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Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?

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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.

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Abbreviations

ACD:

Allergen contact dermatitis

ASD:

Atrial septal defect

DC:

Dendritic cells

MHC:

Major histocompatibility complex

PFO:

Patent foramen ovale

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Authors and Affiliations

  1. First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece

    Anastasios Apostolos, Maria Drakopoulou, Andreas Synetos, George Trantalis, Konstantinos Tsioufis & Konstantinos Toutouzas

  2. First Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, Andreas Suggros Hospital, Athens, Greece

    Stamatios Gregoriou

  3. Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

    Georgios Tsivgoulis

  4. Second Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

    Spyridon Deftereos

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  1. Anastasios Apostolos
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  2. Maria Drakopoulou
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  8. Konstantinos Tsioufis
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  9. Konstantinos Toutouzas
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Contributions

AA, SG, and KT had the idea for the present review. AA had collected the data. AA, MD, and SG had written the draft. AS, GT, GT, KT, and KT have critically revised the manuscript.

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Correspondence to Konstantinos Toutouzas.

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Prof. Toutouzas is proctor for Amplatzer devices.

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Apostolos, A., Drakopoulou, M., Gregoriou, S. et al. Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?. Clinic Rev Allerg Immunol 62, 476–483 (2022). https://doi.org/10.1007/s12016-021-08867-0

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