Intolerance of osteosynthesis material: evidence of dichromate contact allergy with concomitant oligoclonal T-cell infiltrate and TH1-type cytokine expression in the peri-implantar tissue.
BACKGROUND
We report on a 37-year-old man without history of previous allergic disease who developed an aseptic intolerance reaction to a chromium-cobalt alloy, with local discomfort, loosening, and absence of fracture healing. Both in vivo and in vitro allergoimmunologic diagnostic tests were performed.


METHODS
Patch testing was done with a European standard series. Specific serum IgE was measured by CAP-FEIA. In addition to immunohistology (APAAP method), peri-implantar tissue was further analyzed by PCR to determine T-cell-receptor-gamma rearrangement and thus the potential clonal (antigen-driven) T-cell repertoire. The actual tissue mRNA expression for IL-4, IL-6, and IFN-gamma was visualized by RT-PCR.


RESULTS
Skin testing gave a delayed-type reaction to dichromate. Specific serum IgE to natural rubber latex and grass pollen was found--but without clinical symptoms. Immunohistology revealed a monocytic and dense T-cell infiltrate. The latter, instead of being random, showed an oligoclonal T-cell receptor rearrangement. In addition, there was TH1-type mediator expression (IL-6 and IFN-gamma, but not IL-4).


CONCLUSIONS
Skin test, examination of peri-implantar tissue, and the prompt healing after replacement of the osteosynthesis material suggest an allergic reaction. PCR analysis of peri-implantar tissue can further help to identify and understand allergy-mediated implant intolerance reactions.
Thomas
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Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, Germany.
Summer
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Sander
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Przybilla
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Thomas
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Naumann
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D000328:Adult; D002858:Chromium Alloys / Q000009:adverse effects*; D002999:Clone Cells; D016207:Cytokines / Q000378:metabolism*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor / Q000235:genetics; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D010328:Patch Tests; D016133:Polymerase Chain Reaction; D011475:Prosthesis Failure; D013601:T-Lymphocytes / Q000276:immunology*; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism; D014458:Ulna Fractures / Q000601:surgery*
D002858:Chromium Alloys; D016207:Cytokines