title: Patch test reactivity to a cobalt-chromium-molybdenum alloy and stainless steel in metal-allergic patients in correlation to the metal ion release.
abstract: Nickel, chromium, and cobalt released from stainless steel and CoCrMo alloys have been postulated to trigger hypersensitivity reactions. The objective of this study was to assess the ion release from a CoCrMo alloy and stainless steel in vitro and the cutaneous reactivity to it by patch test. 52 metal-allergic patients and 48 non-allergic controls were patch tested to stainless steel and CoCrMo discs. In addition, using atomic absorption spectrometry, the release of nickel, cobalt, and chromium from both materials was assessed upon 2-day exposure to distilled water, artificial sweat (AS), and cell culture medium. There was low nickel ion release from stainless steel (0.3-0.46 microg/cm(2)/2 days) and CoCrMo discs (up to 0.33 microg/cm(2)/2 days) into the different elution media. Chromium release from the 2 materials was also very low (0.06-0.38 microg/cm(2)/2 days from stainless steel and 0.52-1.36 microg/cm(2)/2 days from CoCrMo alloy). In contrast, AS led to abundant cobalt release (maximally 18.94 microg/cm(2)/2 days) from the CoCrMo discs, with concomitant eczematous reaction upon patch testing: 0 of the 52 metal-allergic patients reacted to stainless steel discs and 5 of the 52 patients to CoCrMo discs (all 5 patients were cobalt allergic and 3 also nickel and chromium allergic). None of the controls reacted to the discs. Apart from nickel being a focus of allergological research, our results point to the possibly underestimated association of cobalt release and potential hyperreactivity to CoCrMo alloy.
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, D-80337 München, Germany. burkhard.summer@med.uni-muenchen.de
authors.forename: Burkhard
authors.initials: B
authors.lastname: Summer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Fink
authors.forename: Richard
authors.initials: R
authors.lastname: Zeller
authors.forename: Franziska
authors.initials: F
authors.lastname: Rueff
authors.forename: Sonja
authors.initials: S
authors.lastname: Maier
authors.forename: Gabriele
authors.initials: G
authors.lastname: Roider
authors.forename: Peter
authors.initials: P
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys / Q000737:chemistry; D002857:Chromium / Q000009:adverse effects* / Q000032:analysis; D003035:Cobalt / Q000009:adverse effects* / Q000032:analysis; D003470:Culture Media; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects* / Q000032:analysis; D010328:Patch Tests; D013054:Spectrophotometry, Atomic; D013193:Stainless Steel / Q000009:adverse effects* / Q000737:chemistry; D013542:Sweat
chemical_list: D000497:Alloys; D003470:Culture Media; D002857:Chromium; D013193:Stainless Steel; D003035:Cobalt; D009532:Nickel