This site uses cookies. as this seems like a weird allergy to be tested for. Fisher's Contact Dermatitis. Validity of MELISA for metal sensitivity testing. Dana Jeske, a mechanical engineer living near Seattle, experienced intermittent paralysis for five years, before regaining his ability to walk and move his b "Metal hypersensitivity testing should be offered to patients before surgery to minimize the risk of implant failure", concluded this study from Charles University, Prague; "especially those with autoimmune diseases, asthma, and/or allergies." But what if you feel like your body is rejecting your new dental implant? 3, no. The International Journal of Implant Dentistry notes that due to implants' corrosion and wear, titanium alloy particles can get deposited in the surrounding tissues. Dental implant surgery is performed in stages, requiring adequate healing time after each one. 1. 7. Exposition doesn`t come over night- but gradualy. Immediately after removal of his last palladium containing white gold crown all of his paralysis resolved.At the November 2019 meeting of the FDA's Committee Investigating Metals Used in Medical Devices, Dr. Schroeder presented Jeske's case and the cases of some of his other patients. 2003 Feb-Apr;24(1-2):57-64. The authors declare that they have no conflict of interest associated with this work. She reported a complete resolution of all symptoms one-month postsurgery. 2. Before Bookshelf Zirkonia crowns or bridge, and be cemented. In September 2020, the patient went to a walk-in clinic due to urinary tract infection (UTI) symptoms and was prescribed a course of cephalexin which resolved the infection. What good is using titanium (that will last forever) if it is wreaking havoc with one's immune system, and instead of just having an infected/rotten tooth, now they have rheumatoid arthritis? "MELISAan in vitro tool for the study of metal allergy." This will improve the patients quality of life and prevent serious complications. A. Serati, B. Sharif-Kashani, Z. H. Ahmadi et al., Removing an entrapped pigtail catheter by re-enforcing a traditional method, Tanaffos., vol. Trying to find LTT for titanium but cannot find - is LTT available anywhere in US for metals? The criteria for postimplant metal hypersensitivity are: Since titanium, in the form of titanium dioxide (E171), is used as white pigment in toothpaste, cosmetics and medication, the latent sensitization of susceptible individuals is possible. The striking features of titanium include its stability with increased resistance to corrosion and its biocompatibility to diverse materials [3]. Bethesda, MD 20894, Web Policies Titanium is a transition metal and thus may function as a hapten and trigger cellular hypersensitivity. The patient initially had intermittent RLQ abdominal pain accompanied by nonspecific symptoms. Dermatitis 26;2015:1-25. The behavior of Zircon facing soft tissue and bone really works, showing perfect osseointegration and unbelievable aesthetics due to white colored high tech ceramics. The blood test does not do well as it's "pure" they test for and it only reacts when the item in question IS already in you. 2014;102(2):392399. 3. It's called Melisa. WebTitanium is a reactive metal with a including titanium may mediate metal hypersen- titanium allergy, titanium release without any native oxide film thickness of about 4 Titanium is highly biocompatible. Dear Sarah, It is used worldwide by healthcare professionals to help determine whether patients are "Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity." In this study, blood from 250 patients with clinical symptoms of type IV hypersensitivity to metal were tested with MELISA against up to 20 metals in 23 concentrations. The prevalence of metal hypersensitivity in patients with implants is significantly higher than in the general population, with an even higher rate among patients with failed or failing implanted devices. About 6-8 months ago began with eczematoid/psoriatic rash most prominent over left knee (not present over right knee). Major Referred to me to patch testing. Contact Dermatitis 74.6 (2016): 323-345. I would share this information with the patient and the orthopedist and recommend a titanium implant without nickel unless the repeat tests do not show sensitivity. Any suggestions on the root cause? I had a hip replaced with titanium. But autoimmunedeficiency raised as well as the number of prothetic treatments and envireonmental influence and stress. Journal of Biomedical Materials Research PART A. Copyright 2021 Molly S. Jain et al. 2019. I am severely allergic to many metals..confirmed nickel was "off the charts"..worst case they'd ever seen which I'd know obviously for my entire life. I also had titanium screws inserted into my mouth giving me alot of pain. The surgical pathology report for the removed catheter specified foreign body consisting of synthetic stent measuring 10.0cm in length and 0.3cm in diameter (Figure 4). 15, 2019. RFB should be included in the differential diagnoses when the patient presents with acute reactions after surgical procedures. When exposed to oxygen, titanium oxidizes and There is also no risk of allergic reactions, galvanic shock, or battery effects with ceramic like there is with metal implants. Accessibility M. Little, P. C. Munipalle, and O. Nugud, A rare late complication of laparoscopic cholecystectomy, Case Reports, vol. a. viable lymphocytes are required therefore logistical issues of shipping often complicate testing; This started at 45 minutes per day but the periodic paralysis progressed to 10-12 hours per day of immobility. If a non-metal option is a consideration, then I would recommend if multiple patch tests are positive. Thank you for submitting a question to Ask the Expert. We investigated these questions by measuring lymphocyte responses to implant metals (Cr+3, Co+2, Ni+2 at 0.1 mM, and Ti+4 at 0.001 mM) in six subject groups: Group 1a = young controls, Group 1b = age matched controls, Group 2a = subjects with osteoarthritis (OA) and no history of metal sensitivity, Group 2b = OA subjects with history of metal sensitivity, Group 3a = total hip arthroplasty (THA) subjects with no to mild radiographic osteolysis, and Group 3b = THA subjects with moderate osteolysis. Background: Sensitization to orthopaedic implant materials is an unpredictable event that might affect implant performance. Some of the reported complications of pigtail catheter insertion include lung penetration during pleural effusion removal and entrapment of the catheter in the tricuspid valve leaflet during heart catheterization [8, 14, 15]. Medically Reviewed By Colgate Global Scientific Communications. 1. Source Source Question posted to Ask the Expert website 4/25/2012: This test is also available in the US. Neuro Endocrinol Lett. The patient started having another episode of intermittent right lower quadrant (RLQ) pain starting in January 2020. coating disolves over the years. Tsh Normal All bld normal carol. Zimmer dental, former Sulzer-Calcitek, stil have HA-(hydroxylapatit) coated implants. The follow-up This might be therefore be a solution for about 10 years oral function. 155162, 1999. Contact Dermatitis 2005; 53:1. MELISA Foundation, etc. Stejskal, V. D. M., et al. She reported extensive health issues such as skin rash, hair loss, memory loss, difficulty concentrating, severe shortness of breath, hot and cold flashes, metallic taste in the mouth, abdominal bloating, joint and body aches, muscle pain and tightness, insomnia and more. Lisa: It's interesting that you have these symptoms! Ask the Colgate Chatbot! By comparison of the initial and follow-up MELISA test results, it can be stated that the hypersensitivity to the given metal decreased or disappeared after the therapeutic interventions performed based on the initial MELISA test results. 13, no. Upon removal the pain disappeared. 8487, 2019. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. The MELISA test may be used in two ways for orthopaedic patients. Hypersensitivity to titanium: diagnosis and management. All the best! It causes delayed clinical manifestations after 48 to 72 hours [10]. zirconia has never osseointegrated to bone as titanium or titanium alloys can do. -. Good Luck! A case by Little et al. "Titanium allergy is barely recognized in mainstream medicine - yet laboratories using the MELISA technology have reported that about 4% of all patients tested to titanium will be allergic to it (Valentine-Thon E., et al. To confirm, the patient was further ordered for memory lymphocyte immunostimulation assay (MELISA) that also showed equivocal results for titanium allergy. A test was developed in Europe to detect and measure Titanium allergies. Metal sensitivity in patients with orthopaedic implants: a prospective study. Concerned this may give false negative results with patch testing. Neuroendocrin Letters 2006;27:17-24. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. M. Goutam, C. Giriyapura, S. K. Mishra, and S. Gupta, Titanium allergy: a literature review, Indian Journal of Dermatology, vol. Six metal surgical clips removed from the RUQ via fluoroscopic guidance. The authors declare that they have no competing interests. A LTT metal allergy test showed a mild reactivity to nickel and titanium. Suspicion for titanium allergy is generally localized to the hardware site and may initially be thought to be an infectious process. 12, no. 4. V. A. Zejnullahu, B. X. Bicaj, V. A. Zejnullahu, and A. R. Hamza, Retained surgical foreign bodies after surgery, Open Access Maced J Med Sci., vol. Simply cut, peel, & apply to protect wounds, & more! government site. Showed many positives at 72 and 96 hours including 14 metals and methacrylate glue. Do you feel that Lympocyte Transformation Tests are reasonable diagnostic alternates to patch testing for metal allergy? Dr. Jacqueline A. Pongracic, FAAAAI. In a pilot study, 20 patients also underwent both patch testing and a lymphocyte transformation test (LTT-MELISA) for the same metals. WebDrugs are compounded specifically for each patients allergy test and cannot be used on another patient, so please keep your appointment. 29, no. 2. LTT-MELISA is clinically relevant for detecting and monitoring metal sensitivity. She had to be hospitalized with strict isolation to wait for her medication regimen to work along with the infusion of IV fluids. Thus interpreting these tests is much like interpreting the immediate hypersensitivity skin tests and tests for serum-specific IgE. 1, pp. Responses at 7-10 days after removal may help distinguish a true from false positive result. Very much looking forward to the launch of the first ever podcast dedicated to the adverse effects of metals on health! M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. All rights reserved. Reduction of metal exposure in the FM patients was achieved by replacement of dental metal restorations and by the avoidance of known sources of metal exposure. If LTT-MELISA testing is to be considered, test kits, locations of laboratories offering this test and other information is available at FAQs for US Customers - MELISA. I've had 2 titanium implant procedures with 2 diffenrent surgeons and both implants didn't take which caused me tremendous pain. I think that there is credible evidence in the literature to indicate that delayed hypersensitivity testing to metals can be a useful test in detecting the presence of contact allergy. 2, pp. Just some thoughts. You should get titanium implants bc you probably don't have an allergy to it or you can just get a zirconia based implant and have it fracture shortly after due to a reaction with fluids/water, then have someone remove it, place another, then removed, place another, etc. please note that there are many brands of implants which are used to titanium alloys in making implants so i agree with whose are believe in allergist consultation. Dennis K. Ledford, MD, FAAAAI Toxics. Since Dr Schroeder had been studying metal allergies for years he sent Jeskes blood for MELISA testing for metal allergies. Fowler, Joseph F., and Matthew J. Zirwas. Failure of the implant and delayed or poor wound or surgical site healing hav occurred; PMC Hypersensitivity reactions to metallic implantsdiagnostic algorithm and suggested patch test series for clinical use. Finally, the blood test could be effectively used to diagnose type IV hypersensitivity allergic reactions, including contact dermatitis or eczema reported by few studies on titanium allergy [12]. This can be seen on the fact that bone attachment is usualy tighter and faster with pure ti-implants then in Ti-alloy-implants. All my best. The patient has been recommended to do a close follow-up for a few months to monitor her progress. WebThe only current blood test for titanium allergy, a test called the MELISA(R) test, is available through Breakspear. This study is aimed at proving the clinical benefit of the MELISA test in the minimization or complete elimination of health problems in patients with confirmed hypersensitivity to metals used for tissue replacements. An exact breakdown, which includes trace amounts of metals present, is needed prior to testing, but below is a guideline. Please enable it to take advantage of the complete set of features! No buccal sulcus after closure of OAC: advice. This elevated incidence and averaged level of lymphocyte reactivity supports a metal-specific adaptive immune response and suggests involvement in the pathogenesis of poor implant performance, e.g. In the past decade Dr Schroeder has removed over 1,000 implants in over 400 patients. Of 31/100 patients with an apparent history of nickel sensitivity determined during preoperative assessment of subjects, 12 tested negative on both tests, and 4 with a negative history of nickel sensitivity tested positive. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Seminal studies cited by the International Journal of Implant Dentistry report that titanium allergy symptoms include: Erythema (skin redness, in this case, in the Patch testing to metals planned but patient is receiving steroids with chemotherapy every two weeks and cannot stop. However, all the symptoms were resolved after the removal of the offending agent [57]. Her symptoms became chronic and progressed further to abdominal distension with increasing abdominal girth, fever, and several episodes of watery diarrhea. Please let me know what my possibilities are. On the contrary, IFN-gamma, IL-2, IL-4, IL-10, and IL-12 production to the ELISpot, patch test results, sensitization against other metals, and atopy score did not significantly discriminate between sensitization with and without allergy. I had a patient spit two implant out at me after less than one month with an ISQ (mentor) reading of >50 and initial torque stability at 40-50 Ncm. WebMELISA is a scientifically proven and clinically validated blood test that detects type-IV hypersensitivity to multiple metals at the same time. Safe for patients with metal allergies Zirconia implants are a viable option for patients who have an allergy to titanium or adhere to holistic dental principles. The easiest and most affordable way to clinically deliver bone graft for socket preservation. Therefore a more inert Ti-alloy might be even more secure, as it interacts not that fast with the tissue. In summary, there is no official recommendation to use in vitro methodology as the testing has not been validated by multiple investigators and the FDA has not approved the testing. 12.5 microg/mL of chromium chloride and 50 ng/mL of potassium dichromate were found to be optimal to discriminate between sensitized individuals with and without allergy. There are zyrconia implants like White Sky, that are monoblock type implants, and that are a real option for you.Also Rocksolid from straumann is a combination that may also help you It can feel both disappointing and overwhelming to learn that youre not taking to your new implant as well as you'd hoped. I have been to 7 dr. Could this be form the 3 rods in my femur carol. LTT is another more sensitive test than Results: Only 72 of 100 patients were patch tested both before and after surgery, and 12 of 20 also underwent LTT-MELISA before and after surgery. The patients past medical history consists of depression, polycythemia vera, hypothyroidism, mitral valve prolapse, chronic back pain, and deep vein thrombosis of nonextremity and acute cholecystitis. G. Tawil, P. Tawil, and C. Irani, Zirconium implant as an alternative to titanium implant in a case of type IV titanium allergy: case report, The International Journal of Oral & Maxillofacial Implants, vol. However, in chronic cases of months to years after the operation, a CT scan is usually performed to rule out malignant tumors and possible fistula formations [13]. I would repeat the patch tests with the chamber more than 6 inches apart, take pictures before and at 48 hours, 72 hour, and possibly 4, 5 and 6 days. A team has devised a blood test to determine allergies to nickel and is working on developing blood tests for other allergens such as cobalt and the bone cement that is used in most implants. The patients past surgical history includes a tonsillectomy, an appendectomy, and cholecystectomy. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. WebThe MELISA test has been known to be a more sensitive test to metal allergy but lacks specificity in the proliferation of lymphocytes [ 3 ]. Wood MW, Warshaw EM. These HA-implants heel quite well and also fast. MELISA Test MELISA test, validated by an independent laboratory [ 43 ], was used in this study for assessment of metal hypersensitivity reactions. If all of the positive tests are metals, you may be dealing with irritant reactions, usually pustules and follicular lesions, more common to metals and more likely in atopic individuals, perhaps due to skin barrier issues. If you have history of metal allergy it may be recommended to have a MELISA test before you get an implant. Furthermore, alternatives like absorbable sutures or even different hypoallergenic metal or plastic clips can be considered viable options to replace nickel or titanium-made surgical clips during surgery. See MoreSee Less, Rare Metallic Allergy Reaction Presentation to Cholecystectomy Surgical Clip, Many will have seen the devastating news that singer Celine Dion has been diagnosed with Stiff Person Syndrome. They were clinically examined, and peripheral blood samples were taken to perform follow-up MELISA tests. The bio compatibility of this implant is really impressive. doi: 10.1002/jbm.a.34721. 2006 Dec;27 Suppl 1:31-5. Frigerio E, Pigatto PD, Guzzi G, Altomare G. The one we elected is from a German/Swiss based company called Z-Systems. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. allergic reaction to bio oss is it possible. Schalock PC, Menn T, Johansen JD et al. 2022 Nov 23;10(12):716. doi: 10.3390/toxics10120716. Professor Vera Stejskal is the inventor of the MELISA test. All Rights Reserved. The lymphocyte transformation test has several issues: Since then, has had persistent systemic pruritic papular rash - worse in scalp and hairline. Have new referral 62 year-old female smoker with focal seizure in 2017 - evaluation showed brain tumor confirmed to be malignant with primary in lung. First, prior to surgery, patients whose clinical history suggests metal sensitivity may be pre-tested to ensure that they receive the most suitable implant. The decision forward would be based upon this discussion. I have developed skin burning over my neck chest severe. Yoshihisa, Yoko, and Tadamichi Shimizu. Then the titanium-alluminium-vanadium alloy gets exposed. This requires immediate attention and an X-ray for further investigation. However, the skin-patch test is still not the best diagnostic modality due to failure in positive reaction to most titanium allergy cases [3]. Diagnosing any metal allergy, including titanium allergy, has been complicated by various tests sensitivity and specificity. a. 1, pp. Especially, in our case, the patients extensive past medical history and multiple overlapping medical conditions delayed her diagnosis of RFB and caused her significant life distress. Systemic allergic skin symptoms or signs Pernicious anemia (B 12 def) sneaks up on people very slowly. Objectives: In candidates for hip or knee joint prosthesis implantation, to evaluate preoperative assessments for identifying patients with metal sensitivity, to determine the percentage of patients who developed metal sensitivity at 1 year after prosthesis implantation, and to examine the clinical relevance of patch tests and lymphocyte transformation tests (LTT-MELISA) for the evaluation of metal sensitization. 2/12/2021 Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. Proper history taking, appropriate physical exams, and specific diagnostic modalities can identify rare causes of chronic abdominal pain. M. Hosoki, K. Nishigawa, T. Tajima, M. Ueda, and Y. Matsuka, Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants, Journal of Prosthodontic Research, vol. See MoreSee Less, Share on FacebookShare on TwitterShare on Linked InShare by Email, Another incredible case report of a woman with 18 surgical clips in her neck. Histology consistent with eczema Implants placed too close: Is this restorable? The most likely adverse effect of an allergy to an orthopedic implant is dermatitis, often at the site of the implant but can become generalized and affect the hands; The commercially licensed, in vitro lymphocyte transformation test for detecting sensitivity to metals (LTT-MELISA) is not FDA approved and generally is not covered by insurance (1,2). "A retrospective study on titanium sensitivity: Patch test materials and manifestations." Have 79 year-old man with left knee replacement two years ago. I am sending you a link (copied below) to a study employing delayed hypersensitivity testing to detect metal allergy. Metal allergies are becoming more recognized within the surgical field. The results showed that Jeske was allergic to nickel; the screws in his feet contained 14-16% nickel. I have found through the years that it is females that have these unusual allergies to metals. Due to another foot problem requiring surgery, he returned to his surgeon Dr Schroeder, who noticed swelling over the areas the screws were placed and recommended removal of the screws. of weight loss in only four months of duration. 59, no. i. C. Shi, Y. Xi, B. Contact Dermatitis 2011;66:4-19. The symptoms were so severe that they interfered with the mans lifestyle. 1, pp. It is used worldwide by healthcare professionals to help determine whether patients are hypersensitive to metals 426431, 2018. After removal of the titanium material, fracture healing was achieved and the eczema cleared. With her history of allergy to other metals in the past, a titanium allergy was suspected at this visit, and the patient promptly underwent a titanium skin patch test that turned out positive. I emphasize that this testing is not FDA approved. 4143, 2011. A decision was made to remove all the metal surgical clips laparoscopically via fluoroscopic guidance (Figure 1). Moreover, all her aforementioned symptoms were alleviated once the metal surgical clips were removed surgically. We've been working on metal free implants in my clinic since 2005, so we have mid term results showing the amazing results on our patients. I have summarized her observations and suggestions below. I live with constant pain and stiffness that changes by the minute and radiates through my pelvis and legs. It is used worldwide by healthcare professionals to help determine whether patients are hypersensitive to metals commonly used in dental restorations or medical implants. Apparently, a strong positive reaction to nickel creates a nonspecific hypersensitivity of the surrounding skin and induces a false positive reaction. 5, no. Allergic responses to metals such as nickel, chromium, mercury, cobalt, and gold are widely recognized [1]. Type I hypersensitivity reaction may manifest as anaphylaxis causing urticarial plaques or papules on the skin [3]. Sarah, a potential dental implant patient, asks:I am allergic to titanium. Morphology consistent with acute eczema 2022 Jul 11;8(1):29. doi: 10.1186/s40729-022-00428-0. Pure Titanium is very reactive and might get binded to organic substrate which then promotes the allergic answer. Reference: Concentrations of We describe a case of chronic abdominal pain, which is potentially complicated by retained titanium surgical clips and subsequently a retained portion of a pigtail catheter. Goolge Titanium allergy test and I'm sure you will find it. Lymphocyte proliferation, using Lymphocyte Transformation Testing (LTT), and cytokine release provided quantitative reactivity measurement, where a stimulation index of >2 indicated metal sensitivity. 2. Arakelyan M, Spagnuolo G, Iaculli F, Dikopova N, Antoshin A, Timashev P, Turkina A. 2016;2016:15. doi: 10.1155/2016/8769347.8769347 These can range from simple skin rashes to muscle pain and fatigue. Their are hundreds of people on the web reporting similar symptoms to Titanium. Even if a patient has a positive delayed type hypersensitivity skin test response, reactions to an orthopedic implant are rare and cannot be predicted Trouble is in the United States there are NO approved dental materials (metals and other) patch tests and most allergists will not help you w/o that. Type IV It's called Melisa. WebThis test is used to determine whether titanium dental implants, metal bridges,crowns and over dentures or amalgam fillings are causing allergic reactions within the body. Although rare, metal allergies do occur and can occur with grade IV titanium as pure titanium is too brittle. By continuing to browse this site, you are agreeing to our use of cookies. Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. However, there is no consensus for the utility of the test with critics arguing the test is overly sensitivity (5,6,7). Thirty-two patients reported that they followed the recommendations based on the results of the initial MELISA tests, and of these, 30 patients (94%) confirmed significant health improvement. True positive responses tend to persist for 7-10 days, false positives do not. 4. HIGHLIGHTS SUMMARY Intolerance reaction to pure titanium implants (grade 4) is more likely a pro-inflammatory reactivity of tissue macrophages in contact with titanium oxide particles disseminated into the peri-implant tissue by tribocorrosion rather than a systemic allergic reaction. Disclaimer. Most likely the allergy to the other metals in the alloy. Especially those based on called "nano"-Ti-particles Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. I hope this information is of help to you and your practice. -, Strakowska P., Beutner R., Gnyba M., Zielinski A., Scharnweber D. Electrochemically assisted deposition of hydroxyapatite on Ti6Al4V substrates covered by CVD diamond films -- Coating characterization and first cell biological results. Materials (Basel). The better the coating (cristaliniy degree) the later this happens. ", I had transplants in September 2009 December 16th 2009 very sick and have never been allergic to anything and now 5th time to almost die and surgeon contacted today 25th Jan 2010 going tomorrow morning I have not been in pain other than swelling tongue not breathing and and almost dead We will see wish me luck. There is only one test that can be used to establish titanium allergy, called the MELISA test . This test is also available in the US. Why don't I believe them ??? The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. Dear Richard Hughes, DDS,FAAID, FAAIP.DABOI The test you referred to is not actually a serum test, but a whole blood test which measures lymphocyte reactivity upon exposure to metal. This causes type IV hypersensitivity reaction through sensitization of T lymphocytes and macrophages. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. On November 5, 2020, the embedded right colon foreign body was identified with fluoroscopic guidance (Figures 3(a) and 3(b)) and removed surgically (Figure 4). Orthopedic implants heal well without complications in most patients but fail for unclear reasons in some individuals. Have you seen an allergist to confirm you are allergic? I've asked a few dentist about this problem, with the majority saying that there is no such allegic reaction to titanium. However, IFN-gamma responses towards chromium chloride were significantly correlated with the strength of patch test reactivity (r=0.49, P=0.002). Neuroendocrinology Letters 2003; 24(1/2):57-64, Copyright 2022 MELISA Diagnostics Limited.