Assessment for Metal Allergy: Patch Testing
The method of choice and gold standard in the diagnosis of delayed-type hypersensitivity is patch testing; therefore, patch testing for metal allergy has become routine. Most national and international baseline series for patch testing contain nickel, chromium and cobalt. There are numerous metals of increasing medical importance that are not on routine patch test programmes. With advances of metallurgy and biotechnology, such metals become increasingly widely present in medical devices, e.g. artificial joints, dental implants, vascular stents, clips and pacemakers. These metals are not routinely tested, as some are not yet commercially available as preparations for patch testing, while others may not be well known to many dermatologists and allergists. This chapter outlines current recommendations and common pitfalls when patch testing to metals. Assessing the clinical relevance of a positive patch test reaction is as important as the execution of patch testing. Several illustrative cases will be provided.
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