Clinicians from Ozarks Medical Center in West Plains, Missouri have reported a case of a 58-year-old woman who developed Asthma after implantation of a permanent pacemaker. The case report is published in the Annals of Internal Medicine.

Previous reports of complications after insertion of a permanent cardiac pacemaker have described rare local reactions caused by a metal allergy that can be severe enough to cause wound dehiscence and require pacemaker removal. But asthma induced by the allergy to the metal used in pacemaker has not previously been described. It is unprecedented that an allergic reaction to the metal used in a pacemaker's casing could cause asthma in susceptible patients.

Clinicians from Ozarks Medical Center in West Plains, Missouri cite the case of a 58-year-old woman who had new episodes of wheezing, chest tightness, and worsening shortness of breath on minimal exertion 3 weeks after implantation of a permanent pacemaker.

The patient: a 58-year-old woman who developed wheezing, chest tightness, and worsening dyspnea on minimal exertion 3 weeks after implantation of a permanent pacemaker. The patient was a non-smoker with a history of seasonal allergies in childhood."On physical examination, the patient had diffuse, bilateral expiratory wheezes on chest auscultation and a raised, erythematous, mildly pruritic and non-crusting rash confined to the skin immediately around the insertion site for her pacemaker," reported Biplab Saha, MD, of Ozarks Medical Center in West Plains, Missouri.

The clinical condition of the patient was consistent with a diagnosis of asthma despite her baseline FEV1–FVC ratio not meeting standard measures for airflow obstruction. Asthma was confirmed by the evidence of reversible airway obstruction (improvement after bronchodilator administration in FEV1, FVC, FEV1–FVC ratio, and FEF25%–75%). The patient was treated first with a combination of inhaler that included a long-acting β2-agonist and corticosteroid. She later required oral corticosteroids, a leukotriene receptor antagonist, and high-dose antihistamines.

While asthma induced by the metal allergy has not previously been described, the patient's reaction prompted clinicians to review her medical records for allergies. Her records revealed that she had been hypersensitive to costume jewelry as an adolescent, which led the team to order skin testing for metal allergies. The patient had positive reactions to titanium, nickel, and mercury, but not gold, so the clinicians replaced her titanium-encased pacemaker with a gold-encased pacemaker, and her asthma symptoms disappeared within 24 hours. She was able to stop bronchodilators, inhaled corticosteroids, and oral corticosteroids.

For further reference log on to http://annals.org/aim/article/doi/10.7326/L19-0647