Metal Allergy

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Implantation of stainless steel bars for minimally-invasive repair of pectus excavatum (MIRPE) can induce allergic reactions. Symptoms are mostly a rash (see figure 1) but can also be persistent pain, wound healing problems without bacterial contamination, local swelling, seroma, pleural effusion or abnormal fatigue. These clinical problems often present during the first weeks after MIRPE, if they occur.

Different studies have found increased nickel and chromium levels in blood, urine and tissue that could be the cause of these reactions.

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In most cases, allergic symptoms can successfully be treated with steroids. In just a few cases early bar removal is necessary.

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Metal allergy testing is recommended using a patch test. There has been found no difference in metal allergy incidence if testing is performed in all patients of just selected patients (females, patients with personal or family history of metal sensitivity). But development of a metal allergy in the postoperative course despite a negative preoperative test is also possible.

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Author

Caroline Fortmann, M.D.

 

References

Fortmann et al. PLoS One. 2022

Cundy et al. J Pediatr Surg. 2012

Torre et al. Interact Cardiovasc Thorac Surg. 2021

Obermeyer et al. J Pediatr Surg. 2017

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