Articles dealing with titanium allergy

Published: 11/12/2015

Allergic contact dermatitis caused by titanium screws and dental implants

Maki Hosoki,  Keisuke Nishigawa, Youji Miyamoto, Go Ohe, Yoshizo Matsuka


Patients: Titanium has been considered to be a non-allergenic material. However, several studies have reported cases of metal allergy caused by titanium-containing materials. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. He exhibited allergic symptoms (eczema) after ortho-pedic surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. After removal of dental implants, the eczema disappeared completely. Discussion: Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. Most of the usage of titanium is in the form of titanium dioxide. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. Conclusions: In general, allergic risk of titanium material is smaller than that of other metal materials. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions. 


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Published: 13/02/2015

Hypersensitivity Reactions to Titanium: Diagnosis and Management

Megan M. Wood,  Erin M. Warshaw


This is a must read article for anybody with concerns about titanium exposure, or who has been told that titanium allergy doesn't exists. The article provides a review of literature on reported cases of titanium allergy, diagnostic tests, such as MELISA, and approach to management. Importantly, it also raises the issue that all commercially pure titanium has been shown to contain a small percentage of detectable impurities, such as aluminum, beryllium, cadmium, cobalt, chromium, copper, nickel and others.


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Published: 14/01/2015

Increased frequency of delayed type hypersensitivity to metals in patients with connective tissue disease

Stejskal V, Reynoldsb T, Bjørklund, G. 


Background: Connective tissue disease (CTD) is a group of inflammatory disorders of unknown aetiology.

Patients with CTD often report hypersensitivity to nickel. We examined the frequency of delayed type

hypersensitivity (DTH) (Type IV allergy) to metals in patients with CTD.

Methods: Thirty-eight patients; 9 with systemic lupus erythematosus (SLE), 16 with rheumatoid arthritis(RA), and 13 with Sjögren’s syndrome (SS) and a control group of 43 healthy age- and sex-matched subjects were included in the study. A detailed metal exposure history was collected by questionnaire. Metal hypersensitivity was evaluated using the optimised lymphocyte transformation test LTT-MELISA®(Memory Lymphocyte Immuno Stimulation Assay).


Results: In all subjects, the main source of metal exposure was dental metal restorations. The majority of patients (87%) had a positive lymphocyte reaction to at least one metal and 63% reacted to two or more metals tested. Within the control group, 43% of healthy subjects reacted to one metal and only 18% reacted to two or more metals. The increased metal reactivity in the patient group compared with the control group was statistically significant (P < 0.0001). The most frequent allergens were nickel, mercury, gold and palladium.


Conclusions: Patients with SLE, RA and SS have an increased frequency of metal DTH. Metals such as nickel, mercury and gold are present in dental restorative materials, and many adults are therefore continually exposed to metal ions through corrosion of dental alloys. Metal-related DTH will cause inflammation.


Since inflammation is a key process in CTDs, it is possible that metal-specific T cell reactivity is an etiological factor in their development. The role of metal-specific lymphocytes in autoimmunity remains an exciting challenge for future studies.


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Published: 01/12/2014

Metals as a Common Trigger of Inflammation Resulting in Non-Specific Symptoms: Diagnosis and Treatment

Stejskal, V


Background: The multiple symptoms of chronic fatigue syndrome (CFS) and fibromyalgia resemble those described in patients suffering from autoimmune/inflammatory syndrome

induced by adjuvants (ASIA). It has been suggested that chronic metal-induced inflammation might play a role both in CFS and fibromyalgia as well as in ASIA. Humans are exposed to metals mainly through the release of metal ions from corroding dental restorations and orthopedic implants,

food, vaccines and jewelry. Metals readily bind to sulphur and other groups in the mitochondria, enzymes and cell proteins. Metal-bound proteins are recognized by the immune system of

susceptible subjects and might trigger an abnormal immune response, including allergy and autoimmunity.

Objectives: To study three subjects with CFS and two with fibromyalgia, all of whom suspected metal exposure as a trigger for their ill health.

Methods: We measured delayed-type hypersensitivity to metals (metal allergy) using a validated lymphocyte transformation test, LTT-MELISA.. All patients except one were sensitized to metals present in their dental restorations. The remaining patient reacted to metals in his skull implant.

The removal of sensitizing metals resulted in long-term health improvement. Nine healthy controls matched for gender and age showed only marginal reactivity to the metals tested.

Conclusions: Patients with CFS and fibromyalgia are frequently sensitized to metals found in the environment or used in dentistry and surgery. This allergy to metals might initiate or aggravate non-specific symptoms in metal-sensitized patients.



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Published: 14/11/2014

Titanium allergy: a literature review

Manish Goutam, Chandu Giriyapura, Sunil Kumar Mishra, and  Siddharth Gupta

Titanium has gained immense popularity and has successfully established itself as the material of choice for dental implants. In both medical and dental fields, titanium and its alloys have demonstrated success as biomedical devices. Owing to its high resistance to corrosion in a physiological environment and the excellent biocompatibility that gives it a passive, stable oxide film, titanium is considered the material of choice for intraosseous use. There are certain studies which show titanium as an allergen but the resources to diagnose titanium sensivity are very limited. Attention is needed towards the development of new and precise method for early diagnosis of titanium allergy and also to find out the alternative biomaterial which can be used in place of titanium. A review of available articles from the Medline and PubMed database was done to find literature available regarding titanium allergy, its diagnosis and new alternative material for titanium.


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Published: 04/08/2014

Metal allergy to titanium bars after the nuss procedure for pectus excavatum

Sakamoto K, Ando K, Noma D

The Nuss procedure requires the placement of metal bars in the chest cage to repair pectus excavatum. Metal allergies are one of the complications associated with this procedure. Given that titanium is a biocompatible metal, it induces few allergic symptoms. Therefore, titanium bars are recommended for patients with metal sensitivity. We report the case of a 17-year-old boy with pectus excavatum who had a metal allergy to titanium bars, which occurred after the Nuss procedure. The administration of oral steroids is useful for treating metal allergies. Metal allergies to titanium bars are very rare; however, they can still occur.


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Published: 03/09/2013

Carbon Coated Implants as a New Solution for Metal Allergy in Early-Onset Scoliosis: A Case Report and Review of the Literature

Metal sensitivity is common and is a consideration when choosing orthopedic implants in susceptible individuals. The sensitivity often is to nickel, cobalt, or chromium, and titanium is used as a safe alternative. However, when the allergy is also to titanium, solutions may be much more difficult. This case describes an innovative solution to a complex metal allergy that includes titanium in a child requiring spinal instrumentation for early-onset scoliosis.


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Published: 19/08/2013

Allergy related to dental implant and its clinical significance.

TP Chaturvedi

Clin Cosmet Investig Dent. 2013 Aug 19;5:57-61.

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Published: 01/07/2013

Hypersensitivity to Titanium: A Less Explored Area of Research

Vasantha Vijayaraghavan, Ajay V. Sabane, and K. Tejas

Titanium is considered as an excellent biocompatible metal and it is used in implant dentistry. Literature suggests that Ti can induce clinically relevant hypersensitivity and other immune dysfunctions in certain patients chronically exposed to this reactive metal. At the same time, no standard patch test for Ti has so far been developed, and positive reactions to Ti have therefore only rarely been demonstrated with skin testing. This article reports about the corrosion of dental implants, their significance when hypersensitivity is present, and the literature available till date regarding hypersensitivity of titanium.


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Published: 25/06/2013

Hypersensitivity to suture anchors.

Goto M, Gotoh M, Mitsui Y, Tanesue R, Okawa T, Higuchi F, Shiba N.

Case Rep Orthop. 2013;2013:932167. doi: 10.1155/2013/932167. Epub 2013 Jul 11.

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Published: 04/06/2013

Titanium hypersensitivity. A hidden threat for dental implant patients?

Bilhan H, Bural C, Geckili O.

N Y State Dent J. 2013 Jun-Jul;79(4):38-43.

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Published: 09/01/2012

Hypersensitivity reactions to metallic implants – diagnostic algorithm and suggested patch test series for clinical use

Schalock PC, Menné T, Johansen JD, Taylor JS, Maibach HI, Lidén C, Bruze M, Thyssen JP.

Contact Dermatitis. 2012 Jan;66(1):4-19.

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Published: 27/10/2011

Titanium dioxide in our everyday life; is it safe?

Skocaj M, Filipic M, Petkovic J, Novak S

Radiol Oncol 2011; 45(4): 227-247.

Published: 03/10/2011

Titanium, Sinusitis, and the Yellow Nail Syndrome

Fredrik Berglund and Björn Carlmark

Biol Trace Elem Res. 2011 October; 143(1): 1–7.
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Published: 04/04/2011

Cutaneous and systemic hypersensitivity reactions to metallic implants.

Basko-Plluska JL, Thyssen JP, Schalock PC.

Dermatitis. 2011 Apr;22(2):65-79.

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