title: High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing.
abstract: OBJECTIVE
  A previous study from our group estimated that as few as 2.2% of pectus excavatum patients suffered from allergy to the implanted metal bar. We sought to assess recent changes in incidence of metal allergy and identify the benefit of metal allergy testing prior to surgery.
  
  
  METHODS
  A retrospective review was performed of all consenting patients undergoing pectus repair during the six years between 9/2004 and 12/2010 at our institution. Incidence was based on clinical symptoms and/or T.R.U.E.® patch testing. Demographic data, history of atopy and history of metal allergy were collected. Type and number of bars used, suture site infection, skin rash and wound infection rates were reviewed.
  
  
  RESULTS
  Forty one of 639 patients (6.4%) had clinical or patch test evidence of metal allergy. Family history of metal allergy and pre-operative history of metal sensitivity were found to be statistically significant correlates.
  
  
  CONCLUSIONS
  The rate of metal allergy in the pectus excavatum population may be higher than previously reported. Patient or family history of metal allergy or metal sensitization may indicate increased risk. Metal allergy testing should be performed before Nuss procedure.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Bhairav
authors.initials: B
authors.lastname: Shah
authors.affiliation: Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Amy
authors.initials: A
authors.lastname: Cohee
authors.affiliation: Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Deyerle
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Kelly
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Frazier
authors.initials: F
authors.lastname: Frantz
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kelly
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Kuhn
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Michele
authors.initials: M
authors.lastname: Lombardo
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA.
authors.forename: Robert
authors.initials: R
authors.lastname: Obermeyer
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, VA; Children's Hospital of the Kings and Daughters, Norfolk, VA. Electronic address: michael.goretsky@chkd.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goretsky
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D004485:Eczema / Q000453:epidemiology; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D020022:Genetic Predisposition to Disease; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology / Q000235:genetics; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects*; D010328:Patch Tests; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D012737:Sex Factors; D013249:Sternum / Q000601:surgery*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D019216:Metals, Heavy
keywords: Allergy; Metal; Nickel; Patch; Pectus; Titanium