General Comments And Immunology

A rare and chemically inert metal similar to platinum, palladium occurs at such low concentrations in alloys (e.g., in jewelry or dental fillings) as to pose no notable toxicological hazard. No acute or systemic effects in humans have been reported, other than the observation of allergic sensitization, which can involve the respiratory system, skin, oral mucosa, and eyes, ascribed to contact with the metal itself. Acute contact dermatistis (ACD) and oral mucosal lesions, such as erosive lichen planus, are the principal clinical expression of palladium sensitivity seen in the general population, acquired mainly from the metal in alloys used in dental prostheses which can contain up to 79% of the metal (1,2). Rare cases of immediate type allergy have been reported (3-8). The prevalence of reactions to dental materials has been on the increase since the introduction of palladium-silver alloys in 1973 as a substitute for other materials containing metals suspected of toxicity or allergenicity, such as mercury and nickel, respectively (9). In Germany, dentists have even been advised to stop using palladium or its alloys because of this trend (10).

Striking increases in hypersensitivity to palladium are not limited to oral exposure and corresponding manifestations. In a cohort of 2300 dermatology patients in Italy, 171 (7.4%) had positive reactions to palladium chloride (1% f in petrolatum); notably, 169 also had a concomitant reaction to nickel sulfate.

Contamination of palladium patch test material with nickel was excluded by atomic absorption spectrophotometry analysis. None of the reactants had ever worn a metal dental prosthesis or had an occupational history of exposure to palladium. The prevalence of positive patch tests to nickel in that cohort was

22% (11). Confirming such an increase is the sensitization rate; in Austria, palla- |

dium allergy is now 8.3% in eczema patients, and is only exceeded by nickel (12).

Sensitization to palladium has also been attributed to long-term occupational exposure, where 24-hr skin reactions to patch testing and leukocyte migra-

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