• Multiple Sclerosis (Prochazkova 2003, 2006, Stejskal 2006)
• Chronic Fatigue Syndrome (Stejskal 1994, 1999)
• Rheumatoid Arthritis (Prochazkova 2003, Stejskal 2006)
• Fibromyalgia (Öckert 2006, Stejskal 2013)
• Amyotrophic Lateral Sclerosis (Pleva 2000)
• Cardiovascular disease (Manousek 2016)
• Lupus Erythematosis (Prochazkova 2003)
• Oral Lichen Planus (Stejskal 1996)
• Oral burning and itching (Stejskal 2006)
• Skin diseases such as eczema or psoriasis (Prochazkova 2003, Venclikova 2003, Kohdera, Ionescu)
• Sjögren’s syndrome (Prochazkova 2003)
• Alopecia areata and atopic alopecia (Nakayama and Chen 2018)
• Autoimmune thyroiditis (Sterzl 1999, Prochazkova 2003, 2010, Hybenova 2010)

The prevalence of metal hypersensitivity in patients with implants is significantly higher than in the general population, with an even higher rate among patients with failed or failing implanted devices. (Hallab et al. Metal sensitivity in patients with orthopedic implants. The Journal of Bone and Joint Surgery 2001;83:428)

We are conducting a study to see if metals may be implicated in the development of scoliosis. Read more about the research HERE.

As with any allergy, exposure to the offending allergen should be minimized or, if possible, avoided altogether.
Metals can be found in food and also in medication, such as nickel and titanium dioxide, so in this case, patients might consider diets low in nickel. If a patient is allergic to a metal found in dental fillings or dental implants, it is important to consult a dentist who is experienced in the field of metal-free dentistry. The importance of being protected during the removal of, for example, amalgam fillings, cannot be overstated. Every dentist will have their own protocols, for instance, the SMART protocol from the International Academy of Oral Medicine and Toxicology (IAOMT). For many patients, avoiding metals will be enough for them to feel a significant health improvement.

Metal hypersensitivity is a well-documented factor in the failure of implants, and the need for  testing in sensitive patients is well recognized by both implant manufacturers and by surgeons alike. The prevalence of metal hypersensitivity in patients with implants is significantly higher than in the general population, with an even higher rate among patients with failed or failing implanted devices.

An exact breakdown, which includes trace amounts of metals present, is needed prior to testing, but below is a guideline. Metals usually found in common medical grade alloys include:

Cobalt chrome: cobalt, chromium, manganese, molybdenum, nickel, tungsten
Stainless steel: chromium, manganese, molybdenum, nickel, tungsten
Titanium alloy (TiAl6V4): titanium, vanadium, aluminium, traces of nickel

Recently, cases of titanium hypersensitivity have also been described. Titanium is a transition metal and thus may function as a hapten and trigger cellular hypersensitivity. Since titanium, in the form of titanium dioxide (E171), is used as white pigment in toothpaste, cosmetics and medication, the latent sensitization of susceptible individuals is possible. Traces of nickel (0.03%) may be found even in commercially pure titanium due to the production process.

Both bare metal and drug eluting stents have been occasionally implicated in the developments of various  hypersensitivity reactions. More information about the metals commonly contained in stents can be found HERE. It is important to establish which metals are contained in your device prior to testing.

Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic

Delayed-type hypersensitivity to metals of environmental burden in patients with Takotsubo syndrome – Is there a clinical relevance?

Hypersensitivity to material and environmental burden as a possible cause of late complications of cardiac implantable electronic devices

Delayed-type Hypersensitivity to Metals in Newly Diagnosed Patients with Nonischemic Dilated Cardiomyopathy

Department of Environmental and Occupational Medicine, Sackler School of Medicine, Tel Aviv University

Identification of metal sensitization in sarcoid-like metal-exposed patients by the MELISA® lymphocyte proliferation test — a pilot study

Validation of cellular tests for Lyme borreliosis (VICTORY) study. 150 patient and 225 healthy controls tested in four different cellular tests to determine sensitivity and specificity. More info HERE

Institute of Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic. Data presented at International Conference on Metal Detoxification, Berlin, 10 June 2019

Titanium and Other Metal Hypersensitivity Diagnosed by MELISA Test: Follow up Study

Foot and Ankle Center Wenatchee. Data was presented by Dr Scott Schroeder at FDA Committee Meeting on immune responses to metals in medical devices on 13th November, 2019. See presentation HERE

Rebecca Dutton is conducting research into the possible connection between metal exposure (particularly to mercury) and the development of idiopathic scoliosis. Read more about the research HERE.

Beryllium is a metal that is used in the manufacturing of products like cars, golf clubs and computers, manufacture of thermal coating, nuclear reactors, rocket heat shields, brakes, x-ray tubes, and dental plates. It is found in some dental crowns and dental plates, but exposure to the dust is highest during the manufacturer so those working in dental laboratories may be exposed.

Beryllium-induced lung disease can occur when beryllium dust or fumes are inhaled.  Chronic beryllium disease (CBD, berylliosis) is associated with inhaling beryllium powder or fumes (although inhaling beryllium does not always lead to CBD). An exposed person usually gets sensitized to beryllium prior to progressing to CBD. Sensitization is similar to an allergy; when allergic or sensitized, the body reacts negatively to that particular substance. Beryllium sensitivity (BeS) and CBD can develop soon after exposure or many (30-40) years later. Of those working around beryllium, about 10% get sensitized to it and about half of those progress to develop CBD.

According to NIOSH (the National Institute for Occupational Safety and Health, 2011), “workers exposed to particles, fumes, mists and solutions from beryllium-containing materials may develop beryllium sensitization or chronic beryllium disease, a potentially disabling or even fatal respiratory disease.”  Depending on how workers are exposed, the diseases can affect different tissues and organs. Breathing in fumes or dusts of beryllium compounds may injure the lungs. While most commonly associated with diseases of the lungs, beryllium may also affect such organs as the liver, kidneys, heart, nervous system, and the lymphatic system.

The Centers for Disease Control and Prevention (CDC) states that “sensitization has been found in one to ten percent of workers in cross-sectional studies, with chronic beryllium disease diagnosed in ten to 100 percent of the sensitized”. This statement means that between 1 to 10% of workers who work with beryllium may become sensitized. Of those workers who become sensitized, 10% or all may later develop chronic beryllium disease. Another study stated that on average, 1 to 6% of exposed workers may develop sensitivity, but it may be as high as 16% in workplaces with high exposure levels.

A blood test called beryllium lymphocyte proliferation test (BeLPT) can measure how blood cells react to beryllium. This test can be used for medical surveillance programs. NIOSH states that “it is believed that a person must first be sensitized before beryllium in the lungs can cause the lung damage (called granulomas) of chronic beryllium disease. However, the overall proportion of all sensitized individuals who will eventually develop chronic beryllium disease is not known.”
 

MELISA is involved with a working group that aims to bring standardised beryllium sensitivity testing to Europe to allow exposed workers to be tested for hypersensitivity.
 

Links for the specification for testing for Beryllium hypersensitivity can be found HERE.
 

The medical device market is growing rapidly each year and is expected to reach $30.4 billion by 2025; the dental implant market is predicted to grow to $8 billion during this period. Growth is driven by an ageing population and increasing cardiovascular and neurological diseases. There are international calls for stricter regulations and for more research into device failure. One of the factors contributing to device failure is metal hypersensitivity.

MELISA is seeking to expand its network of laboratories to make the testing more accessible to healthcare practitioners worldwide. As the number of medical devices implanted grows there is concomitant growth in demand for metal hypersensitivity testing. We are looking for laboratory partners, particularly in North America, where demand is highest for testing.

MELISA^® (MEmory Lymphocyte Immuno-Stimulation Assay) is a modified, optimised and clinically validated version of lymphocyte transformation testing (LTT). The MELISA test provides important information for patients suffering from unexplained symptoms after surgery and is also used prior to surgery in patients reporting previous metal sensitivity. Details can be found in our published articles.

Blood must arrive at the laboratory within 48 hours after the blood draw. Lymphocytes are isolated and put into cultures with  against metal allergens, blood is incubated for five days and the lymphocyte reaction is measured by two separate technologies: the uptake of radioisotope by dividing lymphocytes and by microscopy.

A license is needed to handle low-level radioactivity and in the US, the laboratory must be CLIA registered to perform high complexity testing, the test is offered as a Lab Developed Test (LDT) in the US.

MELISA has also been developed to diagnose active infections of Lyme Borreliosis, which appears to be a more accurate test for diagnosing active Lyme disease than standard tests (Western Blot, PCR) particularly in symptomatic patients with serologically ambiguous results.

MELISA is mainly used to determine metal allergy, but the test is also developed for other substances. Some laboratories routinely test for allergy to gluten, candida and moulds. We are extremely interested in developing the test for other substances such as gadolinium, PEEK, pesticides and food allergens.

Inorganic mercury, or ‘metallic mercury’, is a frequent source of metal allergy. It constitutes 50% of dental amalgam fillings. Dental authorities accept that mercury vapour constantly evaporates from the fillings, but argue this is below a safe limit. However, for hypersensitive patients, there is no safe limit.

In 2020 The FDA issued the following statement: “The FDA has found that certain groups may be at greater risk for potential harmful health effects of mercury vapor released from the device. As a result, the agency is recommending certain high-risk groups avoid getting dental amalgam whenever possible and appropriate.” For more information, please check HERE.

One of the groups at greater risk for potential harmful health effects is “People with known heightened sensitivity (allergy) to mercury or other components of dental amalgam.”

Replacing amalgam fillings with non-metallic alternatives has delivered radical health improvements in patients who tested MELISA-positive for mercury. 71% of patients showed health improvements in this study.

Methylmercury is the most toxic form of mercury. It affects the immune system, alters genetic and enzyme systems, and damages the nervous system, including coordination and the senses of touch, taste, and sight. Methylmercury is particularly damaging to developing embryos, which are five to ten times more sensitive than adults. Methylmercury becomes concentrated as it move up the food chain, so the large predator fish such as shark and swordfish have the highest concentrations. Bacteria in the body can transform inorganic mercury into methylmercury.

Phenylmercury is the organic mercury most commonly found in dental root fillings. While it has been phased out in many countries, it is also used as a preservative in eye drops and nose drops. Phenylmercury is used to control the growth of fungus in some interior latex paints manufactured before 1991, some exterior and oil base paints, some caulks, eye-area cosmetics, toiletries and other products.

Ethylmercury is a form of organic mercury. It forms a part of thimerosal, which is used as a preservative in some vaccines, eye drops and nasal sprays.

Thimerosal is one of the most controversial substances is modern medicine. Its main component is ethyl mercury (49.6% by weight), yet it is still used as a preservative in some childhood vaccines, most flu vaccines and some eye drops and contact lens solution. It is being withdrawn from vaccines in many countries.

A special form of mercury can be used to demonstrate that mercury binds to the body proteins. The distribution of mercury in various organs of the body can be traced by sensitive photographic emulsion. Below are four pictures of mice that were injected with mercury labelled with a radioactive isotope. Then, using autoradiography, a special picture was produced. The areas where the mercury is deposited are shown in white.

The pictures demonstrate widespread distribution of mercury in the body of the mice. Organs rich in fat – such as brain and collagen – are very prone to mercury binding. One of the reasons for this is that mercury is particularly keen to bind to two amino acids; methionine and cysteine. Both amino acids contain sulphur hydrogen (SH)-groups. This is a particularly attractive target for mercury. Fat tissues and collagen tissues are rich in SH-groups.

Various materials are used to manufacture fillings, crowns, pins, root-fillings, implants etc. Below you will find an overview of recommended substances for testing. Information about the exact type of restoration used should be included in the patient’s medical record.

Amalgam/silver fillings: Copper, Inorganic mercury, Silver, Tin, Nickel (traces)
Non-noble crowns (bridges): Aluminium, Beryllium, Copper, Cobalt, Chromium, Manganese, Molybdenum, Nickel, Niobium, Tantalum, Tungsten
Noble crowns (bridges): Copper, Gallium, Gold, Indium, Iridium, Palladium, Platinum, Ruthenium, Silver, Tin
Titanium implants (Ti-6Al-4V alloy): Aluminum, Titanium dioxide, Titanium sulphate, Vanadium, Nickel (traces)

Various alloys are used to manufacture hip and knee replacements, spinal implants, plates, screws, nails, pins, clips etc. Below are listed commonly used alloys and their typical compositions. Information about the exact type of implant used during surgery should be included in the patient’s medical record.

Stainless steel: Chromium, Manganese, Molybdenum, Nickel, Tungsten
Cobalt-Chromium alloys: Chromium, Cobalt, Manganese, Molybdenum, Nickel, Tungsten
Titanium (Ti-6Al-4V alloy): Aluminum, Titanium dioxide, Titanium sulphate, Vanadium, Nickel (traces)
Titanium-based alloys (various alloys): Aluminium, Molybdenum, Niobium, Nickel, Tantalum, Tin, Titanium Dioxide, Titanium Sulphate, Vanadium, Zirconium, Zirconia*
Nitinol: Nickel, Titanium Dioxide, Titanium Sulphate,
Zirconium-based alloys: Niobium, Zirconium, Zirconia*, Chromium (traces), Tin (traces)

Foods from contaminated areas may contain more metals than others, whether fish, meat, vegetables or fruit.
Fish can contain high amounts of methyl mercury, which accumulates up in the food chain so that large predatory fish contain more mercury than smaller fish.
Seafood may contain mercury, cadmium and arsenic.
Vegetables from polluted areas may contain cadmium, palladium, lead etc.
Tinned food can contain tin and aluminium.
Wine can contain molybdenum, nickel and lead.
Nickel is found in bananas, cocoa, oatmeal, green vegetables and a variety of other foods, more details can be found HERE

Titanium dioxide is widely used in cosmetics, present in many products such as eye shadow, blush, nail polish, lotion, lipstick, powder and sunscreen. Metal pigments are used to give colour and act as preservatives. The following metals may exist in cosmetic products: lead, mercury, chromium, aluminium, arsenic, beryllium, nickel, cadmium and others.

Antacids contain aluminium and pills may have titanium dioxide (E171) or other metal oxides in their coating to enhance their appearance. Antiseptic preparations used to contain mercury and still do in some countries. Barium is found in x-ray fluids.

May contain thimerosal (a mercury-based preservative) and aluminium.

Both active and passive smoking contain mercury, nickel, cadmium and, manganese.

Costume jewellery may contain a lot of different metals, most notably nickel, which often cause skin rashes in sensitive patienys. Lead may also be present.
In more expensive jewelry, yellow gold is made by mixing pure gold with copper and zinc; rose gold contains copper and white gold is an alloy of gold and some white metals such as silver and palladium. Other metals used in jewelry are platinum, rhodium, tungsten and titanium. Titanium is often used for piercings and there are some rare cases of allergy to titanium alloy piercings.

Construction workers, miners, electricians, rubber/wood/paper/textile industry workers, dentists, hairdressers and painters are some occupations that are more exposed to metals in their work than others.

Living close to a highway, airport, crematory or factory or, for example, in the same building as a dental clinic may lead to increased exposure to metals such as palladium, cadmium, lead and mercury.

Metal hypersensitivity (also called metal sensitivity or metal allergy) is a disorder of the immune system that affects 10% to 15% of the population. In susceptible people, exposure to certain metals is followed by a cell-mediated immune reaction (type IV hypersensitivity, also called delayed-type hypersensitivity).

A type IV hypersensitivity reaction is mediated by T-lymphocytes (white blood cells) that have had prior contact with a given allergen. These cells respond by enlarging (lymphoblast transformation) and dividing (proliferation) when exposed to the sensitising allergen. The newly formed effector cells, together with their secreted cytokines, mediate the resulting allergic reaction.

Inflammation activated by metal allergy may be one of the causes of ill health in patients. Type IV metal allergy is often overlooked as a culprit in many of today’s chronic illnesses, more info HERE.

With a skin test or, more objectively and safely, with a lymphocyte transformation test (also referred to as “LTT” or “LPT” test). MELISA is an optimised and validated lymphocyte transformation test.

The classic symptom of metal hypersensitivity is allergic contact dermatitis. In addition to local symptoms, chronic exposure to metals may cause numerous symptoms associated with an overactive immune system in susceptible people. Patients with metal hypersensitivity report symptoms such as inflammation, joint and muscle pain, cognitive impairment (brain fog), depression and headaches. Metal hypersensitivity has been implicated in the aetiology of chronic fatigue syndrome, autoimmune disease, fibromyalgia and multiple chemical sensitivity.

By optimising the methodology of LTT, MELISA has improved both the specificity and the sensitivity of the test. Below are the four major changes that MELISA implements, in contrast with LTT.

1. MELISA uses a higher number of lymphocytes per test

2. The metal concentrations used have been chosen so that they are non-mitogenic and non-toxic

3. The test uses partial depletion of macrophages which restores the lymphocyte-monocyte balance so that it is similar to that in the blood

4. In addition to objective determination of lymphocyte proliferation by radiolabeled thymidine, morphological examination gives an additional reading directly on the level of stimulated lymphocytes

The MELISA test was validated on 250 patients in 2003 and found to be reproducible, sensitive, specific and reliable for detecting metal sensitivity. Further validation on a larger group of patients was published in 2016. In 2021, a university study wrote about the “significant benefits of MELISA testing”.

To our knowledge, no other LTT except the widely published beryllium-LTT has been validated.

The most frequently allergenic metals are nickel, gold, palladium, cadmium, various mercury compounds, cobalt, chromium and molybdenum. Other metals can induce positive responses in MELISA as well. Everyone has a unique immune system and basically, any substance could trigger an immune response in susceptible individuals.

In a document on nitinol-containing devices (nickel and titanium alloy) , the US FDA writes: “Since there is no known lower limit on the amount of nickel that can elicit allergic reactions in some patients, we recommend that the risk of potential allergic reaction to nickel be mitigated through labelling for nitinol containing devices. Specifically, we recommend that the labelling include a warning for prolonged and permanent contacting devices.”

Stainless steel is an alloy that contains up to 8-13% nickel. Alloys used in surgery contain trace amounts of nickel also. Cobalt chromium contains a trace of nickel at under 1%, whilst titanium alloys contain under 0.05%. However nickel levels may rise in the body may be released from implanted devices at a faster rate (1) or through exposure to nickel containing surgical instruments (2).

1) https://doi.org/10.1016/S0142-9612(97)00208-1
2) https://pubmed.ncbi.nlm.nih.gov/2649648/

Please note that the information below is taken from various sources and may not reflect the situation in your country. For example, a clinic in the USA states that potatoes are high in nickel, while analysis by the Swedish Food Administration found only a low nickel content in potatoes. The discrepancy is most likely due to the mineral and metal content of the soil in which the vegetables are grown.

There is a very thorough website, Rebelytics which has analysed nickel in food data from multiple source and has produced a spreadsheet which should avoid these kind of discrepancies see HERE.

The major dietary source of nickel is from plant-based foods. Nickel-rich food items include nuts, beans, peas, grains and chocolate. Animal foods are low in nickel. Total daily dietary intakes of nickel vary depending on the amount of plant and animal foods consumed. Diets high in plant foods, such as the ones listed above, supply about 900 micrograms daily of nickel. Nickel intake in the United States ranges from 69 to 162 micrograms daily. A daily dietary requirement of 25 to 35 micrograms has been suggested.

Nickel may be found in prepared foods (tinned foods) at markedly higher concentrations than the safe threshold laid down for hypersensitive patients. Some foodstuffs cooked in stainless-steel utensils react with the metal and thus contain much more nickel than when enamel or aluminium saucepans are used. Among the natural organic acids, which may be responsible for dissolving stainless-steel, oxalic acid is the most active at equivalent concentrations.

Source:
Contact Dermatitis. 1979 Jan;5(1):43-5.  Nickel in food: the role of stainless-steel utensils., Brun R.

The normal daily intake of nickel by American adults is about 0.3 to 0.6mg. About 1 to 10% of nickel in food is absorbed in the gastrointestinal tract and the remainder is excreted. The nickel content of food is partially determined by the components of the soil in which the food was grown, pesticides used on it and the equipment used in the handling of the food. Nickel in food may vary considerably from region to region. Certain foods are routinely high in nickel content. Legumes, nuts, grains, chocolate and certain canned fish are among the foods high in nickel. In summary, ingested nickel from food, beverages or cooking utensils can cause a flare of dermatitis is some individuals. Accordingly, motivated persons may see improvement if they can reduce their ingestion of nickel through dietary change.

These articles demonstrate that various “commercially pure” and alloyed titanium samples contain a low but consistent percentage of contaminants that are associated with allergies. Traces of nickel, related to the manufacturing process were found in titanium materials used for surgical implants. Nickel allergic patients may develop hypersensitivity reactions due to this low nickel content.

"Under certain circumstances, these small amounts may be enough to trigger allergic reactions in patients suffering from corresponding allergies, such as a nickel, palladium or chromium allergy.”

Titanium allergy or not? “Impurity” of titanium implant materials, 2010
Article here

"The low nickel content in the implant material results from the production process. The nickel atoms are in solid solution in the titanium lattice. Nickel allergic patients may develop hypersensitivity reactions even due to this low nickel content. Hence, this reaction may be falsely attributed to the titanium material itself. "

Allergic potential of titanium implants, 2005
Abstract here

"Fifteen commercial titanium dental implant systems were analyzed using inductively coupled plasma-mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). All investigated implant samples contained fractions of nickel, chromium, antimony and niobium."

Impurities in commercial titanium dental implants – A mass and optical emission spectrometry elemental analysis, 2022
Article here

“According to our results, all implants immersed in human saliva already released metallic particles of titanium, nickel and vanadium after 7 days.”

Corrosion behavior of dental implants immersed into human saliva: preliminary results of an in vitro study, 2017
Article here

Nickel is released preferentially from orthopaedic devices, so even though there is only a trace it may be released first. More research in the area is needed but an interesting study looks at cobalt chromium hips which were removed and studied. Nickel makes up around 13% of this alloy but was not found in the corroded hips as it was the first metal to have corroded and moved into the body.

In vivo corrosion of 316L stainless-steel hip implants: morphology and elemental compositions of corrosion products, 1998
Abstract here

In another recently published case report, a patient reported severe pain after titanium plate placement, containing only 0.1% nickel. There was no rash, no infection and no loosening but an MRI revealed swelling, patch testing identified a nickel allergy.

The hardware was removed, and the patient’s pain resolved completely.

Could a Titanium Ulnar Shortening Plate Trigger a Metal Allergy? A Case Report, 2019
Abstract here

Titanium does not penetrate unbroken skin either as an alloy or as a nano-particle. The first article concludes “patch testing with the available Ti preparations for detection of type IV hypersensitivity is currently inadequate”. The second article looks at a symptomatic patient with no patch test reactions to metals. The patient subsequently tested positive in a lymphocyte transformation test (like MELISA), the metals were removed and the symptoms resolved

Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity, 2016
Abstract here

Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema, and T-cell hyperresponsiveness in vitro: case report and review of the literature, 2006
Abstract here

Blood based testing may give an more accurate measurement of titanium reactions than patch testing. Titanium particles are too large to penetrate the skin and the relationship between skin sensitivity and systemic hypersensitivity is ill-defined. The Mayo Clinic conducted a decade of patch testing and found no positive reactions to titanium despite published cases of titanium hypersensitivity.

If a health problem start after you have received a titanium implant it is possible that you are hypersensitive to titanium. You can take a MELISA test for titanium hypersensitivity through one of the clinics we cooperate with or send a sample to a laboratory. If you are planning to have a test before receiving a titanium implant it is advised to find out the exact composition of the implant. Vanadium, aluminium and other metals are sometimes added to improve the properties of titanium implants, and allergy to these metals can also be tested.

• Orthopedic and surgical implants.
• Pacemakers and implanted defibrillators.
• Dentistry: in dental implants and as a colour pigment in composites.
• Sunscreen agents: finely ground titanium dioxide blocks the harmful ultraviolet rays from the sun.
• Confectionery: makes candy look brighter and adds a crunchy coat to, for example, chewing gum.
• Cosmetics: used to brighten and intensify the colour of make-up. It is regularly found in eyeshadow, blusher, nail polish, lotions, lipstick and powder.
• Toothpaste: used as a pigment agent to make the toothpaste whiter.
• Medication and vitamin supplements may also get their white coating from titanium dioxide.
• Piercing & jewellery: for example watches and all types of body piercing. Fewer people are allergic to titanium than, for instance, to nickel.

You can check our Patient testimonials page HERE and read about people who recovered from their serious health problems after being diagnosed with titanium hypersensitivity and having their titanium implants removed.

Some researchers believe that titanium allergy does not exist and patients are reacting to the impurities in titanium, for instance nickel, chromium and cadmium. Several studies show that titanium alloys contain traces of nickel (0.03%) as a result of the production process. This can pose trigger health problems in patients with nickel allergy, and also mean that a reaction may be falsely attributed to titanium itself. You can read more about nickel in titanium implants HERE.

The articles Hypersensitivity to titanium: Clinical and laboratory evidence and LTT-MELISA is clinically relevant for detecting and monitoring metal sensitivity published in 2006 can be downloaded from our Article page HERE.

In the former article fifty-six (56) patients who had developed clinical symptoms after receiving titanium-based implants were tested in MELISA against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA.

Of the 56 patients, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA reactivity.

The conclusion of the article is that these data clearly demonstrate that titanium can induce clinically relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants. Below, you will also find several articles which discuss the issue of corrosion of titanium implants and possible reactions due to hypersensitivity.