Sterzl, Ivan, Procházková, Jarmila, Hrdá, Pavlína et al. · Neuro endocrinology letters · 1999
This study tested whether allergies to metals like mercury (found in old dental fillings) and nickel might trigger fatigue and autoimmune problems in people with ME/CFS. Researchers compared three groups of tired patients with healthy controls and found that people with fatigue were more sensitive to these metals. When some patients had their mercury-containing fillings removed and replaced, their fatigue improved significantly.
This research suggests a potential environmental trigger for ME/CFS fatigue involving metal hypersensitivity and immune activation, offering a testable hypothesis for a subset of patients. If validated, it could lead to a simple, non-invasive intervention (dental amalgam removal) with potential clinical benefit for those with metal sensitivity.
This study does not establish causation; it only shows association between metal sensitivity and fatigue. The intervention data come from a small, uncontrolled subset without randomization or blinding, so the symptom improvements cannot definitively be attributed to amalgam replacement alone rather than placebo effect or natural recovery. The study cannot determine what proportion of ME/CFS cases (if any) are actually caused by metal hypersensitivity.
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
Sterzl, Ivan, Procházková, Jarmila, Hrdá, Pavlína, Bártová, Jirina, Matucha, Petr, & Stejskal, Vera DM (1999). Mercury and nickel allergy: risk factors in fatigue and autoimmunity.. Neuro endocrinology letters. https://pubmed.ncbi.nlm.nih.gov/11462117/
BibTeX
@article{mecfsatlas-sterzl-1999-mercury-nickel,
author = {Sterzl, Ivan and Procházková, Jarmila and Hrdá, Pavlína and Bártová, Jirina and Matucha, Petr and Stejskal, Vera DM},
title = {Mercury and nickel allergy: risk factors in fatigue and autoimmunity.},
journal = {Neuro endocrinology letters},
year = {1999},
note = {PubMed: 11462117},
url = {https://www.mecfsatlas.com/evidence/sterzl-1999-mercury-nickel},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/sterzl-1999-mercury-nickel
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