Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants

Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock


Dermatitis. 2011;22(2):65-79. 

In This Article

DTH Reactions

In nonsensitized subjects, de novo metal sensitization may result from a hypersensitivity response to metal ions after either corrosion or mechanical wear of an implant.[9,16] When metals come into contact with biologic fluids, they undergo corrosion to release ionic compounds, which may then bind to endogenous proteins to form metal-protein complexes. Other activation mechanisms have been described in regard to nickel (eg, nickel may directly activate the T-cell receptor in a way that is reminiscent of superantigens).[17] It has been shown that metal ions are liberated from cobalt-chromium-molybdenum alloys that are not subjected to mechanical wear and that these metal ions accumulate in rat liver and kidney tissue.[18] Independent of the mechanism that results in metal ion release and exposure, metal ion exposure may result in activation of macrophages and a DTH response.


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