Metal allergy is a late-type allergic reaction of the immune system to chemical substances such as metal. In the 20th century, industrialization and modern life led to an extreme skin sensitivity to metals and thus an increase in metal allergy. There is a general focus on nickel, cobalt, and chromium because these metals are the most common. Metals such as nickel, cobalt and chromium are found everywhere in our environment.
20. In the first half of the century, nickel allergy and contact dermatitis became more common among people working in the metal and plating industry. Nickel allergy, which is the most common metal allergy we encounter today, is mostly explained by exposure to consumer products containing nickel.
Metal allergy is high in the general population, and it is estimated that 17% of women and 3% of men have nickel allergy. Additionally, cobalt and chromium allergy may occur in 1-3% of cases. Allergies to new metals such as titanium have also been recently shown to occur. This rate is higher in patients suffering from dermatitis.
HOW DOES METAL ALLERGY DEVELOP
Genetic predisposition to the development of metal allergy has been investigated, especially in those with nickel allergy. Although many genes have been studied, no clear gene has been identified.
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Although metal allergy is mainly an environmental disorder, mutations in some genetic complexes show an association between nickel allergy and impaired skin response.
Recently, mutations in the filaggrin gene complex have been linked to nickel allergy or metal allergy. It has been shown in patients with dermatitis.
Metal allergy develops following repeated or prolonged skin contact with metal ions. Before metal ions can elicit an immune response in the skin, they must reach the living skin layer, the epidermis. Therefore, they must cross the stratum corneum above the skin, which normally forms an effective barrier to many chemicals. External causes of skin damage include sunlight, UV rays, skin pH, etc., as well as aging of the skin and the penetration of nickel into the tissue depending on the skin areas on the body. As a result of all these, when there is damage to the skin, Tal ions can reach the lower layers of the skin and stimulate the immune system in the skin.
WHAT ARE THE MOST COMMON METAL ALLERGIES?
Today, metal objects and chemical substances, which are increasing day by day in modern life with industrialization, are new. It leads to the development of allergic reactions.
Nickel, cobalt and chromium are the metals that are most emphasized because they are the most commonly used metals.
Allergic complaints about titanium, which has started to be used more in recent years, have started to be published. It is seen that titanium allergies will increase, especially with the use of titanium in implants.
Nickel
Nickel began to be used extensively in modern life in the 1960s. It attracted attention with the occurrence of tooth-related dermatitis cases in the mouth due to its use in dental fillings. Then, due to its other uses, there was an explosion of dermatitis cases in the areas of sock straps. In the following years, it was observed that the release of nickel in jean buttons and zippers caused dermatitis in both genders. The increasing popularity of ear piercing and the use of nickel-plated jewelry in the 1980s led to nickel allergy and dermatitis in a large proportion of women.
Many countries in Europe have made legal regulations to restrict the use of nickel, even though nickel use has decreased. Nickel is used in many places. Today, it has been observed that new sources of nickel allergy may include, for example, fasteners in headphones, mobile phones and children's clothing.
Although necessary precautions are taken in workplaces, occupational nickel exposure still continues to be a problem. Finally, an Australian study showed that nickel was the most common occupational allergen in female patients with dermatitis and the 10th most common occupational allergen among men.
Chromium
The most important cause of chromium allergy. is occupational exposure to cement. Chromium dermatitis, which was first seen in construction workers, was later seen to increase due to exposure to cement.
In 1983, the mandatory addition of iron sulfate to cement resulted in lower water-soluble levels. It reduced the amount of chromium and the prevalence of chromium allergy in construction workers in Denmark. In 2005, a reduction in cement-related chromium dermatitis was observed in a member state of the European Union that limits the marketing and use of cement containing more than 2 ppm hexavalent chromium.
Cement-related chromium dermatitis was reduced. In addition to exposure, occupational chromium exposure can result from contact with dyestuffs, metal alloys, pottery paints, and rust prevention agents. It was found that chrome was commonly found on the hands of locksmiths, carpenters and cashiers. It showed that there is a danger of chromium allergy in contact with chrome-plated metal products such as screws and fittings.
Recently, chromium exposure has become a problem for us consumers rather than an occupational problem. Today, approximately 90% of global leather production consists of chromium sulphates. Controls carried out in Germany showed that more than half of 850 leather goods contained hexavalent chromium and one sixth contained more than 10 mg of chromium. Most cases of chromium allergy appear to occur following exposure to chromium in finished leather products. It is accepted that contact dermatitis occurs due to chromium in leather products.
Cobalt
Cobalt is a metal used in the production of alloys, magnets, prostheses, paints, pigments and jewelry. The most common cause of dermatitis due to cobalt allergy in women is the use of cobalt mixed with nickel alloys in jewelry.
The reason for the simultaneous allergy to nickel and cobalt is explained by cosensitization rather than cross-reactivity.
Increased cobalt in dental alloys. Its use may be a source of sensitization that may have been previously overlooked.
Isolated cobalt allergy has been observed in hard metal workers, the glass and ceramics industry, and painters. Cobalt can be seen isolated as a result of occupational exposure, or it can be seen together with nickel allergy.
Titanium
Although titanium allergy is generally not well known, it has been reported that approximately 4% of all patients will be allergic. Symptoms can be very different and variable in people with titanium allergy. These range from simple skin rashes to contact dermatitis. or muscle pain and chronic fatigue.
Exposure to titanium (Ti) in implants and exposure to titanium used as nanoparticles (NP) in personal care products are the most common causes of titanium allergy.
Titanium allergy. dioxide (TiO 2 ) is widely used in consumer products because it is nontoxic, although it triggers allergies in some people. It is known as the "pearl agent" because it makes paper and paint shiny and white. Titanium dioxide can be found in foodstuffs, pills and cosmetic products, especially products containing titanium
Orthopedic and surgical implants.
Dentistry: As colored pigment in dental implants and composites.
Sunscreen ingredients: fine titanium dioxide blocks harmful ultraviolet rays from the sun.
Confectionery: It makes candy appear brighter and can be found, for example, in chewing gum.
Cosmetics: to brighten the color of make-up and Used to intensify. It is regularly found in eye shadow, blush, nail polish, lotions, lipstick and powders.
Toothpaste: Used as a pigment substance to make Toothpaste whiter.
Dye: TiO 2 improves the durability of coatings and gives white color.
Plastic carrier bags: increases durability and gives white color.
Medical pills and vitamin supplements can also get the white coating from titanium dioxide.
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Piercings and Jewelry: can be found in watches and all kinds of body piercing products.
Many people's exposure to Titanium appears to come predominantly from dental and medical implants, personal care products, and foods. Although Ti is thought to be highly biocompatible compared to other metals, titanium, especially in dental implants, is likely to be released into biological fluids and tissues under certain conditions.
Most studies have found titanium to be pure Ti, an alloy, or a nanoparticle such as Ti oxide. It does not penetrate the skin barrier. However, signs of Ti penetration into the oral mucosa have been seen.
Patch testing with existing Ti preparations is currently inadequate for Ti for the detection of type IV hypersensitivity. Including lymphocyte stimulation tests Although several other methods have been proposed for the detection of contact allergy, they have not yet gained general acceptance and the diagnosis of Ti allergy is primarily based on clinical evaluation.
The diagnosis of Ti allergy is primarily based on clinical evaluation. Reports on clinical allergy and adverse events are rarely published. This may be due to lack of awareness of possible reactions to this metal, difficulties in detection methods, or because the metal is actually thought to be relatively safe.
Gold, Palladium and Aluminum
Palladium and gold are often used in dental restorations and It is used in jewellery. Gold is also used for coronary stents and rheumatic treatment. Occupational palladium exposure may occur in the electronics and chemical industries.
Aluminum allergy is mostly associated with occupational exposure.
WHAT ARE THE DISEASES CAUSED BY METAL ALLERGY?
Metal Allergies can be seen as contact dermatitis where the allergen comes into contact, or as widespread systemic allergic contact dermatitis. The most important problem seen in metal allergies is the rejection of implants and stents used in orthopedic, dental or cardiovascular diseases, leading to implant failure.
1.Allergic contact dermatitis due to metal allergy
Allergic contact dermatitis. The mechanism required for its emergence consists of two different phases. The first phase is the induction phase and the other phase is the emergence phase. The induction phase usually develops over a few days to a few weeks and involves events in the immune system following initial skin contact with the metal. In this phase, antigen-specific T cells develop and the person becomes sensitive.
Activation of antigen-specific T cells results in dermatitis in the skin area contacted by the allergen.
At the clinical level, the induction phase is contact sensitization or contact. While it is called allergy, the following phase is called allergic contact dermatitis. Contact allergy is considered a chronic and lifelong condition.
Allergic contact dermatitis can occur anywhere on the body. Dermatitis due to nickel and cobalt typically occurs on the face (ears), body (jewelry and piercing areas) and hands.
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