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Clinical And Experimental Studies of Contact Allergy to Stent Metals - with focus on gold

Ekqvist, Susanne LU (2008) In Lund University, Faculty of Medicine Doctoral Dissertation 2008:93.
Abstract (Swedish)
Popular Abstract in Swedish

I det här arbetet studerades kontaktallergi för metaller som finns i olika stentar. Patienterna som ingick i studien hade blivit stentade med olika typer av stentar. En av stentarna var gjord av rostfritt stål (nickelstent) och den andra var förgylld (guldstent). Resultaten av lapptestningen visade att patienterna hade en hög frekvens av både guld- och nickelallergi, och att man inte kunde utesluta att metallerna i stentarna hade bidragit till att patienterna fått sin kontaktallergi.



De stentade patienterna jämfördes också med en kontrollgrupp bestående av patienter som sökt för misstänkt kontaktallergi vid vår klinik. I den jämförelsen undersöktes inte bara kontaktallergier... (More)
Popular Abstract in Swedish

I det här arbetet studerades kontaktallergi för metaller som finns i olika stentar. Patienterna som ingick i studien hade blivit stentade med olika typer av stentar. En av stentarna var gjord av rostfritt stål (nickelstent) och den andra var förgylld (guldstent). Resultaten av lapptestningen visade att patienterna hade en hög frekvens av både guld- och nickelallergi, och att man inte kunde utesluta att metallerna i stentarna hade bidragit till att patienterna fått sin kontaktallergi.



De stentade patienterna jämfördes också med en kontrollgrupp bestående av patienter som sökt för misstänkt kontaktallergi vid vår klinik. I den jämförelsen undersöktes inte bara kontaktallergier för metaller utan även andra kända kontaktallergen. Resultatet visade att kontaktallergi för ett ämne som används i parfym och smaksättning (Myroxylon pereirae) samt lokalbedövningsmedel (kain mix) var betydligt vanligare hos de stentade patienterna jämfört med kontrollgruppen. Myroxylone pereirae används bland annat i en tandcement och de stentade patienterna hade mycket guld i munnen. Förekomsten av dentalguld kan betyda att patienterna fått gjort större dentalarbeten och på så sätt fått sin kontaktallergi för Myroxylone pereirae via tandcementen. En förklaring till kontaktallergin för kain mix kan vara att de stentade patienterna fått lokalbedövningsmedel i samband med sin stentning.

Det har framkommit i andra studier att patienter som behandlats med en guldstent har drabbats av fler restenoser än patienter som behandlats med andra stentar. Kontaktallergi har diskuterats kunna vara en bidragande orsak. Vi undersökte därför också restenosfrekvensen hos de stentade patienterna och fann att patienter med en guldstent hade fler restenoser jämfört med patienter med en nickelstent. Vi fann också ett samband mellan guldstent, kontaktallergi för guld och ett ökat antal restenoser. Vi kunde inte se något motsvarande samband mellan nickelstent, kontaktallergi för nickel och restenos. Guldstentar används inte mer idag p.g.a. rapporterna om en ökad restenosrisk men dagens stentar innehåller andra kända metaller som eventuellt kan ge en kontaktallergisk reaktion.

Det här arbetet understryker vikten av en noggrann utvärdering av nya produkter, rutiner och material med hänsyn till riskerna för att ge en kontaktallergisk reaktion samt möjligheten för att orsaka en ny kontaktallergi.

Vi undersökte också patienternas guld- och nickelhalt i blodet. Resultatet visade att patienter med en guldstent hade en högre guldhalt i blodet jämfört med patienterna med en nickelstent. Vi såg också att ju högre guldhalt i blodet patienterna hade, desto starkare kontaktallergi uppvisade de. För att undersöka det vidare gjorde vi en experimentell studie som också visade på ett liknande samband. Resultaten indikerar att ett kontaktallergens koncentration i blodet, i alla fall för guld, har betydelse för hudens reaktion i kontakt med guld. Om resultaten blir bekräftade med fler studier och med andra kontaktallergen kan det innebära en förändring i behandling och förebyggande arbete mot allergiskt kontakt eksem då även ett allergens koncentration i blodet måste tas i beaktande. (Less)
Abstract
A large number of patients are treated with coronary stents, and restenosis (recurrent narrowing of the vessel) is a serious problem. Contact allergy to metal ions eluted from stainless steel stents has been suggested to contribute to in-stent restenosis. Studies have reported a higher rate of restenosis with gold-plated stents, but the correlation to contact allergy was not evaluated. Nickel is the most common contact allergen known, with a median prevalence of 8.5% in North America and Western Europe. Contact allergy to gold has been demonstrated by patch testing with various gold salts and with the metal itself. The patients included in the study had received one type of stent manufactured from stainless steel but differing in that one... (More)
A large number of patients are treated with coronary stents, and restenosis (recurrent narrowing of the vessel) is a serious problem. Contact allergy to metal ions eluted from stainless steel stents has been suggested to contribute to in-stent restenosis. Studies have reported a higher rate of restenosis with gold-plated stents, but the correlation to contact allergy was not evaluated. Nickel is the most common contact allergen known, with a median prevalence of 8.5% in North America and Western Europe. Contact allergy to gold has been demonstrated by patch testing with various gold salts and with the metal itself. The patients included in the study had received one type of stent manufactured from stainless steel but differing in that one was electroplated with gold.

The result of this work show that contact allergy to gold is more common in a stented population than in a control population. Dental gold, ear piercing and age were all found to be independent risk factors for contact allergy to gold. However, the possibility of sensitization due to the gold-plated stent remains. Statistical analysis suggests the induction of contact allergy to gold due to the gold-plated stent implanted in the coronary vessel. Allergy to Myroxylon pereirae (a wood extract used in dental cement, as fragrance in cosmetics, creams, ointments and as flavouring) and caine mix (three anaesthetics for topical use), was also more common in the stented population than in controls, indicating the importance of the oral mucosa for sensitization. A correlation was found between gold-plated stents, contact allergy to gold and an increased frequency of restenosis. The gold concentration in blood (B-Au) was 5 times higher in gold-stented patients than in Ni-stented patients. The patch test reactions for gold were also correlated to B-Au: the higher the B-Au, the stronger the patch test reaction and the lower the concentration eliciting a positive patch test.



In conclusion, the results indicate that implantation of a gold-plated stent in the coronary vessel induces gold allergy, and that contact allergy could be a risk factor in the restenosis process. The findings underline the importance of careful evaluation of new products, routines and materials with regard to the risk of sensitization and/or elicit an allergic reaction to a contact allergen. The gold concentration in blood was shown to correlate with the result of patch tests, which indicates that systemic exposure to an allergen, at least in the case of gold, causes skin reactivity to gold following topical exposure. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Docent Berg, Mats, Hudkliniken vid Mälarsjukhuset, Eskilstuna
organization
publishing date
type
Thesis
publication status
published
subject
keywords
B-Au, patch testing, restenosis, contact allergy, Dermatology, metals, gold, stent, B-Ni, nickel
in
Lund University, Faculty of Medicine Doctoral Dissertation
volume
2008:93
pages
146 pages
publisher
Department of Occupational and Environmental Dermatolog, Deparment of Dermatology, Malmö University Hospital
defense location
Universitetssjukhuset MAS, MFC,Ing 59 entréplan, lilla aulan
defense date
2008-11-07 09:00
ISSN
1652-8220
ISBN
978-91-86059-46-0
language
English
LU publication?
yes
id
7b92647c-a00f-44b2-bf6b-4c7a345f7d80 (old id 1243747)
date added to LUP
2008-10-14 14:51:43
date last changed
2016-09-19 08:44:46
@phdthesis{7b92647c-a00f-44b2-bf6b-4c7a345f7d80,
  abstract     = {A large number of patients are treated with coronary stents, and restenosis (recurrent narrowing of the vessel) is a serious problem. Contact allergy to metal ions eluted from stainless steel stents has been suggested to contribute to in-stent restenosis. Studies have reported a higher rate of restenosis with gold-plated stents, but the correlation to contact allergy was not evaluated. Nickel is the most common contact allergen known, with a median prevalence of 8.5% in North America and Western Europe. Contact allergy to gold has been demonstrated by patch testing with various gold salts and with the metal itself. The patients included in the study had received one type of stent manufactured from stainless steel but differing in that one was electroplated with gold. <br/><br>
The result of this work show that contact allergy to gold is more common in a stented population than in a control population. Dental gold, ear piercing and age were all found to be independent risk factors for contact allergy to gold. However, the possibility of sensitization due to the gold-plated stent remains. Statistical analysis suggests the induction of contact allergy to gold due to the gold-plated stent implanted in the coronary vessel. Allergy to Myroxylon pereirae (a wood extract used in dental cement, as fragrance in cosmetics, creams, ointments and as flavouring) and caine mix (three anaesthetics for topical use), was also more common in the stented population than in controls, indicating the importance of the oral mucosa for sensitization. A correlation was found between gold-plated stents, contact allergy to gold and an increased frequency of restenosis. The gold concentration in blood (B-Au) was 5 times higher in gold-stented patients than in Ni-stented patients. The patch test reactions for gold were also correlated to B-Au: the higher the B-Au, the stronger the patch test reaction and the lower the concentration eliciting a positive patch test. <br/><br>
<br/><br>
In conclusion, the results indicate that implantation of a gold-plated stent in the coronary vessel induces gold allergy, and that contact allergy could be a risk factor in the restenosis process. The findings underline the importance of careful evaluation of new products, routines and materials with regard to the risk of sensitization and/or elicit an allergic reaction to a contact allergen. The gold concentration in blood was shown to correlate with the result of patch tests, which indicates that systemic exposure to an allergen, at least in the case of gold, causes skin reactivity to gold following topical exposure.},
  author       = {Ekqvist, Susanne},
  isbn         = {978-91-86059-46-0},
  issn         = {1652-8220},
  keyword      = {B-Au,patch testing,restenosis,contact allergy,Dermatology,metals,gold,stent,B-Ni,nickel},
  language     = {eng},
  pages        = {146},
  publisher    = {Department of Occupational and Environmental Dermatolog, Deparment of Dermatology, Malmö University Hospital},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation},
  title        = {Clinical And Experimental Studies of Contact Allergy to Stent Metals - with focus on gold},
  volume       = {2008:93},
  year         = {2008},
}