Jacob P. Thyssen (editor) - Metal Allergy: From Dermatitis to Implant and Device Failure

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Contact allergy to metals has been recognized for centuries. The description of allergic contact dermatitis in bricklayers following skin contact with lime, along with the eczema rubrum caused by skin contact with mercury, provided the basis for the pioneering description of the skin disease eczema by Thomas Bateman. It was also one of the first diseases where it was learned that a specific exposure can create a recognizable disease that may reoccur in the event of subsequent exposure.

With the Industrial Revolution, the isolation and use of metals exploded. Today, metals constitute the backbone in, for example, trains, cars, buildings, airplanes and many types of industrial machines. Thus, metals are indeed essential elements for modern society, both as a basic element but also in many sophisticated products.

Contact allergy to new elements has been typically first described among workers exposed to high concentrations or repeated handling of the metal in question. Epidemics of contact allergy have traditionally been seen in consumers at much later stages. The Dane Poul Bonnevie (1939) correctly described this sequence for nickel allergy, as industrial development resulted first in nickel dermatitis in workers and later in consumers. Dr. Bonnevie also introduced the first standard patch test series and described nickel, chromium and cobalt as common allergens among patients with eczema. Ever since, contact allergy to metals has been the most frequent cause of allergic contact dermatitis worldwide.

Importantly, metals may have many different adverse effects on human health, e.g. cancer, lung diseases and allergic contact dermatitis. The latter is undoubtedly the most frequent, affecting up to 20% of the general population, with nickel being the most prevalent. Regulations are now in force to protect workers and consumers against metal dermatitis. The more recent EU regulations for nickel and chromium exposure protect more than 500 million Europeans and serve as good examples of the public adverseness to allergic contact dermatitis from metals.

The editors of the present volume, Jennifer K. Chen and Jacob P. Thyssen, are personally active in many metal allergy research areas. Their network and collaboration with international leaders within this research area have paved the way for this excellently composed, organized and edited comprehensive textbook. It has been possible to assemble global research leaders from all topics. The book amalgamates knowledge about the use of metals, basic immunology, regulatory aspects, and both general and highly specific clinical areas. It is the first compendium on metal allergy that encompasses all relevant metals. A similar text is not currently present. The book includes all the classic areas of metal allergy and also, for the first time, an in-depth overview on allergy to implanted metals. Uncommon and controversial manifestations have also been included for completeness.

This pioneering textbook on metal allergy is highly appreciated as it covers a need for combining old knowledge with new insights and possible new avenues of research. This text is useful for the clinician, covering relevant patient care recommendations. As it provides an in-depth understanding of exposure hazards for individual metals, both in the occupational and the consumer universe, this text is also meant to be useful for responsible industrial personnel and public health administrators.

It is unsurprising that metal allergy has become a subject we encounter almost on a daily basis, especially for any specialist in allergic contact dermatitis. After all, nickel has long been the most commonly positive allergen seen in patch testing, and metals are ubiquitous in our society. What was a surprise to us, however, was the lack of any reference text specifically dedicated to the nuances and details of detecting and managing metal allergy.

Aside from metals being common sources of contact sensitization that are often difficult to avoid, there are a number of challenging or controversial presentations of metal allergy that may be difficult to diagnose, from implant failure to systemic contact dermatitis after dietary exposure to metals. Thus, there is a clear need for a comprehensive resource that can be consulted for guidance in both common and rare scenarios. This text is meant to fulfill this unmet need and serve as an indispensable reference for all things metal allergy.

The editors are deeply grateful to each of our chapter authors, without whom this text would not be possible. We feel very fortunate to have learned so much from their expertise. We hope that you will benefit from this text as much as we have.