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.
Testing for titanium hypersensitivity
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.
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.
Titanium: where to find it
- 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.
Do you suspect you have 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.
How about studies?
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.
How about patients’ stories?
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.
Publications dealing with titanium
A list of references can be found in our brochures:
Titanium implants – testing for allergy (dental)
Titanium in orthopedics
- Metal Allergens of Growing Significance: Epidemiology, Immunotoxicology, Strategies for Testing and Prevention, Forte G. et al. Inflamm Allergy Drug Targets. 2008 Sep;7(3):145-62.
- Full-mouth oral rehabilitation in a titanium allergy patient using zirconium oxide dental implants and zirconium oxide restorations. A case report from an ongoing clinical study.
Oliva X. et al. Eur J Esthet Dent. 2010 Summer;5(2):190-203.
- Study on patch test reagent for titanium. Nakajima K. Kokubyo Gakkai Zasshi. 2007 Jun;74(2):92-8.
- Allergies to dental metals. Titanium: a new allergen. Evrard L, Waroquier D, Parent D. Rev Med Brux. 2010 Jan-Feb;31(1):44-9.
- Implant failure due to Titanium hypersensitivity/allergy? – Report of a case SADJ February 2007
- Ultrafine titanium dioxide particles in the absence of photoactivation can induce oxidative damage to human bronchial epithelial cells Toxicology 2005
- Titanium particles stimulate bone resorption by inducing differentiation of murine osteoclast J Bone Joint Surg Am. 2001
- Immunohistochemical study of the soft tissue around long-term skin-penetrating titanium implants Biomaterials 1995
- In vitro corrosion of titanium Biomaterials. 1998
- Sensitivity to titanium. A cause of implant failure? Bone Joint Surg Br. 1991
- A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy Breast Cancer. 2001
- Biocompatibility of dental casting alloys Crit Rev Oral Biol Med. 2002
- Validity of MELISA® for metal sensitivity testing Neuro Endocrinol Lett. 2003
- Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis A. Schuh, et al. Der Orthopäde Volume 34, Number 4, 327-33
- Tissue reaction to bone plates made of pure titanium: a prospective, quantitative clinical study. A. Ungersboeck, et al. Journal of Materials Science: Materials in Medicine Volume 6, Number 4, 223-229
- Maternal exposure to nanoparticulate titanium dioxide during the prenatal period alters gene expression related to brain development in the mouse. M Shimizu et al.Particle and Fibre Toxicology 2009, 6:20