{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:37:06Z","timestamp":1788781026494,"version":"build-2803163510"},"reference-count":86,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Patent foramen ovale (PFO) is implicated in cryptogenic stroke and other clinical syndromes, with transcatheter closure demonstrating superiority over medical therapy in selected patients. Most closure devices are composed of nitinol, a nickel\u2013titanium alloy, raising concerns in individuals with nickel hypersensitivity, one of the most prevalent contact allergies worldwide. Although typically manifesting as localized dermatitis, nickel allergy has been associated with systemic reactions after device implantation, including chest pain, palpitations, migraines, dyspnea, and cutaneous eruptions. Recent evidence indicates that nickel-sensitive patients experience a significantly higher incidence of post-procedural device-related symptoms. Nevertheless, severe reactions remain rare, and the benefits of PFO closure generally outweigh the risks. The predictive value of pre-implantation patch testing remains uncertain, and the lack of nickel-free alternatives constrains device selection. Management strategies are empirical, relying on symptomatic treatment with corticosteroids, antihistamines, or device explantation in refractory cases. Future research should focus on elucidating the pathophysiology of nickel-induced hypersensitivity in cardiovascular implants, improving diagnostic algorithms, and developing biocompatible, nickel-free devices. A multidisciplinary approach involving cardiologists, dermatologists, and allergists is essential to optimize outcomes in this complex subset of patients.<\/jats:p>","DOI":"10.3390\/jcm14217540","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T05:48:46Z","timestamp":1761716926000},"page":"7540","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Management of Patients with Nickel Hypersensitivity Undergoing Patent Foramen Ovale Closure"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-7952","authenticated-orcid":false,"given":"Anastasios","family":"Apostolos","sequence":"first","affiliation":[{"name":"Unit of Structural Heart Diseases, First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital of Athens, 115 27 Athens, Greece"},{"name":"First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital of Athens, 115 27 Athens, Greece"},{"name":"Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-1032","authenticated-orcid":false,"given":"Stamatios","family":"Gregoriou","sequence":"additional","affiliation":[{"name":"First Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Syggros Hospital, 161 21 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Drakopoulou","sequence":"additional","affiliation":[{"name":"Unit of Structural Heart Diseases, First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital of Athens, 115 27 Athens, Greece"},{"name":"First Department of Cardiology, 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General Hospital of Athens, 115 27 Athens, Greece"},{"name":"Medical School, European University of Cyprus, 2404 Egkomi, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":false,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, \u201cAttikon\u201d University Hospital, 124 62 Athens, Greece"},{"name":"Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Stratigos","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital of Athens, 115 27 Athens, 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General Hospital of Athens, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"ref_1","first-page":"401","article-title":"Patent Foramen Ovale","volume":"31","author":"Dattilo","year":"2013","journal-title":"Cardiol. 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