Concepts in allergy to pectus metal implants

Allergy to pectus implants is infrequent. Cutaneous allergic reactions to stainless steel Nuss bars may take the form of skin erosions, granulomas, erythema or seromas; keloids have also been reported, posssibly as an end result of an erosion in a predisposed patient. Pleural effusions and pericarditis have also been implicated as systemic reactions to metals. Epicutaneous patch testing is a tool that can be used to identify allergy to metal implants. Although routine pre-operative patch testing is not recommended for most implants and prostheses unless the patient has a significant history of metal sensitivity or previous cutaneous or systemic reaction to an implant or device, Nuss’s group now performs metal patch testing on all patients priot to the Nuss procedure. Patients in whom a diagnosis of allergy to an implant is made have been treated with corticosteroids and antihistamines, removal of the implant, or replacement of the implant. Titanium implants are generally well tolerated in patients with nickel metal allergy.