New Blood Test Finds Allergies Before Surgery
Published on May 16, 2013
A growing number of patients learn of nickel allergies to new hips & knees only
after surgery is done
DENVER, CO – May 15, 2013- Imagine what Paula Spurlock must have been going
through. Shortly after having a total hip replacement in 2011, the trouble
started. “I had horrible itching, really bad migraines and intense pain
throughout my body,” she said. “I couldn’t take it. Every single thing in me
itched.”
After many months and several trips to specialists, Spurlock was told it could
be anything from food allergies to her medication. But no matter what she
changed, the symptoms persisted and Spurlock resigned herself to a life of
misery. “I just kind of thought that’s what life was going to be like,” she
said.
Then, she got a phone call. “I had a PET scan for a lung problem and they said,
‘Paula, what’s going on with your right hip?’ I told them I had it replaced and
they said, ‘Well, it lights up on your PET scan.’ ”
More than a year after it was implanted, tests showed Paula was highly allergic
to the nickel metal in her new hip and to the surgical cement often used to hold
joints in place. “That’s the one thing that never occurred to any of us,” she
said. “No wonder I was miserable.”
It’s a problem that is sure to get worse in the coming years. By 2030, the
demand for hip and knee replacements in the U.S. will skyrocket. More than
11,000 people a day are expected to have implant surgeries by then, an increase
of 174 percent for hip replacements and nearly 700 percent for knees.
“It’s huge,” said Karin Pacheco, MD an allergist at National Jewish Health in
Denver. “We are an aging society, and the number of people who need new joints
is going to increase and, for some of these people, they won’t know that they’re
allergic to nickel until after the implant is put in.”
“Nine out of 10 people who get implants do great,” said Pacheco. “But 10 percent
don’t, and they’re miserable.”
The best way to tell if someone is allergic is to do a skin patch test. “But not
everybody knows how to do it, not everybody has access to the right antigens,
and it also takes about a week to do,” she said. “Not everybody has that kind of
time before their surgery.”
So, Pacheco and her team at National Jewish Health have come up with an
alternative, developing the first blood test that can detect allergies to
nickel.
Nickel is not only one of the most common metals used in joint implants, but
it’s also the most common contact allergen in the U.S. “We think about 15
percent of the population is sensitized to nickel,” she said.
Pacheco says there are many advantages to the concept of using a blood test to
check for allergies before surgery. “First of all it’s much easier,” she said.
“You can send the blood in and it will get developed quickly, and you won’t need
to have somebody available who knows how to do the patch testing.” Then, if an
allergy is detected, patients could avoid the misery of an allergic reaction by
choosing a different implant, and the health care system could save millions of
dollars in revision procedures.
“If we find a patient is allergic after the fact, unfortunately, the only option
right now is to take the joint out and replace it with something to which
they’re not allergic,” said Pacheco. “It would be nice to get it right the first
time.”
Studies to evaluate the nickel blood test are continuing, and soon researchers
here hope to develop blood tests to other allergens, like cobalt and bone
cement.
After having her metal hip removed and replaced with a ceramic model, Paula
Spurlock’s life is back to normal. “I haven’t had any migraines or itching or
any problems,” she said. “It’s been wonderful.” But, she cautions, if you even
think you have an allergy to metal, get it checked out before implant surgery.
“It’s really important that we get that out there,” she said, “so others can can
avoid all the things that I went through. It was a very long and miserable year
and a half.”
Researchers hope the blood test will be approved and widely used in the next
couple of years.
National Jewish Health is known worldwide for treatment of patients with
respiratory, cardiac, immune and related disorders, and for groundbreaking
medical research. Founded in 1899 as a nonprofit hospital, National Jewish
Health remains the only facility in the world dedicated exclusively to these
disorders. U.S.News & World Report has ranked National Jewish Health the number
one respiratory hospital in the nation for 15 consecutive years.