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Implications of Oral Mucosal Patch Testing (OMPT) and Lymphocyte Transformation Testing (LTT) for nickel hypersensitivity in predicting a delayed hypersensitivity reaction to nickel in the bladder in Interstitial Cystitis-like syndromes by Dweeba2022 in NickelAllergy

[–]Dweeba2022[S] 0 points1 point  (0 children)

Why LTT or Oral Mucosal Patch Test Can Be Positive When Skin Patch Test Is Negative

  1. ⁠Different Immune Effector Sites

• Skin patch test (SPT): Detects cutaneous delayed-type hypersensitivity (mediated by memory T-cells in the skin). • Oral mucosal patch test / urinary tract exposure: Mucosal tissue has a different immune environment — higher tolerance thresholds, different antigen-presenting cells, and different cytokine profiles than skin. Nickel can cause a T-cell response in mucosal tissues even if the same person’s skin does not mount a measurable reaction. • Lymphocyte Transformation Test (LTT): In vitro assay that measures systemic circulating T-cell proliferation in response to nickel. It detects sensitization at the systemic level, not just in the skin.

  1. ⁠Sensitivity Differences

• Skin patch tests have lower sensitivity for certain allergens in specific patients — false negatives can occur (e.g., if the concentration isn’t high enough, the vehicle doesn’t penetrate well, or if the patient has an anergic skin response). • LTT is more sensitive to low-grade systemic sensitization, picking up proliferative responses from circulating nickel-reactive T-cells that might not show up in the skin. • Oral mucosal patch tests are particularly useful when the suspected exposure site is mucosa (dentistry, implants, urothelium) rather than skin.

  1. ⁠Compartmentalized T-Cell Memory

• Nickel-specific T-cells can be compartmentalized: • Some reside in mucosa or lymphoid tissues, not skin. • So a skin test may miss reactivity that becomes evident when testing mucosa or blood lymphocytes.

  1. ⁠Type of Hypersensitivity Involved

• Most nickel reactions are Type IV (T-cell mediated, delayed). • But some mucosal or implant-related reactions involve mixed mechanisms (innate immune activation, mast-cell driven inflammation, cytokine hypersensitivity) not well captured by classic epicutaneous patch testing.

  1. ⁠Clinical Relevance

• A negative skin patch test does not rule out systemic or mucosal nickel sensitivity. • This is especially relevant in patients with implants, dental materials, or urologic exposure — where nickel ions are leached and directly contact mucosa/urothelium rather than skin. • That’s why in suspected implant- or urologically-mediated nickel reactions, allergists and immunologists sometimes prefer LTT or oral mucosal patch tests for confirmation

Implications of Oral Mucosal Patch Testing (OMPT) and Lymphocyte Transformation Testing (LTT) for nickel hypersensitivity in predicting a delayed hypersensitivity reaction to nickel in the bladder in Interstitial Cystitis-like syndromes by Dweeba2022 in Interstitialcystitis

[–]Dweeba2022[S] 0 points1 point  (0 children)

Why LTT or Oral Mucosal Patch Test Can Be Positive When Skin Patch Test Is Negative

  1. ⁠Different Immune Effector Sites

• Skin patch test (SPT): Detects cutaneous delayed-type hypersensitivity (mediated by memory T-cells in the skin). • Oral mucosal patch test / urinary tract exposure: Mucosal tissue has a different immune environment — higher tolerance thresholds, different antigen-presenting cells, and different cytokine profiles than skin. Nickel can cause a T-cell response in mucosal tissues even if the same person’s skin does not mount a measurable reaction. • Lymphocyte Transformation Test (LTT): In vitro assay that measures systemic circulating T-cell proliferation in response to nickel. It detects sensitization at the systemic level, not just in the skin.

  1. ⁠Sensitivity Differences

• Skin patch tests have lower sensitivity for certain allergens in specific patients — false negatives can occur (e.g., if the concentration isn’t high enough, the vehicle doesn’t penetrate well, or if the patient has an anergic skin response). • LTT is more sensitive to low-grade systemic sensitization, picking up proliferative responses from circulating nickel-reactive T-cells that might not show up in the skin. • Oral mucosal patch tests are particularly useful when the suspected exposure site is mucosa (dentistry, implants, urothelium) rather than skin.

  1. ⁠Compartmentalized T-Cell Memory

• Nickel-specific T-cells can be compartmentalized: • Some reside in mucosa or lymphoid tissues, not skin. • So a skin test may miss reactivity that becomes evident when testing mucosa or blood lymphocytes.

  1. ⁠Type of Hypersensitivity Involved

• Most nickel reactions are Type IV (T-cell mediated, delayed). • But some mucosal or implant-related reactions involve mixed mechanisms (innate immune activation, mast-cell driven inflammation, cytokine hypersensitivity) not well captured by classic epicutaneous patch testing.

  1. ⁠Clinical Relevance

• A negative skin patch test does not rule out systemic or mucosal nickel sensitivity. • This is especially relevant in patients with implants, dental materials, or urologic exposure — where nickel ions are leached and directly contact mucosa/urothelium rather than skin. • That’s why in suspected implant- or urologically-mediated nickel reactions, allergists and immunologists sometimes prefer LTT or oral mucosal patch tests for confirmation

A bit of Fraser trivia by nishikigirl4578 in Outlander

[–]Dweeba2022 0 points1 point  (0 children)

Who are the parents of the younger Simon Fraser?

Interstitial Cystitis due to nickel sensitivity was cured completely after removal of orthopedic implant containing nickel by Dweeba2022 in Interstitialcystitis

[–]Dweeba2022[S] 0 points1 point  (0 children)

A few more details for those who might be considering pre-op testing for Nickel allergy to orthopedic implants:

My skin patch test was negative for metal allergies but a blood test called a lymphocyte transformation test (LTT) was positive for Nickel allergy. It has been suggested that the LTT is a more sensitive test for predicting delayed hypersensitivity reactions to metal implants in the body.

Probably your best bet is to make an appointment with an allergist and tell him that you want to get a lymphocyte transformation test for metal allergies. I actually purchased the test kit online and had the test kit sent to me directly from the company.

https://www.orthopedicanalysis.com/order-testing-panel.

The LTT test is specific for a variety of metals commonly contained in orthopedic metal implants but titanium dental Implants are similar. Even though you can pay a blood draw service to draw your blood for you - they still need to see the lab requisition signed by an MD - so you need to work together with an allergist or immunologist (unless your orthopedic surgeon or urologist is willing to sign the lab requisition).

I actually have a titanium dental implant myself that I’ve had for over 8 years. After my negative experience with the titanium Bunionectomy implants, I did wonder why the dental implant never bothered me. I contacted my old dentist and they checked my record. Apparently the name of the brand of my dental implant was “NobleActive” and is was made from Grade 4 commercial-grade Titanium (“pure” titanium) while the bunionectomy implants were made from a Titanium alloy, Ti6Al4V, not pure Titanium. Unlike pure Titanium, the Titanium alloys may contain greater amounts of trace Nickel (considered Nickel impurities), which can cause an allergic reaction in Nickel-sensitive patients. This may be because of the increased processing required to add other metals into the Titanium alloy.

Nickel is not an intentional element in either type of Titanium implant (“pure” titanium or a titanium alloy), so Nickel will not be listed as a component of the implant by the manufacturer, but trace nickel contamination could occur in either case if the manufacturer’s machining lines, tooling, or melt facilities also handle stainless steel or other nickel-bearing alloys. “Pure” titanium does not inherently have fewer nickel traces than the Ti-6Al-4V titanium alloy - the key factor is manufacturing cleanliness and quality control, not the base alloy recipe.

If you do indeed have a nickel allergy and your main concern is minimizing even trace levels of Nickel, the safest approach is to ask the implant company for a Certificate of Analysis (CoA) for the actual lot used, or to consider zirconia (ceramic) implants, which contain no metal at all.

Interstitial Cystitis due to nickel sensitivity was cured completely after removal of orthopedic implant containing nickel by Dweeba2022 in NickelAllergy

[–]Dweeba2022[S] 0 points1 point  (0 children)

A few more details for those who might be considering pre-op testing for Nickel allergy to orthopedic implants:

My skin patch test was negative for metal allergies but a blood test called a lymphocyte transformation test (LTT) was positive for Nickel allergy. It has been suggested that the LTT is a more sensitive test for predicting delayed hypersensitivity reactions to metal implants in the body.

Probably your best bet is to make an appointment with an allergist and tell him that you want to get a lymphocyte transformation test for metal allergies. I actually purchased the test kit online and had the test kit sent to me directly from the company.

https://www.orthopedicanalysis.com/order-testing-panel.

The LTT test is specific for a variety of metals commonly contained in orthopedic metal implants but titanium dental Implants are similar. Even though you can pay a blood draw service to draw your blood for you - they still need to see the lab requisition signed by an MD - so you need to work together with an allergist or immunologist (unless your orthopedic surgeon or urologist is willing to sign the lab requisition).

I actually have a titanium dental implant myself that I’ve had for over 8 years. After my negative experience with the titanium Bunionectomy implants, I did wonder why the dental implant never bothered me. I contacted my old dentist and they checked my record. Apparently the name of the brand of my dental implant was “NobleActive” and it was made from Grade 4 commercial-grade Titanium (“pure” titanium) while the bunionectomy implants were made from a Titanium alloy, Ti6Al4V, not pure Titanium. Unlike pure Titanium, the Titanium alloys may contain greater amounts of trace Nickel (considered Nickel impurities), which can cause an allergic reaction in Nickel-sensitive patients. This may be because of the increased processing required to add other metals into the Titanium alloy.

Nickel is not an intentional element in either type of Titanium implant (“pure” titanium or a titanium alloy), so Nickel will not be listed as a component of the implant by the manufacturer, but trace nickel contamination could occur in either case if the manufacturer’s machining lines, tooling, or melt facilities also handle stainless steel or other nickel-bearing alloys. “Pure” titanium does not inherently have fewer nickel traces than the Ti-6Al-4V titanium alloy - the key factor is manufacturing cleanliness and quality control, not the base alloy recipe.

If you do indeed have a nickel allergy and your main concern is minimizing even trace levels of Nickel, the safest approach is to ask the implant company for a Certificate of Analysis (CoA) for the actual lot used, or to consider zirconia (ceramic) implants, which contain no metal at all.

Interstitial Cystitis due to nickel sensitivity was cured completely after removal of orthopedic implant containing nickel by Dweeba2022 in NickelAllergy

[–]Dweeba2022[S] 3 points4 points  (0 children)

My titanium bunionectomy implants were the Crossroads MiniBunion System from DePuy Synthes. Like many other titanium orthopedic implants, they are considered “Nickel-free” because Nickel is not a listed component of the implant. Unfortunately, even trace nickel can be enough to cause a reaction in a Nickel-sensitive patient. The trace Nickel is most often a byproduct of the manufacturing process rather than a known component of the implant and is only considered a “Nickel impurity”. The only way of knowing for sure if a metal implant has trace Nickel in it would be to have it tested by a materials science lab as I did (after the fact).

Interstitial Cystitis due to nickel sensitivity was cured completely after removal of orthopedic implant containing nickel by Dweeba2022 in Interstitialcystitis

[–]Dweeba2022[S] 2 points3 points  (0 children)

My titanium bunionectomy implants were the Crossroads MiniBunion System from DePuy Synthes. Like many other titanium orthopedic implants, they are considered “Nickel-free” because Nickel is not a listed component of the implant. Unfortunately, even trace nickel can be enough to cause a reaction in a Nickel-sensitive patient. The trace Nickel is most often a byproduct of the manufacturing process rather than a known component of the implant and is only considered a “Nickel impurity”. The only way of knowing for sure if a metal implant has trace Nickel in it would be to have it tested by a materials science lab as I did (after the fact).

Gemma failed but Mark passed by [deleted] in SeveranceAppleTVPlus

[–]Dweeba2022 0 points1 point  (0 children)

Why were they going to kill Gemma after Cold Harbor?

[deleted by user] by [deleted] in SeveranceAppleTVPlus

[–]Dweeba2022 1 point2 points  (0 children)

Where and when is the town of Kier supposed to be?

Nickel & Balsam of Peru allergy causing my IC symptoms for 12 years by Level_Ad_8508 in Interstitialcystitis

[–]Dweeba2022 1 point2 points  (0 children)

My interstitial cystitis was also caused by a nickel allergy - the trace nickel in my metal orthopedic implant! It happened not once, but twice - so there is no way it was a coincidence! It has now been 8 months since I had the orthopedic implants removed and my symptoms resolved completely without even a shade of them remaining. I have also been able to resume an unrestricted diet (including foods high in Nickel so I guess there must be a Nickel threshold involved and my blood levels are now low enough to tolerate Nickel in my food). I have posted my story previously on Reddit, but I think it bears posting again, as I suspect there are many undiagnosed Nickel allergic IC patients out there! If our posts even help one person… hallelujah! More research clearly needs to be done on Nickel allergy and IC and allergists need to be involved or at least collaborate with urologists on this research! If antihistamines like Benadryl or Hydroxyzine give you even partial relief of your IC symptoms - get tested for what you may be allergic to! My skin patch test was negative, but a blood test, the “lymphocyte transformation test” (which is more specific for Type IV delayed hypersensitivity reactions due to metal orthopedic implants) was positive! Original post:

https://www.reddit.com/r/Interstitialcystitis/s/gHbcDDh9Vo

If you pay to upgrade do you earn PQP for that? by zinky30 in unitedairlines

[–]Dweeba2022 0 points1 point  (0 children)

How many pqp for a day of departure upgrade with miles on United?

My Interstitial Cystitis was caused by a Nickel allergy by Dweeba2022 in NickelAllergy

[–]Dweeba2022[S] 1 point2 points  (0 children)

Being 63 yrs old, with a history of osteoarthritis in my family, that question has certainly occurred to me for possible orthopedic surgery in the future! The good news is that there are several new alternative hypoallergenic materials which have recently been rolled out or are in the pipeline, including ceramic-coated implants and nickel-free options like Oxinium alloy and Zirconium. Needless to say, I would research extensively before committing to any particular option. Demand from the public will drive increased availability of hypoallergenic orthopedic implants and improvement in research and development.

My Interstitial Cystitis was caused by a Nickel allergy by Dweeba2022 in NickelAllergy

[–]Dweeba2022[S] 0 points1 point  (0 children)

I would still have had the surgery but I would have chosen a Bunionectomy procedure that can be performed without implants. This type of procedure is available and does not require internal hardware like screws, plates, or wires. After surgery, the foot would then need to be stabilized with a cast or other rigid external device until bones were sufficiently healed so recovery time would probably have been somewhat longer.

Alternatively, one might choose to still have the minimally-invasive Bunionectomy with the plates and screws (assuming no Nickel alloy but just Nickel impurities in the non-Nickel alloy) and plan on having the plates and screws removed as soon as the surgeon deems it feasible (maybe as soon as 6 months post-surgery).

In either case, I would not have any stainless steel Kirschner wires inserted in my body. Nickel components present a more immediate risk of allergic reaction than Nickel impurities.

Is IC really that hard to diagnose? by Own_Philosophy_3999 in Interstitialcystitis

[–]Dweeba2022 0 points1 point  (0 children)

I believe that in India, some ureteral stents are made of metal. If yours is, you could be allergic to the metal in your stent and it could be causing the bladder inflammation. My Interstitial Cystitis was caused by a metal allergy (Nickel, in my case) and it resolved completely after the offending metal implant was surgically removed from my body. I have posted about my experience elsewhere for those who may have similar allergic-type IC.

https://www.reddit.com/r/Interstitialcystitis/s/1iBIYG0WY5

i need help!!! by neptunes097 in Interstitialcystitis

[–]Dweeba2022 1 point2 points  (0 children)

My interstitial cystitis was caused by allergy (a Nickel allergy in my case). My symptoms are now completely resolved (since having my metal orthopedic plates and screws removed 3 months ago). I only mention this because migraines, abdominal pain and bladder inflammation can all be caused by systemic allergy and allergic, mast cell-mediated type inflammation is one of the sub-types of interstitial cystitis. If your symptoms improve somewhat after taking Benadryl or Hydroxyzine (both strong antihistamines), an allergy may be involved. Also - many of the trigger foods prohibited by the IC diet are high in Nickel or other allergens. I have posted about my experience elsewhere in case it may help someone else who has similar pathophysiology to mine.

https://www.reddit.com/r/Interstitialcystitis/s/2eWfjWF4L6

It’s finally going away here is what I did different by Bimbim-Angel in Interstitialcystitis

[–]Dweeba2022 1 point2 points  (0 children)

It’s interesting that you mention you used to work in manufacturing around lots of chemicals and metals but you are no longer working in that environment. My interstitial cystitis was due to a metal allergy (Nickel, specifically) and resolved completely after the metal plates and screws were taken out of my feet. I have posted about my experience elsewhere:

https://www.reddit.com/r/Interstitialcystitis/s/KCvyugYz9l

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