Nickel hypersensitivity and coronary artery stents
- Sarita U Patil, MD
Sarita U Patil, MD
- Allergy and Immunology Fellow
- Massachusetts General Hospital
- Aidan Long, MD
Aidan Long, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
Within the past decade, there has been growing concern about possible allergic (hypersensitivity) reactions to foreign materials implanted in the body. A question that has frequently generated consults to allergy specialists is whether hypersensitivity reactions to materials in intracoronary artery stents could be associated with stent restenosis.
Many coronary stents are made from stainless steel, which is steel with added nickel and chromium, and nickel is one of the most common causes of allergic contact dermatitis (ACD). Thus, a possible association between nickel hypersensitivity and stent restenosis has been questioned.
The evidence supporting and refuting an association between nickel hypersensitivity and intracoronary artery stent restenosis will be reviewed here. Restenosis of intracoronary stents is discussed separately. (See "Intracoronary stent restenosis".)
A brief review of nickel hypersensitivity and the composition of intracoronary stents is helpful in understanding the studies presented in this topic.
Metal hypersensitivity — The most common form of metal hypersensitivity is allergic contact dermatitis (ACD) caused by nickel. Cobalt, chromium, molybdenum, and gold are less often implicated in ACD . Estimates of the prevalence of nickel sensitivity in the general population range from 4 to 19 percent [1,2]. Nickel is found in many commercial products, including zippers, buttons, jewelry, watches, eyeglass frames, and mobile phones, and many of these items have been linked to contact dermatitis reactions.
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- Thyssen JP, Engkilde K, Menné T, et al. No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study. Contact Dermatitis 2011; 64:138.
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- Metal hypersensitivity
- Allergic contact dermatitis
- - Risk factors
- Materials in coronary stents
- POSSIBLE MANIFESTATIONS OF METAL HYPERSENSITIVITY IN IMPLANT RECIPIENTS
- Sensitization to metal
- Cutaneous inflammation
- Stent restenosis
- - Initial restenosis of bare-metal stents
- - Drug-eluting stents
- - Recurrent stent restenosis
- In-stent thrombosis
- Other symptoms
- SUMMARY AND RECOMMENDATIONS