Advertisement

High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing

      Abstract

      Purpose

      A previous study from our group estimated that as few as 2.2% of pectus excavatum patients suffered from allergy to the implanted metal bar. We sought to assess recent changes in incidence of metal allergy and identify the benefit of metal allergy testing prior to surgery.

      Methods

      A retrospective review was performed of all consenting patients undergoing pectus repair during the six years between 9/2004 and 12/2010 at our institution. Incidence was based on clinical symptoms and/or T.R.U.E.® patch testing. Demographic data, history of atopy and history of metal allergy were collected. Type and number of bars used, suture site infection, skin rash and wound infection rates were reviewed.

      Results

      Forty one of 639 patients (6.4%) had clinical or patch test evidence of metal allergy. Family history of metal allergy and pre-operative history of metal sensitivity were found to be statistically significant correlates.

      Conclusions

      The rate of metal allergy in the pectus excavatum population may be higher than previously reported. Patient or family history of metal allergy or metal sensitization may indicate increased risk. Metal allergy testing should be performed before Nuss procedure.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nuss D.
        • Kelly R.E.
        • Croitoru D.P.
        • et al.
        A 10-year review of a minimally invasive technique for the correction of pectus excavatum.
        J Pediatr Surg. 1998; 33: 545-552
        • Rushing G.D.
        • Goretsky M.J.
        • Gustin T.
        • et al.
        When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum.
        J Pediatr Surg. 2007; 42: 93-97
        • So S.
        • Harris I. a
        • Naylor J.M.
        • et al.
        Correlation between metal allergy and treatment outcomes after ankle fracture fixation.
        J Orthop Surg (Hong Kong). 2011; 19: 309-313
        • Garner L.A.
        Contact dermatitis to metals.
        Dermatol Ther. 2004; 17: 321-327
        • Schram S.E.
        • Warshaw E.M.
        • Laumann A.
        Nickel hypersensitivity: a clinical review and call to action.
        Int J Dermatol. 2010; 49: 115-125
        • Spiewak R.
        • Pietowska J.
        • Curzytek K.
        Nickel: a unique allergen — from molecular structure to European legislation.
        Expert Rev Clin Immunol. 2007; 3: 851-859
        • Schmidt M.
        • Goebeler M.
        Nickel allergies: paying the toll for innate immunity.
        J Mol Med (Berlin, Germany). 2011; 89: 961-970
        • Aneja S.
        • Taylor J.S.
        • Soldes O.
        • et al.
        Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum.
        Contact Dermatitis. 2011; 65: 317-321
        • Rosato E.
        • Giovannetti A.
        • Rossi C.
        • Menghi G.
        • Pisarri S.
        • Salsano F.
        Recurrent infections in patients with nickel allergic hypersensitivity.
        J Biol Regul Homeost Agents. 2009; 23: 173-180
        • Schalock P.C.
        • Menné T.
        • Johansen J.D.
        • et al.
        Hypersensitivity reactions to metallic implants — diagnostic algorithm and suggested patch test series for clinical use.
        Contact Dermatitis. 2012; 66: 4-19
        • White J.M.L.
        Patch testing: what allergists should know.
        Clin Exp Allergy. 2012; 42: 180-185
        • Krob H.A.
        • Fleischer A.B.
        • D'Agostino R.
        • et al.
        Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of published T.R.U.E. test data.
        J Am Acad Dermatol. 2004; 51: 349-353
        • Redlinger R.E.
        • Kelly R.E.
        • Nuss D.
        • et al.
        One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique—effective in most regardless of initial operative approach.
        J Pediatr Surg. 2011; 46: 1177-1181
        • Siddiqi A.
        • Payne A.G.T.
        • De Silva R.K.
        • et al.
        Titanium allergy: could it affect dental implant integration?.
        Clin Oral Implants Res. 2011; 22: 673-680