Stejskal, V D, Cederbrant, K, Lindvall, A et al. · Toxicology in vitro : an international journal published in association with BIBRA · 1994 · DOI
This study tested whether certain metals used in dental work and medical devices can trigger immune system reactions in people with chronic fatigue and mouth problems. Researchers used a laboratory test called MELISA to measure how immune cells from patients responded to metals like mercury, gold, and palladium. They found that people with symptoms had stronger immune reactions to these metals than healthy people without symptoms, suggesting a possible connection between metal exposure and their health problems.
For ME/CFS patients, this study is relevant because it explores a potential immunological mechanism—metal hypersensitivity—that might contribute to symptoms in genetically predisposed individuals. The findings suggest that dental restorations and medical devices containing metals could trigger abnormal immune responses in some patients, which could inform clinical decision-making about material selection and biocompatibility testing.
This study does not prove that metal exposure causes ME/CFS in the general population, only that certain metals can induce immune responses in some symptomatic individuals. The small sample size, lack of longitudinal data, and absence of controls for other confounders limit causal inference. Correlation between metal exposure and symptoms does not establish that metal is the primary cause of chronic fatigue.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Stejskal, V D, Cederbrant, K, Lindvall, A, & Forsbeck, M (1994). MELISA-an in vitro tool for the study of metal allergy.. Toxicology in vitro : an international journal published in association with BIBRA. https://doi.org/10.1016/0887-2333(94)90233-x
BibTeX
@article{mecfsatlas-stejskal-1994-melisa-vitro,
author = {Stejskal, V D and Cederbrant, K and Lindvall, A and Forsbeck, M},
title = {MELISA-an in vitro tool for the study of metal allergy.},
journal = {Toxicology in vitro : an international journal published in association with BIBRA},
year = {1994},
doi = {10.1016/0887-2333(94)90233-x},
note = {PubMed: 20693060},
url = {https://www.mecfsatlas.com/evidence/stejskal-1994-melisa-vitro},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/stejskal-1994-melisa-vitro
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