Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?
- Publication date
- Publisher
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