palpitation, and dyspnea. Skin patch tests are the first-line approach to diagnose nickel hypersensitivity. However, diagnostic criteria for the device syndrome have not been developed, and diagnosis in reported cases is established by a process of elimination. Management-drug therapy (corticosteroids, clopidogrel, etc.) or even surgical explantation in severe cases-of patients developing such clinical manifestations after percutaneous PFO/ASD occlusion is empirical. Undoubtedly, endocardiac device-related nickel hypersensitivity requires more focused research to discover the underlying mechanism as well as to develop reliable prognostic tests for detecting high-risk patients and preventing severe nickel hypersensitivity reactions.
镍是世界上最常见的接触过敏原之一；它被用作房间隔缺损 (ASD) 和卵圆孔未闭 (PFO) 封堵装置的主要成分。在 PFO/ASD 封堵后发生镍过敏的情况在医学文献中描述得明显比典型的镍接触过敏少见。这种“器械综合征”的确切病理生理机制尚不清楚，许多人对其实际发生率甚至这种临床实体的存在提出质疑。然而，它与广泛的症状相关，包括胸痛、偏头痛、心悸和呼吸困难。皮肤斑贴试验是诊断镍过敏的首选方法。然而，尚未制定器械综合征的诊断标准，在已报道的病例中，通过排除法来确立诊断。对于出现此类临床表现的患者，管理方法为药物治疗（皮质类固醇、氯吡格雷等），甚至在严重情况下进行手术取出-经皮 PFO/ASD 封堵后的经验性治疗。毫无疑问，与心内器械相关的镍过敏需要更集中的研究来发现潜在的机制，并开发可靠的预后检测方法，以发现高危患者并预防严重的镍过敏反应。
