Nickel-Allergic Patient Considering Hysteroscopic Sterilization

Original article:

Bergman D., B.S., Goldenberg A. MAS, MD, Jacob S.E., MD Update on Providing Re-Essure-ance to the Nickel-Allergic Patient Considering Hysteroscopic Sterilization.

Review by Daniel Bergman, BS. MSIII, Loma Linda University

Nickel allergic contact dermatitis (Ni-ACD) has become a widely recognized disease process with an exponential increase in the last three decades within the United States. A subpopulation of ACD patients will manifest with systemic contact dermatitis (SCD) when exposed to nickel systemically such as orally, per rectum, intravenously, intravesically, transcutaneously, intrauterinely, or by inhalation. The Bergman et al[i] article highlights:

• The FDA reports 212 incidences of Essure^TM removal due in part to nickel allergy with 55% confirmed improvement of symptoms after removal.
• Nickel allergy is not a contraindication for Essure^TM, however, assessing for a history of moderate to severe reactions to nickel is crucial in reducing patient morbidity. This history should prompt further evaluation including possible referral to a specialist and patch testing.
• The patch test is the gold standard for diagnosing ACD. In the hands of a trained professional the patch test is a proven predictor of ACD.
• The pathophysiology is different between ACD and SCD. Therefore, not every woman with a history of ACD and a positive patch test will develop SCD to Essure^TM.

[i] Bergman D., B.S., Goldenberg A. MAS, MD, Jacob S.E., MD Update on Providing Re-Essure-ance to the Nickel-Allergic Patient Considering Hysteroscopic Sterilization.