Metal hypersensitivity in total joint arthroplasty

This literature review was published in Ann Allergy Asthma Immunology in 2014.

Total joint arthroplasty procedures are increasing, as are the hypersensitivity reactions to these implants. We don't know if metal joint implants increase metal sensitivity or whether metal sensitivity leads to prosthesis failure.

How to diagnose metal hypersensitivity in total joint arthroplasty ?

Patch testing is still the most widely used method for determining metal hypersensitivity. However, there are no standardized commercial panels specific for total joint replacements available at this time.

In vitro testing has shown comparable results in some studies. However. its use in the clinical setting may be limited by the cost and need for specialized laboratories.

Hypersensitivity testing is generally recommended before surgery for patients with a reported history of metal sensitivity.

In cases of metal hypersensitivity-related joint failure, surgical revision ultimately may be required.

Evaluation of hypersensitivity reactions after total joint arthroplasty requires a systematic approach, including:

- careful history
- targeted evaluation with skin testing
- possibly in vitro studies


Metal hypersensitivity in total joint arthroplasty. Pinson ML1, Coop CA2, Webb CN2. Ann Allergy Asthma Immunol. 2014 Jun 13. pii: S1081-1206(14)00337-8. doi: 10.1016/j.anai.2014.05.012. [Epub ahead of print]

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A Mom's Thoughts on Food Allergies - ACAAI video

From ACAAI YouTube channel: Emily Kloser is the mom of two kids with food allergies. Both of her children are champion athletes. She shares what she's learned over the years about coping with food allergies.

Recombinant C1-esterase inhibitor Ruconest approved for hereditary angioedema (HAE)

The first recombinant C1-esterase inhibitor, Ruconest, was approved by the FDA as a new therapeutic option for hereditary angioedema (HAE). It is a treatment for acute episodes of HAE in adults and adolescents.

Ruconest is derived from the milk of genetically modified (transgenic) rabbits, and relieves HAE symptoms by restoring plasma C1-esterase inhibitor to normal levels. It is manufactured by Pharming Group in Leiden, the Netherlands.

HAE is rare and it affects an estimated 6,000 to 10,000 Americans. This explains why the FDA approval was obtained on the basis of a small trial with 44 patients. Ruconest-treated patients had a time to onset of symptom relief of 90 minutes vs. 152 minutes in placebo-treated patients (P=0.031).

Treatments for Hereditary Angioedema (HAE) (click to enlarge the image).


FDA approves new product to treat rare genetic disease

Atopic dermatitis - top articles for July 2014

Atopic dermatitis is a long-term (chronic) skin disorder that causes scaly and itchy rashes. It affects 17% of people and is a part of the allergic (atopic) march:

Allergic (atopic) march (click here to enlarge the image).

Here are my suggestions for some of the top articles about atopic dermatitis for July 2014:

Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant

Omalizumab has proven useful in treating asthma, but it may also prove valuable for other conditions, such as allergic rhinitis, food allergies, chronic urticaria, and AD

Atopic dermatitis 2.0: from the clinical phenotype to the molecular taxonomy and stratified medicine

Use of dilute bleach baths to treat atopic dermatitis - AAAAI Ask the Expert

Anterior nares and subungual spaces are important reservoir of skin-colonizing S aureus in early childhood eczema

Early-onset atopic dermatitis linked to increased risk of food allergy (age 2) and asthma (age 7)

Atopic dermatitis is very heterogenous: Natural course can be divided into subgroups w different clinical features

Management of Difficult-to-Treat Atopic Dermatitis - good review and a great stepwise approach outlined in the figure

CSACI statement on safety of topical calcineurin inhibitors in atopic dermatitis: no link between TCIs and malignancy

Many ways lead to Rome: a glance at the multiple immunological pathways underlying atopic dermatitis

Children with atopic dermatitis (eczema) are at increased risk of ADHD

Probiotics in the First 6 Months of Life Did Not Protect against Eczema and Allergy

Staphylococcus aureus Colonization in Atopic Dermatitis increases with age

New bleach-based body wash cleanser was helpful in Atopic Dermatitis

Over 20% of children in developed countries are affected by atopic dermatitis, prevalence continues to increase. Multiple genetic/environmental factors are involved in complex atopic dermatitis pathogenesis. Single therapy won't work. Recent AD research focused on FLG mutations, STAT6 polymorphisms, vitamin D pathway genes, protein profiles in vernix

Multiple factors affect the association between atopic dermatitis and contact sensitization - Use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients.

A review of the options for systemic therapy for atopic dermatitis

Steep rise in the burden of atopic dermatitis (AD) - up to 20% of children in developed countries now have it

Atopic Dermatitis Treatment - Illustrated (click to enlarge the image).

The articles were selected from my Twitter stream @Allergy and Google Reader RSS subscriptions. Some of the top allergy accounts on Twitter contributed links. I appreciate the curation provided by @JuanCIvancevich @AllergyNet @IgECPD4 @DrAnneEllis @AACMaven @AllergieVoeding @allergistmommy @mrathkopf @wheezemd.

Ear, Nose and Throat - Oxford Medical Exam Videos

This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the ear using an otoscope. It also demonstrates the anatomy of the tympanic membrane. All videos on this channel are linked to Oxford Medical Education ( This video was produced in collaboration with Oxford Medical Illustration - a department of Oxford University Hospitals NHS Trust. For more information, please visit

This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the mouth.

This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the nose. This part covers inspection only.

This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the nose, including use of a nasoendoscope.
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