Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA.
J Toxicol Environ Health B Crit Rev. 2022 Aug 18;25(6):279-341. doi: 10.1080/10937404.2022.2104981. Epub 2022 Aug 16.
Allergic disease represents one of the most prominent global public health crises of the 21 century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described. ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
过敏疾病是 21 世纪全球最突出的公共卫生危机之一。尽管已知许多不同的物质会引起过敏反应，但金属是导致过敏相关疾病总负担中相当大一部分的主要过敏原类别之一。一些最常见的金属过敏形式，包括过敏性接触性皮炎，是众所周知的；然而，据我们所知，目前的科学文献中没有关于金属过敏患者所涉及的许多独特疾病变异的综合综述。因此，撰写本综述的主要目标是：(1) 生成一份包含这些信息的最新参考文件，以协助实验室研究人员、临床医生、监管毒理学家、工业卫生学家和其他关注金属过敏的科学家的工作；(2) 确定与疾病相关的知识空白。因此，对科学文献进行了广泛的回顾，从中确定了数百篇描述人类患者金属特异性过敏反应的论文，并对其进行了收集和分析。然后，利用从这些文章中获得的信息，编制了一份详尽的与金属过敏相关的独特皮肤/眼部、呼吸、胃肠道和全身过敏反应清单。本文简要讨论了这些疾病变异中的每一种，其中确定了与每种反应类型相关的特定金属，总结了潜在的免疫学机制，并描述了每种反应的主要临床表现。ACD：过敏性接触性皮炎，AHR：气道高反应性，ASIA：佐剂诱导的自身免疫/炎症综合征，BAL：支气管肺泡灌洗，CBD：慢性铍病，CTCL：皮肤 T 细胞淋巴瘤，CTL：细胞毒性 T 淋巴细胞，DRESS：药物反应伴嗜酸性粒细胞增多和全身症状，GERD：胃食管反流病，GI：胃肠道，GIP：间质性肺炎，GM-CSF：粒细胞巨噬细胞集落刺激因子，HMLD：硬金属肺病，HMW：高分子量，IBS：肠易激综合征，Ig：免疫球蛋白，IL：白细胞介素，LMW：低分子量，PAP：肺泡蛋白沉积症，PPE：个人防护设备，PRR：病原体识别受体，SLE：系统性红斑狼疮，SNAS：全身性镍过敏综合征，Th：辅助性 T 细胞，UC：溃疡性结肠炎，UV：紫外线。
