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Metals Allergy Testing Program

Up to 10% of joint replacements will fail, causing pain, swelling and/or instability. The MetALLs Allergy program at National Jewish Health was developed to evaluate allergy to the metal and bone cement components used in joint replacements as a potential cause of failure. 

The MetALLs program offers individualized evaluation that can help guide the selection of hardware, minimize failure due to allergy and reduce the need for surgical revision in joint replacement patients.


Who should be referred for MetALLs allergy evaluation?

After joint replacement (post-op): patients with persistent pain, swelling and/or loosening should be referred after infection and biomedical mis-match have been excluded as a cause.

Before joint replacement (pre-op): patients with a history of allergy or sensitivity to metals or artificial nails.


What MetALLs evaluations are available?

We currently offer two options for assessing joint replacement patients for allergies:

  1. We offer patch testing at our clinic in Denver, CO. Our customized, comprehensive patch test panel evaluates sensitivity to multiple components used in joint replacements, including nickel, cobalt, chromium, titanium, benzoyl peroxide, and bone cement itself. Testing involves three visits to our clinic in a 4-5 day period.

  2. We also offer the nickel lymphocyte proliferation test (NiLPT). The NiLPT is a simple blood assay that has been validated by patch testing, which detects nickel sensitization. This is an ideal test for patients who cannot travel to Denver for our comprehensive medical evaluation but who are concerned that they might be allergic to nickel. Order a test.


Tests We Offer

Allergy MetALLs Nickel Lymphocyte Proliferation (NiLPT) Testing

The nickel lymphocyte proliferation test (NiLPT) is a simple blood test for nickel allergy that measures the proliferation of lymphocytes (white blood cells) when presented with a challenge agent. The NiLPT offers physicians the ability to diagnose nickel allergy if patch testing is unavailable. It also can be used when patch test results are inconclusive.

Thirty milliliters (or three tubes) of blood are drawn at the physician’s office and sent by overnight courier to the Advanced Diagnostics Laboratory (ADx) at National Jewish Health. Results typically will be available within 14 days.

The NiLPT has been validated against patch testing and demonstrated to have a specificity of 98% and sensitivity of 68%.

Development of a validated blood test for nickel sensitization. Pacheco K, Barker L, Maier L, Erb S, Sills M, Knight V. J Allergy Clin Immunol. 2013 Sep;132(3):767-9.


If you are interested in having an NiLPT performed, please contact the MetALLs Allergy Program at 800.423.8891 ext. 1723 or via e-mail at

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