Published: 03/11/2013

Mercury-induced inflammation: Yet another example of ASIA syndrome

Stejskal V. Isr Med Assoc J. 2013 Nov;15(11):714-5.
Excerpt from the editorial: In this issue of IMAJ, the occurrence of a plethora of psychoneuro-immunological symptoms (also called ASIA or Shoenfeld syndrome) is described in three different patients. Segal and co-authors present an 85 year old woman who underwent total hip replacement and experienced side effects. Patch testing showed hypersensitivity to cobalt and chromium. The metal components were replaced with ceramics and the symptoms disappeared. The second case, reported by Pineda and team, concerns a 53 year old woman with breastimplants. Since silicone was found in herlymph nodes, removal of her implants was recommended. Finally, Cruz-Dominguez et al. present the thought-provoking case of a patient exposed subcutaneously to a large amount of metallic mercury. The case illustrates that mercury might act as a potent adjuvant, inducing ASIA.


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Published: 01/10/2013

Metal-induced inflammation triggers fibromyalgia in metal-allergic patients

Stejskal V, Öckert K, Bjørklund G. Neuroendocrinol Lett 2013; 34(6):559–565.
This article studied the frequency and clinical relevance of metal allergy in 15 fibromylagia (FM) patients. Metal allergy was measured by a lymphocyte transformation test, MELISA®. Ten healthy age matched women were used as controls. Reduction of metal exposure in the FM patients was achieved by replacement of dental metal restorations and by the avoidance of known sources of metal exposure. Objective health assessment was performed 5 years after treatment. Subjective health assessmentwas established by a questionnaire, completed 2, 5 and in some cases 10 years after the start of the study. Follow-up MELISA was also performed. All FM patients tested positive to at least one of the metals tested. Objective examination 5 years later showed that half of the patients no longer fulfilled the FM diagnosis, 20% had improved and the remaining 30% still had FM. All patients reported subjective health improvement.

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Published: 01/12/2011

Metal sensitivity in patients with orthopaedic implants: a prospective study

Frigerio, E., Pigatto, P. D., Guzzi, G. and Altomare, G. (2011). Contact Dermatitis, 64: 273–279. 
A total of 100 patients referred for total hip or total knee arthroplasty were assessed for metal allergy preoperatively and then at 1 year post-implantation by means of patch tests. In a pilot study, 20 patients also underwent both patch testing and a lymphocyte transformation test (LTT-MELISA®) for the same metals.  Of 31/100 patients with an apparent history of nickel sensitivity determined during preoperative assessment of subjects, 12 tested negative on both tests, and 4 with a negative history of nickel sensitivity tested positive. One year post-implantation (72 patients), 5 patients who had  initially tested negative for a metal allergy became positive for at least one or more metal constituents of the prosthesis on at least one or the other test. Given the discrepancies between the information obtained while taking patient histories and test results, preoperative history-taking alone appears to be insufficient for identifying patients with metal sensitivity. Moreover, the increase in the percentage of patients who tested positive for metal sensitivity 1 year postimplantation suggests the possibility of prosthesis-induced sensitization. Therefore, objective determination of metal sensitivity at preoperative assessment should be considered in planning arthroplasty intervention, as it would help the surgeon in selecting the most appropriate prosthesis for the patient and could benefit implant performance.

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Published: 27/10/2011

Health observations before and after amalgam removal Paul Engel, Lyss-Strasse 24, 2560 Nidau, Switzerland
Dr Engel was asked by 90 of his patients to replace their dental amalgams with another material - mostly composites and compomere. In this article, he reports how their health was affected afterwards.

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Published: 20/04/2011

Orthopaedic surgery in a patient with metal sensitivity

Adala R, Chakravarthy M, Srinivas V, Pai S. J Cutan Aesthet Surg. 2011 Jan-Apr; 4(1): 67-68.
When patients with hypersensitivity to metals present for surgery where metallic prostheses are required, problems arise about the choice of the prosthesis. We present a case of a patient with proven metal sensitivity to cobalt, chromium, nickel and molybdenum, who required bilateral total knee replacement for osteoarthritis and was successfully managed by a titanium prosthesis. The MELISA® test in the patient revealed strongly positive allergy to nickel and chromium and weakly positive results for cobalt and molybdenum. Based on the MELISA® report, the implant to be used in our patient was chosen to be of titanium and a polyethylene insert was used to avoid the possible metal allergy. Our case demonstrated the need for proper investigation with tests such as MELISA® and also the need for proper history in all such patients.

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Published: 14/10/2010

The role of environmental factors in autoimmune thyroiditis

Hybenova M, Hrda P, Prochazkova J, Stejskal V, Sterzl I. Neuro Endocrinol Lett. 2010;31(3):283-9.
Environmental factors can play an important role in the development of autoimmune
thyroiditis (AT) and other autoimmune diseases. This article reviews the
role of heavy metals and infectious agents in AT. It has been found that patients with AT and other autoimmune diseases, such as multiple sclerosis, psoriasis, systemic lupus erythematosus and atopic eczema, show increased lymphocyte reactivity in vitro to inorganic mercury, nickel and other metals compared to healthy controls. The important source of mercury is dental amalgam. Replacement of amalgam in mercury-allergic subjects resulted in improvement of health in about 70% of patients.

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Published: 09/10/2006

Micro analysis of metals in dental restorations as part of a diagnostic approach in metal allergies

Muris J, Feilzer A. Neuro Endocrinol Lett 2006; 27(Suppl 1): 49-52
This paper describes a diagnostic approach from a dentist's point of view, which enables analysis of metals in a patient's oral cavity. If metal allergy is suspected, a micro analysis can be used to determine which metals are present in the restorations. Two patients with nickel allergy are described where removal of nickel-containing materials resulted in the marked alleviation of symptoms and improvement of health.

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Published: 05/09/2006

Diagnosis and treatment of metal-induced side-effects

Stejskal V, Hudecek R, Stejskal J, Sterzl I. Neuro Endocrinol Lett 2006; 27(Suppl 1): 7-16
This article discusses both patch testing and in vitro blood testing for the diagnosis of metal allergy. Both tests were in 15 patients who suffered from clinical metal sensitivity in addition to other health problems. The concordance of the two tests was good but MELISA® detected more metal allergies than patch test. The removal of incompatible dental material resulted in long-term health improvement in the majority of patients.

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Published: 05/09/2006

Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis

Sterzl I, Prochazkova J, Hrda P, Matucha P, Bartova J, Stejskal V. Neuro Endocrinol Lett 2006; 27(Suppl 1): 25-30
The impact of dental amalgam removal on the levels of anti- thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies was studied in patients with autoimmune thyroiditis (AT) with and without mercury allergy. Thirty-nine patients with AT were tested by MELISA® for allergy to inorganic mercury. Patients were divided into two groups: Group I (n = 12) with no hypersensitivity to mercury and Group II (n = 27) with hypersensitivity to mercury. Amalgam fillings were removed from the oral cavities of 15 patients with hyperensitivity to mercury (Group IIA) and left in place in the remaining 12 patients (Group
IIB). The laboratory markers of AT, anti-TPO and anti-Tg autoantibodies were
determined in all groups at the beginning of the study and six months later. Compared to levels at the beginning of the study, only patients with mercury hypersensitivity who underwent amalgam replacement (Group IIA) showed a significant decrease in the levels of both anti-Tg (p=0.001) and anti-TPO (p=0.0007) autoantibodies. The levels of autoantibodies in patients with or without mercury hypersensitivity (Group I and Group IIB) who did not replace amalgam did not change.

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Published: 04/09/2006

Hypersensitivity to titanium: Clinical and laboratory evidence

Muller K, Valentine-Thon E. Neuro Endocrinol Lett 2006; 27(Suppl 1): 31-35
Fifty-six patients who had developed clinical symptoms after receiving titanium-based implants were tested in the MELISA® test 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. Following removal of the implants, all 54 patients showed remarkable clinical improvement.

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Published: 09/08/2006

LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity

Valentine-Thon E, Muller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M. Neuro Endocrinol Lett 2006; 27(Suppl 1): 17-24
Blood from 700 consecutive patients was tested against a total of 26 metals in the validated LTT-MELISA®. For reproducibility testing, 391 single metal tests from 63 patients were performed in parallel. Finally, to assess clinical relevance, 14 patients with known metal exposure showing local (dry mouth, Oral Lichen Planus, Burning Mouth Syndrome, eczema) and/or systemic (chronic infections, fatigue, autoimmune disorders, central nervous system disturbances, depression) effects were tested and their cases reported.

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Published: 06/08/2006

Increased levels of transition metals in breast cancer tissue

Ionescu J, Novotny J, Stejskal V, Latsch A, Blaurock-Busch E, Eisenmann-Klein M. Neuro Endocrinol Lett 2006; 27(Suppl 1): 36-39
The content of heavy and transition metals in 20 breast cancer biopsies and 8 healthy biopsies was assessed by a standardized Atomic Absorption Spectrofotometry and Inductive Coupled Plasma–Mass Spectroscopy technique. A highly significant accumulation of iron (p<0.0001), nickel (p<0.00005), chromium (p<0.00005), zinc (p<0.00001), cadmium (p<0.005), mercury (p<0.005), and lead (p< 0.05) was found in the cancer samples when compared to the control group. The data suggest that pathological accumulation of transition metals in breast tissue may be closely related to the malignant growth process.

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Published: 27/07/2006

A novel lymphocyte transformation test (LTT-MELISA®) for Lyme borreliosis

Valentine-Thon E, Ilsemann K, Sandkamp M. Diagn Microbiol Infect Dis. 2006 Jul 27
In this study, we describe the development and clinical relevance of a novel LTT using a validated format (MELISA®) together with well-defined recombinant Borrelia-specific antigens. From an initial screening of 244 patients with suspected Borrelia infection or disease, 4 informative recombinant antigens were selected: OspC (Borrelia afzelii), p41-1 (Borrelia garinii), p41-2 (B. afzelii), and p100 (B. afzelii). Thereafter, 30 seronegative healthy controls were tested in LTT-MELISA® to determine specificity, 68 patients were tested in parallel to determine reproducibility, and 54 lymphocyte-reactive symptomatic patients were tested before and after antibiotic therapy to assess clinical relevance. Most (86.2%) of the 36.9% (90/244) LTT-MELISA® positive patients were seropositive and showed symptoms of active LB. Specificity was 96.7% and reproducibility 92.6%. After therapy, most patients (90.7%) showed negative or markedly reduced lymphocyte reactivity correlating with clinical improvement. This novel LTT-MELISA® assay appears to correlate with active LB and may have diagnostic relevance in confirming LB in clinically and serologically ambiguous cases.

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Published: 02/02/2006

Metal-specific lymphocyte reactivity is downregulated after dental metal replacement.

Yaqob A, Danersund A, Stejskal VD, Lindvall A, Hudecek R, Lindh U. Neuro Endocrinol Lett. 2006 Feb-Apr;27(1-2):189-97.
This study was done to evaluate the results and clinical relevance of an optimized lymphocyte proliferation test, MELISA, for metal-induced inflammation in patients with CFS-like symptoms. The treatment of patients consisted of the replacement of incompatible dental materials (RID) together with supportive anti-oxidant therapy.
513 patients were tested by MELISA at the beginning of the study. Out of this group, 248 patients were available for follow-up MELISA after RID. Replacement of incompatible dental materials resulted in down-regulation of metal-induced lymphocyte sensitivity in vitro, as well as in the improvement of health status of majority of patients with unspecific CFS-like symptoms.

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Published: 27/11/2005

Sensitization to inorganic mercury could be a risk factor for infertility

Podzimek S, Prochazkova J, Bultasova L , Bartova J, Ulcova-Gallova Z, Mrklas L, Stejskal V, Neuroendocrinology Letters, 2005:26(4);277-282
Heavy metals can negatively influence the reproduction due to the fact that they are able to impair the immune reactions including autoantibody production in susceptible individuals. used by altered pathologic immune reaction. The diagnosis of metal allergy was performed by the lymphocyte proliferation method modified for metals. In supernatants of tissue cultures of lymphocytes without the antigen stimulation and after stimulation with mercury chloride, the in vitro production of gamma interferon and antisperm antibodies was studied by ELISA. More than 50% of patients were reacting to mercury, iron, aluminium and silver as mean by lymphocyte reactivity. When compared the lymphocyte reaction in patients with and without mercury allergy we found that the lymphocytes of patients with mercury intolerance produced less gamma interferon and more antisperm antibodies in supernatants after mercury stimulation of their lymphocytes.In patients with metal intolerance diagnosed by the MELISA® test the release of metal ions from dental materials can be one of the stimulating factors which may adversely affect fertility.

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