Upon surgery only transient inflammatory response may be observed in contrast to some developing immune response to metal implants as result of material characteristics or individual reagibility. This is predominantly a macrophage-driven foreign body like response to particulate debris. Metal implant allergy may develop as result of preexisting allergy or upon newly induced lymphocyte sensitisation. Clinical manifestations encompass eczema, recurrent swelling, seroma formation and impaired wound heating. Allergy-dependent implant loosening is also suspected. We discuss more detailed clinical-allergological testing, the analysis of periimplantar immune reaction and report about an interdisciplinary data collection (metal implant allergy register).