Usefulness of lymphocyte transformation test and in vitro cytokine release in differentiating between independent and cross-reacting nickel/palladium allergy.

Florian Kapp,Burkhard Summer,Peter Thomas

doi:10.1002/iid3.329

Florian Kapp, Burkhard Summer + Show 1 more

Open Access

https://doi.org/10.1002/iid3.329

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Abstract

BackgroundOften concomitant patch test (PT) reactivity to palladium (Pd) and nickel (Ni) is found.ObjectivesTo determine whether lymphocyte transformation test (LTT) could be useful in discrimination between cross‐reacting or distinct PT results, and to compare the results with in vitro cytokine production upon Pd or Ni stimulation.Materials and MethodsThe study population consisted of two groups: 13 individuals with Pd PT reactions (10 with concomitant Ni PT reaction, 3 individuals with only Pd PT reactivity) and 10 Ni/Pd PT negative individuals. LTT and assessment of cytokine release (interferon‐gamma, interleukin‐5 [IL‐5], IL‐8, IL‐17A, tumor necrosis factor alpha) by cytometric bead assay were performed.ResultsAll 10 patients with positive PT to Ni and Pd showed positive LTT to Ni (P < .05) as compared with the 10 Pd/Ni PT negative patients—but had no significant LTT reaction to Pd. In all, 9 out of 10 Pd/Ni PT negative patients were also LTT negative to Ni and 10 out of 10 to Pd. In the 3 only Pd PT reactors 2 out of 3 remained LTT negative to Ni and 0 out of 3 to Pd. As a major finding, cytokine production gave clearly enhanced IL‐5 response to Ni in Ni PT positive individuals (P < .05), whereas Pd PT reactivity was not linked with such enhanced IL‐5 production in vitro to Pd.ConclusionsPd and Ni sensitization are mostly found concomitantly, and cross‐reactivity is questioned. By different LTT reactions and particularly IL‐5 production in vitro, predominant Ni sensitization becomes more evident.

Highlights

The main exposure of the general population to palladium (Pd) is by jewelry and dental applications
Muris et al[6] reported that by use of a different patch test (PT) preparation, that is, Na2PdCl4, there was a substantial gain in positive reactions
The “gold“ standard method to confirm the clinical suspicion of metal allergy is the PT

Summary

| INTRODUCTION

The main exposure of the general population to palladium (Pd) is by jewelry and dental applications. Hindsen et al[11] reported the in vivo correlate of such cross‐reactivity by systemic Ni administration. Both authors discuss that primary sensitization was to Ni. In addition, Ni and Pd have another property in common as they are described to induce T‐cell activation by direct binding to TLR4, according to Rachmawati et al and Schmidt et al[12,13] and Pd allergy has been a subject of debate for decades and its prevalence is supposed to be underestimated.[14,15,16] Muris et al[6] reported that by use of a different patch test (PT) preparation, that is, Na2PdCl4, there was a substantial gain in positive reactions. The aim of our study was (a) to evaluate a potential link between Ni/Pd reactivity in PT and LTT and (b) to determine whether in vitro cytokine response to Ni and Pd might further distinguish cross‐reacting from isolated single Pd sensitization

| MATERIALS AND METHODS

| RESULTS

Findings

| DISCUSSION