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  • Title: Mercury allergy
  • Subtitle: Metal exposure
  • Intro text editor:

    There are different forms of mercury, MELISA testing can differentiate between allergy to each form. Each type has its different properties and is therefore utilized in different ways in dentistry, medicine and industry or is present in the environment. Allergy to mercury is specific, so an individual can be allergic to inorganic mercury and not to phenylmercury. This is because the cells involved in Type IV allergic reaction –  memory T cells – will recognise a specific form of mercury. Naturally, it is possible that an individual can be allergic to all four types of mercury. In many cases it is important to locate the source of exposure to mercury that causes inflammation in the body, so that exposure can be stopped.
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    • List text:

      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.

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      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.

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      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.

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      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.

    • List text:

      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.

    • List title: Full body autoradiograph, List text:

      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.
  • References:
     

    Mouse fig1

    Figure 1. Distribution of radioactivity in male mouse 6 hours after intravenous injection of 203HgCl2. Magnification 2x.

    Mouse fig2

     Figure 2. Distribution of radioactivity in male mouse 24 hours after intravenous injection of 203HgCl2. Magnification 2x.

    mouse fig3

     Figure 3 and 4. Distribution of radioactivity in male mouse 2 days after intravenous injection of 203HgCl2. Magnification 2x and 9x (right).

     

     

     

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  • Title: Titanium hypersensitivity
  • Subtitle: Metal exposure
  • Intro text editor:

    Titanium hypersensitivity is uncommon and titanium is generally described as a bio-compatible material – yet laboratories using the MELISA technology have reported that about 4% of all patients tested to titanium will have titanium sensitivity (HERE). Recent data from a single MELISA laboratory shows 6% positive responses from 100 consecutive tests.

    Titanium and its main alloy (Ti 6Al 4V) are used in  orthopaedic and spinal surgery, in pacemakers and clips and coils as well as in dental titanium implants. It is generally seen as a bio compatible alternative to traditional alloys like stainless steel and cobalt chromium. Titanium dioxide is also used in food manufacturing, toothpaste and in the coating of some medications.

    Like all metals, titanium releases particles and ions through corrosion. These metals ions bind to proteins in the body. For those who react, the body’s immune system will attack this new protein/metal structure. This may start an immune reaction. The MELISA test a scientifically-proven test which can objectively test for the presence of titanium hypersensitivity and measure its severity.
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    • List title: Testing for titanium hypersensitivity, List text:

      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.

    • List title: Do you suspect you have titanium hypersensitivity?, List text:

      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.

    • List title: Titanium: where to find it, List text:
      • 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.
    • List title: How about patients’ stories?, List text:

      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.

    • List title: Titanium impurities, List text:

      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.

    • List title: How about studies?, List text:

      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.
  • References:

    Publications dealing with titanium

    A list of references can be found in our brochures:
    Titanium implants – testing for allergy (dental)
    Titanium in orthopedics

    Further studies

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  • Title: Nickel allergy
  • Subtitle: Metal exposure
  • Intro text editor:

    Nickel triggers more hypersensitive reactions than any other metal – up to 15% of the population, mostly women, suffers from some form of nickel allergy. Nickel is an exceptionally common metal. It may be found in dental restorations, orthopaedic prostheses, cosmetics, stainless steel cutlery, pots and pans, costume jewellery buttons and coins (including the Euro). Dermatologists have developed low nickel diets, mainly for the treatment of hand eczema, which aims to nickel-rich foods in the diet (e.g. cocoa, chocolate, broccoli, nuts). It may also be beneficial to supplement with vitamin C and iron. More details on low nickel diet can be found HERE.
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    • List title: Nickel in surgery, List text:

      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/

    • List title: Nickel content in food, List text:
      High content
      (more than 0.5 mg/kg)      		 Medium content
      (0.1-0.5 mg/kg)      		 Low content
      (less than 0.1 mg/kg)
      Mussels Various mushrooms Meat
      Dark chocolate Oysters Ham
      Cocoa powder Milk chocolate Sausage
      Liquorice Eggs Poultry
      Hazel nuts Raspberries Liver
      Almonds Blackcurrants Kidney
      Peanuts Cloudberries Cucumber
      Pistachio nuts nuts Kale Cheese
      Walnuts Parsley Milk
      Alfalfa seeds Garlic Yoghurt
      Brown beans Parsnip Onion
      Soy beans Horseradish Cabbage
      Pulses (green) Corn flour Beetroot
      Mung beans Rye Spinach
      Chickpeas Barley Corn
      Yellow peas Rice Flour
      Linseed   Salad
      Poppy seed   Carrots
      Oatmeal   Potatoes
      Wheat bran   Fish
      Oat bran   Squash
      Millet   Apple
      Soy flour   Pear
      Buckwheat   Strawberries
      As analysed by the Swedish Food Administration
    • List title: Further information on dietary nickel, List text:

      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.

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Metal sources

Metal exposure

The testing panels offered by MELISA laboratories have been devised to include the most commonly found allergy-causing metals in various metal alloys used in dentistry and surgery. Below you will find an overview of metals found in frequently used dental and orthopaedic restorations as well as an overview of metals present in our environment.

Laboratories offer different testing panels to help doctors and patients choose what to test. Typically, the choice of panels for testing will be based on the patient’s current exposure. Patients should contact their health care provider to find out the exact composition of their fillings, crowns, wires, pins and/or implants.

  • Dental restorations

    Various materials are used to manufacture fillings, crowns, pins, root-fillings, implants etc. Below are listed metals commonly present in dental restorations. Information about the exact type of restoration used should be included in the patient’s medical record.

    Amalgam/silver fillings: copper, mercury, nickel, silver, tin
    Crowns non noble: beryllium, cobalt, chromium, manganese, molybdenum, nickel, tungsten
    Crowns noble: gallium, gold, indium, iridium, palladium, platinum, ruthenium, silver
    Titanium implants: aluminium, titanium, vanadium, nickel (traces)

  • Orthopedic and body implants

    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: cobalt, chromium, manganese, molybdenum, nickel, tungsten
    Titanium (Ti-6Al-4V): aluminium, titanium, vanadium, nickel (traces)
    Nitinol: nickel, titanium
    Oxinium: niobium, zirconium (oxidized), chromium (traces),  tin (traces)

  • Food

    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

  • Piercings and jewellery

    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.

  • Medication

    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.

  • Cosmetics

    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.

  • Vaccines

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

  • Smoking

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

  • Occupational exposure

    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.

  • Residential exposure

    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.

  • Title: Metal exposure
  • Subtitle: Melisa
  • Intro text editor:

    The testing panels offered by MELISA laboratories have been devised to include the most commonly found allergy-causing metals in various metal alloys used in dentistry and surgery. Below you will find an overview of substances recommended for MELISA testing based on the composition of frequently used dental and orthopaedic restorations as well as an overview of metals present in our environment.

    Laboratories offer a variety of testing panels to help doctors and patients choose suitable tests. Find an example of testing panels HERE.
    Typically, the choice of panels for testing will be based on the patient’s current exposure. Patients should contact their healthcare provider to find out the exact composition of their fillings, crowns, wires, pins, implants, devices etc.

    Due to the manufacturing process, traces of various metals may be present in most materials/alloys used in dentistry and orthopedics. Trace quantities of more allergenic metals such as Nickel and Cobalt may seemingly initiate an allergic reaction in someone sensitised to the metals.

    Note that MELISA does not detect sensitivity to the alloyed material but sensitivity to individual components of the alloy.
  • Section title: Common sources of metal exposure
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    • List title: Dental restorations, List text:

      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)

    • List title: Orthopedic and body implants, List text:

      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)

    • List title: Food, List text:

      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

    • List title: Cosmetics, List text:

      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.

    • List title: Medication, List text:

      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.

    • List title: Vaccines, List text:

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

    • List title: Smoking, List text:

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

    • List title: Piercings and jewellery, List text:

      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.

    • List title: Occupational exposure, List text:

      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.

    • List title: Residential exposure, List text:

      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.
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