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• W2027886612 abstract "Authors' reply Sir—Fiona Keane and colleagues are surprised by the molybdenum allergy. They emphasise their comment with a reference from a study in which molybdenum caused no contact dermatitis in mice.1Dueva LA Stepanian SS Clinico-immunologic characteristics and prevention of occupational allergic dermatoses due to molybdenum exposure.Vestn Dermatol Venerol. 1989; 10: 47-50PubMed Google Scholar However, hyper-sensitivity reactions to molybdenum are reported and it is identified as a sensitiser.1Dueva LA Stepanian SS Clinico-immunologic characteristics and prevention of occupational allergic dermatoses due to molybdenum exposure.Vestn Dermatol Venerol. 1989; 10: 47-50PubMed Google Scholar, 2Federmann M Morell B Graetz G et al.Hypersensitivity to molybdenum as a possible trigger of ANA-negative systemic lupus erythematosus.Ann Rheum Dis. 1994; 53: 403-405Crossref PubMed Scopus (26) Google Scholar Keane and colleagues state that guidance on salt to concentration in patch tests is limited. For this reason, we followed the recommendations of the International Contact Dermatitis Research Group. We take note of their concern that we did not investigate patients who had no suspected restenosis. However, we do not believe that this additional cohort is essential to answer the questions of our study. We included an angiographically verified control group without restenosis. With this control cohort, an association of positive tests with or without restenosis can be detected. We agree that a prospective design might have been better to study the association between restenosis and hypersensitivity reaction. However, patients with nickel allergy are unlikely to agree to implantation of stainless steel stents, if carbon-coated stents with less metal ion release are available.3Gutensohn K Beythien C Bau J et al.In-vitro analyses of diamond-like carbon-coated stents: reduction of metal ion release, platelet activation, and thrombogenicity.Thromb Res. 2000; 99: 577-585Summary Full Text Full Text PDF PubMed Scopus (258) Google Scholar The direct activation of endothelial cells by nickel chloride mentioned by Keane and colleagues is a different mechanism from the hypersensitivity reaction that we studied. However, their speculations about this as a factor for the development of in-stent restenosis seem plausible. We share Keane and colleagues' opinion that many workers cannot answer whether nickel-containing prostheses should be avoided. In relation to whether our results are translatable into the clinical setting, we pointed out that the results are preliminary, mainly because of the number of patients. However, if these results are confirmed in a larger series of patients, possible benefits of carbon-coated stents might be assessed in these patients. In answer to Ha and Lalla's comment about the distribution of hypercholesterolaemia in the study cohorts, the difference in the frequency of hypercholesterolaemia and in the treatment with statins between the groups was not significant. Therefore, cholesterol-related and statin-related effects, such as they describe might not have greatly altered our results. Daniel Mimouni and colleagues suspect that the 316L steel stents in our study had high sulphur content. We did not measure sulphur content, because 316L has a defined low-sulphur composition. Accordingly, in the studies they cite, 316L steel was listed among the grades of stainless steel with low sulphur content. We have no reason to believe that the steel used for stents should vary from this defined 316L composition. Allergy in coronary in-stent restenosisRalf Köster and colleagues (Dec 2, p 1895)1 report on nickel and molybdenum contact allergies in patients with coronary restenosis. We have reservations about their study design and the interpretation of their findings. Full-Text PDF Allergy in coronary in-stent restenosisRalf Köster and colleagues'1 proposed mechanism of nickel and molybdenum contact allergies being of importance in patients with coronary in-stent restenosis is intriguing. However, they include no information on the use of inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Full-Text PDF Allergy in coronary in-stent restenosisRalf Köster and colleagues1 do not discuss the behaviour of stainless-steel grades in relation to nickel contact dermatitis. Full-Text PDF" @default.
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• W2027886612 title "Allergy in coronary in-stent restenosis" @default.
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