title: DKG statement on the use of metal alloy discs for patch testing in suspected intolerance to metal implants.
abstract: Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, 'prophetic'/prophylactic patch testing should not be performed. Pre-implant patch testing should only be done to verify or exclude metal allergy in patients with a corresponding history. In case of implant-related complications - in particular following replacement arthroplasty - such as pain, effusion, skin lesions, reduced range of motion or implant loosening, orthopedic causes should be ruled out first. Workup of suspected metal implant allergy should then be done using the DKG standard series, which includes nickel, cobalt, and chromium preparations. Various studies assessing the usefulness of metal alloy discs for patch testing have shown this particular approach to be ineffective with respect to providing reliable information on metal allergy. Any positive reaction in such tests cannot be assigned to a specific metal contained within the alloy. Furthermore, there is a risk of broad and indiscriminate use of these readily available discs. Accordingly, given the lack of additional benefit compared to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.
authors.affiliation: Department of Dermatology and Allergology of the Ludwig-Maximilians, University Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Information Network of Departments of Dermatology (IVDK), Institute at the University of Göttingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Geier
authors.affiliation: Department of Dermatology, Venereology, and Allergology, St.-Josef-Hospital, Ruhr-University Bochum, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Dickel
authors.affiliation: Clinical Social Medicine, University Hospital Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Diepgen
authors.affiliation: Department of Dermatology, University Hospital Essen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Hillen
authors.affiliation: Department of Dermatology and Venereology, University Hospital Halle (Saale) of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Kreft
authors.affiliation: Information Network of Departments of Dermatology (IVDK), Institute at the University of Göttingen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schnuch
authors.affiliation: Department of Dermatology, Bethesda Hospital, Freudenberg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Szliska
authors.affiliation: Department of Dermatology, University Hospital Erlangen, Friedrich- Alexander University Erlangen, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Mahler
mesh_terms: D000497:Alloys; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology; D003880:Dermatology / Q000592:standards*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D008670:Metals / Q000009:adverse effects*; D010328:Patch Tests / Q000592:standards*; D017410:Practice Guidelines as Topic; D019736:Prostheses and Implants / Q000009:adverse effects*
chemical_list: D000497:Alloys; D008670:Metals