title: Patch Testing for Metal Allergy With Manufacturer-Supplied Materials Before Nuss Bar Insertion.
abstract: BACKGROUND
  The increasing use of metal implantable devices has raised awareness of nickel allergy. Preoperative patch testing for patients with pectus excavatum (PE) with a known metal allergy or history of atopy is an accepted practice before the Nuss procedure. The Nuss bar manufacturer offers a metal disc for preoperative testing for metal sensitivities. However, the efficacy of this disc is not well understood.
  
  
  OBJECTIVE
  The purpose of this study was to determine the sensitivity of the metal disc in detecting nickel allergy compared with that of standard patch testing.
  
  
  METHODS
  Two PE patients were referred for preoperative patch testing with the metal disc to screen for metal allergy before the Nuss procedure. Based on our initial findings, 7 patients without PE scheduled for patch testing for the evaluation of chronic dermatitis were additionally tested with the metal disc if they were found to have risk factors for nickel allergy. All patch testing was performed according to set standards.
  
  
  CONCLUSIONS
  The metal disc may not be adequately sensitive to determine nickel allergy before the Nuss procedure. Patch testing alone with standard formulations of nickel sulfate in petrolatum may be more sensitive in diagnosing nickel allergy.
authors.affiliation: From the Departments of *Dermatology, †Surgery, and ‡Microbiology/Immunology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Kerry
authors.initials: K
authors.lastname: Heitmiller
authors.forename: Andrea
authors.initials: A
authors.lastname: French
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Alaish
authors.forename: Ronald
authors.initials: R
authors.lastname: Goldner
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Gaspari
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects* / Q000276:immunology; D010328:Patch Tests; D057234:Preoperative Period; D019736:Prostheses and Implants / Q000009:adverse effects*
chemical_list: C029938:nickel sulfate; D009532:Nickel