| 1. |
- Ekqvist, Susanne, et al.
(författare)
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A correlation found between gold concentration in blood and patch test reactions in patients with coronary stents.
- 2008
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Ingår i: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 59:3, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with dental gold restorations are known to have a higher level of gold concentration in blood (B-Au). OBJECTIVES: To further investigate, in a study on patients with intracoronary stents and contact allergy to metals, the gold and nickel release from stainless steel stent with (Au stent) and without (Ni stent) gold plating. METHOD: A total of 460 patients treated with stenting underwent patch testing with metals, and information on gold and nickel exposure and blood samples were collected. About 200 blood samples were randomly selected and the analysis of B-Au and nickel concentration in blood (B-Ni) was made using inductively coupled plasma mass spectrometry. RESULTS: There was a correlation between the intensity of Au patch test reaction and B-Au (P < 0.001). This correlation could not be seen between Ni patch test reaction and B-Ni. A Au stent gave a fivefold higher B-Au than a Ni stent. CONCLUSIONS: Gold is released from the Au stent and patients with a Au stent have a fivefold higher B-Au than patients with an Ni stent. The patch test reactions for gold were correlated with B-Au.
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| 2. |
- Ekqvist, Susanne
(författare)
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Clinical And Experimental Studies of Contact Allergy to Stent Metals - with focus on gold
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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. 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.
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| 3. |
- Ekqvist, Susanne, et al.
(författare)
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Does gold concentration in the blood influence the result of patch testing to gold?
- 2009
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 160:5, s. 1016-1021
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Tidskriftsartikel (refereegranskat)abstract
- We have recently found a correlation between contact allergy to gold sodium thiosulphate (GSTS) and gold concentration in the blood (B-Au) in a stented population: the higher the B-Au, the stronger the patch-test reaction. To further investigate the correlation between B-Au and patch-test reactivity to gold. In this provocation control cross-over trial of 24 patients with dermatitis with a known contact allergy to gold, the patients were randomized into two groups where one was topically provoked to gold (15 mg GSTS) and one to the control. All patients were simultaneously patch tested with GSTS in 10 aqueous dilutions (1.1 mg GSTS). Patch-test readings were performed and blood was drawn. After 6 weeks, the experiment was repeated and the group that had previously been provoked with gold was now provoked with the control and vice versa. B-Au was higher after gold provocation whereas no treatment effect was discerned for minimal eliciting concentration (MEC) or summarized test score (STS). Instead, significant differences in period effect were observed implying higher B-Au and STS and lower MEC on test occasion II. The most likely explanation is the increased B-Au and/or booster effect from test occasion I. There was a correlation between B-Au and MEC: the higher the B-Au, the lower the MEC. The correlation between B-Au and MEC indicates that the B-Au is of importance for the skin reactivity to gold.
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| 4. |
- Ekqvist, Susanne, et al.
(författare)
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High frequency of contact allergy to gold in patients with endovascular coronary stents
- 2007
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 157:4, s. 730-738
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Tidskriftsartikel (refereegranskat)abstract
- Background Stent implantation is an effective method for treatment of atherosclerotic disease. Factors predisposing to in-stent restenosis are still largely unknown. Contact allergy to metal ions eluted from the stent has been suggested to be a risk factor. Objectives To explore whether there is a possible induction of contact allergy to metals used in stents among patients with a stainless steel stent containing nickel (Ni stent) and patients with a gold-plated stent (Au stent). Methods Adults (n = 484) treated with coronary stent implantation participated in the study with patch testing. The study design was retrospective and cross-sectional with no assessment of contact allergy before stenting. Age- and sex-matched patch-tested patients with dermatitis (n = 447) served as controls. Results Of Au-stented patients, 54 of 146 (37%) were allergic to gold compared with 85 of 447 (19%) controls (P < 0.001). Within the stented population there were no statistically significant differences in contact allergy to gold or nickel between Ni-stented and Au-stented patients. In multivariate models where other risk factors for contact allergy to gold were considered, the Au stent showed a trend towards statistical significance (odds ratio 1.43, 95% confidence interval 0.95-2.16; P = 0.09). Conclusions As the frequency of contact allergy to gold is higher in stented patients independent of stent type it suggests a previous sensitization. However, several pieces of circumstantial evidence as well as statistical analysis indicate the possibility of sensitization in the coronary vessel by the Au stent. Ni stents and Au stents should not be ruled out as risk factors for induction of contact allergy to these metals.
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| 5. |
- Netterlid, Eva, et al.
(författare)
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There is an association between contact allergy to aluminium and persistent subcutaneous nodules in children undergoing hyposensitization therapy.
- 2009
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Ingår i: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 60:1, s. 41-49
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The development of persistent itchy nodules at the injection site following hyposensitization therapy with aluminium-precipitated antigen extract has been described in several reports. Occasionally, contact allergy to aluminium has been reported in individuals with such nodules. OBJECTIVES: To investigate if hyposensitization therapy can induce contact allergy to aluminium and examine if there is any association between persistent subcutaneous nodules and aluminium allergy. PATIENTS/METHODS: Sixty-one children with allergic asthma and/or allergic rhinitis participated in the study of whom 37 had had hyposensitization therapy. The study consisted of a non-clinical part based on a questionnaire and a clinical part with a physical examination, self-assessment of itching, and patch testing. To secure an unbiased evaluation of possible reactions, the investigators were blinded. RESULTS: Contact allergy to aluminium was found in eight participants, all in the exposed group (8/37 versus 0/24, P = 0.02). Examination showed nodules on the upper arms in 13 participants, all in the group exposed to hyposensitization therapy. Nodules were over-represented in patients with contact allergy to aluminium. CONCLUSIONS: There was a statistically significant association between contact allergy to aluminium and persistent subcutaneous nodules in children who had had hyposensitization therapy.
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| 6. |
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| 7. |
- Svedman, Cecilia, et al.
(författare)
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A correlation found between contact allergy to stent material and restenosis of the coronary arteries.
- 2009
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Ingår i: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 60:3, s. 158-164
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Metallic implants, stents, are increasingly being used especially in patients with stenosis of the cardiac vessels. Ten to thirty per cent of the patients suffer from restenosis regardless of aetiology. We have shown increased frequency of contact allergy to stent metals in stented patients. OBJECTIVES: To we evaluate whether contact allergy to stent material is a risk factor for restenosis. METHODS: Patients with stainless steel stents, with or without gold plating, were epicutaneously tested and answered a questionnaire. The restenosis rate was evaluated. RESULTS: We found a correlation between contact allergy to gold, gold stent, and restenosis (OR 2.3, CI 1.0-5.1, P = 0.04). The risk for restenosis was threefold increased when the patient was gold allergic and stented with a gold-plated stent. An increased degree of chest pain in gold-allergic patients stented with gold-plated stent was found. CONCLUSIONS: We found a correlation between contact allergy to gold, gold-stent, and restenosis. It may be of importance to consider contact allergy when developing new materials for stenting.
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| 8. |
- Svedman, Cecilia, et al.
(författare)
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Unexpected sensitization routes and general frequency of contact allergies in an elderly stented Swedish population
- 2007
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Ingår i: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 56:6, s. 338-343
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Tidskriftsartikel (refereegranskat)abstract
- Contact allergy to stent material has been proposed to be a risk factor for restenosis, after percutaneous transluminal coronary angioplasty (PTCA) and stenting. Information on the general frequency of contact allergy in the elderly population is scarce and knowledge of possible sensitization routes is important to investigate. The aim of this study was to investigate contact allergy to stent materials and other allergens. Here we report our findings on the frequency of contact allergies apart from those from stent material. In this retrospective study, we patch tested an elderly population, treated with PTCA and stented, with our standard series. A dermatitis population served as controls. We found a high frequency of contact allergy in both groups but a greater 'contact allergy burden', with generally higher frequencies for contact allergens, in the dermatitis patients as expected. Myroxylon pereirae and caine mix were apart from metals exceptions with statistically significant higher frequencies (P < 0.01) for the stented patients. Contact allergy to nonmetal sensitizers is common in an elderly Swedish stent population although, on the whole, substantially less than in an age and sex-matched dermatitis population. The findings indicate the importance of the oral mucosa for sensitization. In a general population that has been treated with a special medication/treatment procedure, contact allergies not suspected (such as to M. pereirae and to the metals) might suddenly peak. This underlines the importance of a careful evaluation of new products and routines with regard to contact allergies in the population.
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