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The below is an excerpt from LTT-MELISA® is clinically relevant for detecting and
monitoring metal sensitivity by Dr Elizabeth Valentine-Thon et al., Neuro Endocrinol
Lett. 2006; 27(Suppl1).
Please note that the following text has been slightly edited, for example references to articles and tables have been removed.
It lists 10 patients with various symptoms and discusses their metal exposure and reaction in the MELISA® test, and what treatment was required to improve the patients' health.
1. Patient with concentration difficulties, loss of memory, and coordination problems, and allergy to mercury and gold
Female, 51 years old, presented
with central nervous system (CNS) disturbances, concentration
difficulties, loss of memory, and coordination
problems. She also suffered from fatigue, depression,
muscle weakness, and chronic infections. She has been
exposed to amalgam fillings and Au/Pd crowns but
also to pentachlorophenol and lindan in her home. All
skin tests in standard and metal series were negative.
In MELISA® she showed strong multiple metal
sensitization, especially to HgCl2and Ni. She underwent
complete amalgam and Au/Pd crown removal, followed
by metal elimination therapy with glutathione, sodiumthiosulfate
( 10%), and thiopronine. She also changed
her place of residence. After 6 months, significant improvement
of all symptoms occurred. At the same time,
MELISA® to most metals became negative. In this
case, MELISA® initially showed strong sensitization
especially to HgCl2 and Ni, despite negative patch test results;
clinical relevance of this sensitivity was confirmed
by its significant reduction upon removal of the relevant
dental metals. Such cases demonstrate a major advantage
of LTTs compared to skin testing in their ability to detect
systemically- as well as dermally-induced sensitizations. In addition, because heavy metals
(particularly HgCl2) and pentachlorophenol are both
detoxified by the glutathione system, complete recovery
of this patient required not only removal of dental metals
and avoidance of pentachlorophenol but also metal
elimination therapy.
2. Patient with inflammation of joints and allergy to beryllium
Male, 70 years old, with amalgam
fillings and Au crowns, presented with seronegative
oligoarthritis. MELISA® was strongly positive to
Be but negative to all other metals including Ni. Four
months after complete dental metal replacement and
metal elimination therapy, significant improvement
of clinical symptoms and normalization of Be-specific
reactivity occurred. As this patient reported no occupational
exposure to Be, exposure was most likely due to
Be-contaminated dental metals.
3. Patient with inflammation of the mucous and dry mouth with nickel and palladium allergy
Female, 77 years old, presented
early 2003 with stomatitis and extremely dry mouth.
She had Pd-containing Au crowns, and her lymphocytes
reacted to Pd and Ni. One year after removal of crowns,
her symptoms did not improve. Her metal-induced reactivity also persisted, and she became positive to
Au as well. The patient reported that she had had two
Ni-containing screws inserted into her kneecap in
December 2003 and, in addition, used an electric razor
daily. The rotating head of the razor was subsequently
found to contain Pd (175 mg/kg). No Pd was found in
her blood (<0.2 µg/ml) or stool (<10 µg/kg). Despite
her history of metal sensitivity, she was fitted with a Ti
bridge in early 2005. A subsequent third MELISA®
in mid-2005 showed still very strong responses to Pd (SI
= 119.5), which could be caused by her razor, higher
responses to Ni than previously (SI = 7.9), perhaps due
to the screws, and now lower responses to Au (SI = 2.9),
probably due to Au crown replacement. The patient’s
symptoms remained unchanged. This case demonstrates
that a thorough and ongoing anamnesis of the patient is
required to identify all, often obscure, sources of metal
exposure.
4. Patient with arthritis and multiple metal allergies
Female, 46 years old, presented
with acute polyarthritis 10 days (!) after implantation of
a Ti pin. She had amalgam fillings as well as Ti implants.
Multiple metal reactivities were found at the lymphocyte
level, in particular to TiO2 (SI = 14.8) and HgCl2 (SI
= 6.8). Seventeen months after complete dental metal
removal as well as chelation with 2,3-dimercapto-
propane sulfonate (DMPS) and 2,3-dimercaptosuccinic
acid (DMSA), significant clinical improvement
and normalization of all metal reactivities was observed.
This case strongly suggests that the patient developed
sensitivity not only to HgCl2 due to Hg-containing
amalgams but also to Ti due to chronic exposure to Ti-containing
implants. The insertion of a Ti pin possibly
provided a booster effect leading to the acute clinical
symptoms.
5. Patient with acne, fatigue, and headaches after Ni-containing orthodontic braces
Female, 13 years old, developed
severe acne, fatigue, and headaches after implantation of
Ni-containing orthodontic brackets. Her lymphocytes
reacted strongly to Ni (SI = 34.2) only, while the patch
test to Ni was negative. The patient also had high interleukin-2 (IL-2) in blood (127 pg/ml, normal value <15 pg/ml). Six months after removal of brackets, acne and
other symptoms significantly improved, in vitro reactivity
to Ni significantly decreased (SI = 17.1), and the IL-2
level returned to normal. Further therapy, including Ni-free
diet, is ongoing. Ni-containing brackets have been
reported to induce Ni sensitization with local and/or
systemic effects. The fact that the patch test
to Ni is sometimes negative despite clinical Ni allergy
might be due to alternative exposure to Ni via mucosal
membranes, rather than via dermis of the skin.
6. Patient with implant pain and nickel allergy
Female, 65 years old, presented
at the end of 2004 with chronic excruciating pain in her
knee six months after implantation of a knee endoprosthesis.
As she was patch test positive for Ni, she was assured
that her implant was a Ni-free Ti alloy. Because of
her pain, she contacted the laboratory for testing of possible
Ti allergy. In MELISA® tests of two consecutive
blood samples, she was found to have no sensitization
to the common components of Ti alloys but showed a
strong sensitization to Ni (SI = 25.8 in the first test, 27.8
in the second test). Her
orthopedic clinic assured her that this had no clinical
relevance as her implant did not contain Ni and advised
her to continue her palliative treatment of physiotherapy
and pain medication. After 10 more months of chronic
pain, the patient insisted on removal of the implant, one
portion of which was subsequently found to contain no
Ti but primarily Co, Cr, and Mo (> 99%) and a small
amount of Ni (0.124%), the other portion containing
primarily Ti (96%), V (4%), and spurious amounts of
other metals including Ni (0.014%). The clinic admitted
its regrettable mistake and replaced both parts with a
“pure” Ti prosthesis. One week later (!) the patient was
free of pain, and her Ni reactivity had dropped to SI =
17.8.
7. Patient with eczema, bone and joint pain and titanium allergy (exposure via cosmetics)
Female, 56 year-old entertainer,
presented with eczema and bone and join pain. She had
only amalgam fillings but massive occupational exposure
to TiO2 via daily cosmetics (up to 854 mg/kg in some
products). She exhibited strong reactivity to TiO2 (SI =
24.9) and weak reactivity to Be and Pt (both SI = 3.8).
Five months after avoiding TiO2-containing cosmetics,
in addition to metal elimination therapy, significant
clinical improvement and normalization of lymphocyte
reactivity was observed. The patient continued avoiding
TiO2, and three years later, lymphocyte reactivity
remained in a normal range, and the patient was still in
good health.
This case demonstrates not only the potential risk of
developing hypersensitization to TiO2 in cosmetics but
also the stability of negative MELISA® reactivity
during consequent exposure avoidance.
On the other hand, strong lymphocyte reactivity to
metals persisted in follow-up samples from 2 patients
with multiple Pd-containing Au crowns who did not
undergo dental replacement.
8. Two patients with multiple symptoms and multiple metal allergies
A female suffered from burning mouth syndrome, severe
chronic dry coughing, and multiple allergies. She responded
strongly to Ni (SI = 70.9), less strongly to Pd
(SI = 11.4), and weakly to Co (SI = 3.6) in 2003 and
nearly identically 2 years later. Lymphocyte responses
to HgCl2, PhHg, Au, Sn, Cd, and TiO2 remained negative.
Similarly, another patient, who complained
of Quincke’s edema of the tongue, vulvitis, and eczema
of the hands, responded strongly to Ni (SI = 52.2), less
strongly to Au (SI = 14.6) and Pd (SI = 10.3), and weakly
to Cd (SI = 4.2) and Pb (SI = 3.5) in 2005. Her metal-induced
lymphocyte responses were similar one year
later, with only an insignificant decrease in reactivity
to Cd and Pb. Interestingly, skin tests with this patient
were positive for Ni, Pd, and Co as well as for Au in the
form of sodium thiosulfate aurate but not for Au in the
form of Au Degunorm discs obtained from the dentist.
In both cases clinical symptoms, as well as lymphocyte
reactivity, remained unchanged.
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