High frequency of contact allergy to implant and bone cement components, in particular gentamicin, in cemented arthroplasty with complications: usefulness of late patch test reading.
BACKGROUND
Arthroplasty patients with complications may be sensitized to implant components.


OBJECTIVE
To quantify patch test reactions to implant materials in aseptic cemented arthroplasty patients with complications, and to evaluate the benefit of late patch test reading at D6.


METHODS
Analyses of patch test reactions to baseline series and bone cement components and of the questionnaire-aided histories of 250 consecutive patients with suspected implant allergy were performed. Patch tests were read at D2, D3, and D6.


RESULTS
There were 187 positive reactions to the 29 allergens of the baseline series, and 52 to the seven allergens of the bone cement series. Forty-nine of 250 patients reacted to the bone cement series. In contrast to 'early allergens' such as fragrance mix, late reading at D6 increased the number of positive reactions by 11/32 for nickel, 1/5 for cobalt, and 2/4 for chromium. With bone cement components, most reactions were to gentamicin (25 of 250 patients), and 17 of 25 appeared only at D6.


CONCLUSIONS
Late reading is useful for patch tests with metals and bone cement components. With only D2/D3 readings, 32 reactions to nickel, cobalt, chromium and bone cement components would have been missed. This underlines the utility of late reading in general and in complicated cemented arthroplasty patients, given the unexpectedly high number of gentamicin reactions.
Department of Dermatology and Allergology, Ludwig-Maximilians-University, 80337 Munich, Germany.|Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University, 91054 Erlangen, Germany.
Benjamin
B
Thomas
Department of Dermatology and Allergology, Ludwig-Maximilians-University, 80337 Munich, Germany.
Daniela
D
Kulichova
Department of Dermatology and Allergology, Ludwig-Maximilians-University, 80337 Munich, Germany.
Ronald
R
Wolf
Department of Dermatology and Allergology, Ludwig-Maximilians-University, 80337 Munich, Germany.
Burkhard
B
Summer
Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University, 91054 Erlangen, Germany.
Vera
V
Mahler
Department of Dermatology and Allergology, Ludwig-Maximilians-University, 80337 Munich, Germany.
Peter
P
Thomas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019643:Arthroplasty, Replacement / Q000295:instrumentation*; D001843:Bone Cements / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D005260:Female; D005839:Gentamicins / Q000009:adverse effects*; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins
allergy; bone cement; gentamicin; implant; late reaction; metal; nickel; patch test