scholarly journals Patients with Intolerance Reactions to Total Knee Replacement: Combined Assessment of Allergy Diagnostics, Periprosthetic Histology, and Peri-implant Cytokine Expression Pattern

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Peter Thomas ◽  
Christine von der Helm ◽  
Christoph Schopf ◽  
Farhad Mazoochian ◽  
Lars Frommelt ◽  
...  
Keyword(s):  
Inflammatory Mediator ◽  
Symptom Relief ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Tissue Response ◽  
Diagnostic Strategies ◽  
Type Iv ◽  
Allergy Diagnostics ◽  
Total Knee ◽  
Lymphocytic Infiltrates

We performed a combined approach to identify suspected allergy to knee arthroplasty (TKR): patch test (PT), lymphocyte transformation test (LTT), histopathology (overall grading; T- and B-lymphocytes, macrophages, and neutrophils), and semiquantitative Real-time-PCR-based periprosthetic inflammatory mediator analysis (IFNγ, TNFα, IL1-β, IL-2, IL-6, IL-8, IL-10, IL17, and TGFβ). We analyzed 25 TKR patients with yet unexplained complications like pain, effusion, and reduced range of motion. They consisted of 20 patients with proven metal sensitization (11 with PT reactions; 9 with only LTT reactivity). Control specimens were from 5 complicated TKR patients without metal sensitization, 12 OA patients before arthroplasty, and 8 PT patients without arthroplasty. Lymphocytic infiltrates were seen and fibrotic (Type IV membrane) tissue response was most frequent in the metal sensitive patients, for example, in 81% of the PT positive patients. The latter also had marked periprosthetic IFNγexpression. 8/9 patients with revision surgery using Ti-coated/oxinium based implants reported symptom relief. Our findings demonstrate that combining allergy diagnostics with histopathology and periprosthetic cytokine assessment could allow us to design better diagnostic strategies.

Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Medial Displacement Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis

2016 ◽  
Vol 106 (sp1) ◽  
pp. 11-11
Author(s):  
Stephen J. Kriger ◽  
Shontal A. Behan ◽  
Parth J. Bhakta ◽  
Nicholas G. Bruning ◽  
Brennan A. Menninger ◽  
...  
Keyword(s):  
Wound Healing ◽  
Contact Dermatitis ◽  
Hypersensitivity Reaction ◽  
External Fixation ◽  
Patch Test ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Diagnostic Tools ◽  
First Metatarsal ◽  
Type Iv

INTRODUCTION AND OBJECTIVES: Due to its inert character and desired biocompatibility, titanium (Ti) implants have been universally accepted as safer alternatives to the previous conventional orthopedic hardware implants. However, a recent emergence of Type IV hypersensitivity reactions to Ti have displayed symptoms that include eczema, contact dermatitis, prolonged fever, sterile osteomyelitis, and impaired fracture and wound healing. The following case presents a patient with postoperative incision dehiscence and devascularization of cortical surfaces in contact with Ti hardware after undergoing a medial displacement calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis. To our knowledge, this is the only reported case of an allergic reaction to a Ti implant in the foot or ankle in the United States. METHODS: Diagnostic tools to confirm a Ti hypersensitivity reaction include a patch test and lymphocyte transformation test. The lymphocyte transformation test can be utilized if a false negative patch test is suspected. Potential treatment options include immunosuppressants, removal or substitution of the Ti hardware, and external fixation. RESULTS: In this case, the patient's allergy to Ti was confirmed with a patch test, and all hardware was subsequently removed with no other complications. CONCLUSIONS: A hypersensitivity reaction to Ti should remain a differential diagnosis for a patient presenting with symptoms such as prolonged fever, contact dermatitis, sterile osteomyelitis, and impaired wound healing. Preoperative diagnostic tools, such as the patch test, can be utilized to prevent allergic reactions from occurring. Treatments for Ti hypersensitivity should be tailored to fit the patient's needs and can include removal or substitution of the Ti hardware, external fixation, and immunosuppressants.

Diagnostic methods for confirming drug-allergy – the lymphocyte transformation test in dermatology

2008 ◽  
Vol 149 (24) ◽  
pp. 1107-1114
Author(s):  
Sarolta Makó ◽  
Réka Lepesi-Benkő ◽  
Márta Marschalkó ◽  
Gyöngyvér Soós ◽  
Sarolta Kárpáti
Keyword(s):  
Drug Allergy ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Diagnostic Methods

A gyógyszermellékhatások felismerése és a tüneteket kiváltó gyógyszer oki szerepének bizonyítása komoly felkészültséget igényel. E közlemény célja a gyógyszerallergiás reakciók diagnosztikai lehetőségeinek rövid áttekintése és a lymphocytatranszformációs teszt gyógyszer-hiperszenzitivitási reakciókban való bizonyító szerepének bőrgyógyászati szempontok szerinti értékelése. A lymphocytatranszformációs teszt azon a megfigyelésen alapul, hogy a gyógyszerrel való első találkozáskor kialakult antigénspecifikus T-sejtek osztódni kezdenek az antigénnel való in vitro megismételt találkozás után. A szenzibilizációt az osztódó T-sejtekbe történő 3 H-timidin-beépülés mértéke jelzi. A hatóanyag-specifikus T-sejtek szinte mindig részt vesznek a gyógyszerallergiás reakciókban, ezért a vizsgálat előnye, hogy sok gyógyszernél és különböző immunreakciók eseteiben egyaránt jól alkalmazható. Hátránya a munkaigényesség, valamint az, hogy specificitásának és szenzitivitásának bizonyításához hiányoznak a széles körű, nagy beteganyagon elvégzett tanulmányok. Emiatt a teszt nem egyértelműen elfogadott a gyógyszerallergia igazolására. Hiányosságai ellenére azonban, jobb prediktív értékű egyéb vizsgálatok hiányában, a lymphocytatranszformációs tesztnek fontos szerepe van a gyógyszerallergiák diagnosztizálása terén.

scholarly journals TO010A NEW IMMUN-TOXICOLOGICAL TEST TO DETECT POLYSULFONE HYPERSENSITIVITY IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Joachim Beige ◽  
Ralph Wendt ◽  
Despina Rüssmann ◽  
Karl-Peter Ringel
Keyword(s):  
False Negative ◽  
False Negative Rate ◽  
Lymphocyte Transformation ◽  
Clinical Problem ◽  
Lymphocyte Transformation Test ◽  
Laboratory Research ◽  
Humoral Immune ◽  
Before And After ◽  
Positive Results

Abstract Background and Aims Incompatibility of dialysis procedure due to hypersensitivity against dialyzer material which currently is mainly based on polysulfone and derivatives can not be assessed by routine laboratory tests. Although the frequency of such symptoms is suspected to be low (below 2%) such resembles an important clinical problem because dialysis procedures are frequently accompanied by symptoms of non-tolerability with reasons not being entirely clear while circulatory reasons are suspected to play a major role. Method To enlighten the role of polysulfone hypersensitivity, we adapted known standardized material immune-toxicological tests (lymphocyte transformation test, basophil degranulation test) to the specific conditions of dialysis and polysulfone material sensitivity. We developed a method of polysulfone micronisation and measured humoral immune response of isolated patient´s lymphocytes when incubated with polysulfone dispersion. Results 39 samples from 103 patients with suspected polysulfone hypersensitivity showed positive results for type 1 (n=19), type 4 (n=18) or both type (n=2) reactions. There were no significant differences in the level of stimulation measured for DI, SI and lymphogenesis before and after dialysis (average delta -0.4; -0.28; - 1.74, p = 0.71; 0.34; 0.37) and with different dialyzer materials (Tab. 1). Patients with pos. type 4 results (LTT and lymphogenesis) showed highly correlated results in either LTT or lymphogenesis test (Fig. 1, R=0.87, p<0.0001). 8 out of 8 samples from patients with repeated test on different PS showed positive results on either PS. One patient tested positive on PS showed no hypersensitivity with another non-PS (PMMA) material. Conclusion This is the first methodological report showing plausible in-vitro results of patients samples concerning polysulfone intolerance. On the first superficial view, a “false-negative” rate of 60% looks rather disappointing, because all samples derived from patients with suspicion of PS hypersensitivity. However, due to the clinical variability of intolerance symptoms and the high prevalence of any problems after HD initiation, mainly of circulatory origin after initiating extracorporeal circuit, this rate may obviously express the true frequency of isolated PS material hypersensitivity in suspected patients. Alternative pathophysiological pathways of material sensitivity like complement activation, remain to be elucidated and incorporated into a comprehensive future testing panel. Further clinical and laboratory research is needed to define true polysulfone hypersensitivity and to enlighten the field of hypothetic subclinical material incompatibility in patients with impaired dialysis tolerability.

Reexamination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease

1991 ◽  
Vol 88 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Margaret M. Mroz ◽  
Kathleen Kreiss ◽  
Dennis C. Lezotte ◽  
Priscilla A. Campbell ◽  
Lee S. Newman
Keyword(s):  
Blood Lymphocyte ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Chronic Beryllium Disease ◽  
Beryllium Disease
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