A case of titanium-coated pacemaker allergy in a 14-year-old patient

Abstract

Currently, titanium is widely used in implants, particularly in cardioresynchronizing devices, such as pacemakers, because it is well tolerated by patients and rarely causes allergic reactions. The low informative value of the allergy testing for titanium makes its allergy diagnosis difficult. Experts reported that false negative results of skin application tests with titanium may be associated with the use of titanium tetrachloride in allergy testing, which is not pure metal. The use of glucocorticoids in treating pacemaker component-related allergy is temporary and does not exclude recurrence of inflammation. The main treatment for patients is the replacement of the implantable system with a device made of the most hypoallergenic materials. The present paper describes a case of a 14-year-old patient with an allergy to a titanium-coated pacemaker. This is the first time eosinophil cationic protein and tryptase are detected at the inflammation site while diagnosing allergy to a titanium-coated pacemaker. This study concludes that the level of eosinophilic cationic protein and tryptase in the inflammation site is a promising marker in metal allergy diagnosis and requires further research. Timely diagnosis of titanium allergy and the reimplantation of a gold-coated pacemaker prevent the recurrence of inflammatory changes in the area of pacemaker insertion and infectious complications, thereby significantly improving patient prognosis.