Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?

Abstract

Nickel is one of the most common contact allergens worldwide; it is used as the main component of the devices used for atrial septal defects (ASDs) and patent foramen ovale (PFO) closure. Developing nickel hypersensitivity after PFO/ASD occlusion is significantly rarer described in medical literature than typical nickel contact sensitization. The exact pathophysiological mechanism of this "device syndrome" remains unknown, and many question the real incidence or even the existence of this clinical entity. Nevertheless, it has been associated with a wide spectrum of symptoms, including chest pain, migraines, palpitation, and dyspnea. Skin patch tests are the first-line approach to diagnose nickel hypersensitivity. However, diagnostic criteria for the device syndrome have not been developed, and diagnosis in reported cases is established by a process of elimination. Management-drug therapy (corticosteroids, clopidogrel, etc.) or even surgical explantation in severe cases-of patients developing such clinical manifestations after percutaneous PFO/ASD occlusion is empirical. Undoubtedly, endocardiac device-related nickel hypersensitivity requires more focused research to discover the underlying mechanism as well as to develop reliable prognostic tests for detecting high-risk patients and preventing severe nickel hypersensitivity reactions.

• Authors: Anastasios Apostolos, Maria Drakopoulou, Stamatios Gregoriou, Andreas Synetos, George Trantalis, Georgios Tsivgoulis, Spyridon Deftereos, Konstantinos Tsioufis, Konstantinos Toutouzas
• Journal: Clinical reviews in allergy & immunology (Clin Rev Allergy Immunol) Vol. 62 Issue 3 Pg. 476-483 (Jun 2022) ISSN: 1559-0267 [Electronic] United States
• PMID: 34129170 (Publication Type: Journal Article, Review)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Nickel

Topics

• Cardiac Catheterization (adverse effects)
• Device Removal (adverse effects)
• Foramen Ovale, Patent (complications, surgery)
• Humans
• Hypersensitivity (diagnosis, etiology, therapy)
• Nickel (adverse effects)
• Septal Occluder Device (adverse effects)
• Treatment Outcome