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PubMed1979

Evaluation of bee sting allergy by skin tests and serum antibody assays.

We studied 55 subjects who had had anaphylactic reactions to bee stings within the previous 3 years. 38 out of 54 tested had IgE antibody to honey bee venom (HBV) as measured by radioallergosorbent test (RAST). On skin testing, 30 out of 34 had a positive test to HBV. Of these, 26 had a positive RAST. A positive skin test to HBV at high dilution or else a high anti-HBV RAST score appeared to identify those who, in a 6-month follow-up period, were at risk of developing further anaphylaxis following bee stings or immunotherapy. Of the two tests, RAST appeared to be the less sensitive. Measurements of IgG antibody to phospholipase A were seldom available for the period immediately preceding an anaphylactic episode and proved to be a poor means of predicting the liability to bee sting anaphylaxis in subsequent months.

Anaphylaxis↗
PubMed2007

Reaction pattern to histamine and codeine in a human intradermal skin test model.

BACKGROUND: Skin prick and intradermal skin tests (IDT) are useful tools in evaluating IgE-mediated allergic disorders. In the literature, many variations of the techniques used are described. No general agreement exists on test procedures and reading of test results. OBJECTIVE: To analyse test conditions for IDT to facilitate comparability between different study protocols. METHODS: We tested 24 healthy volunteers with three concentrations of histamine and codeine each on the upper back, lateral upper arm and volar forearm, with/without addition of ethylene diamine tetra-acetic acid. Reading of the resulting weal was performed by taking a digital image of the weal, later outlining the weal perimeter in triplicate and calculating the weal area using the NIH Image J software version 1.3. RESULTS: Weal size was dose dependent for both substances, generally larger on the upper back than on the forearm and upper arm, and larger after codeine than after histamine. Addition of the Ca2+ -chelator ethylene diamine tetra-acetic acid did not significantly affect weal size. Weal size induced by histamine showed better consistency than that induced by codeine. CONCLUSIONS: The results and our technique provide valuable tools for the daily routine as well as for the ability to compare information of intradermal tests from different studies or clinical reports. When assessing skin reactivity, we recommend the use of 1 mg/mL codeine as well as 0.1 mg/mL histamine to reflect aspects of mast-cell releasability and of vascular reactivity. The involvement of local factors influencing the vascular reactivity or differences in opiate receptor density on mast cells surfaces needs to be addressed in future studies.

Adult↗
PubMed1998

Use of Mycobacterium tuberculosis complex-specific antigen cocktails for a skin test specific for tuberculosis.

The tuberculin skin test currently used to diagnose infection with Mycobacterium tuberculosis has poor diagnostic value, especially in geographic areas where the prevalence of tuberculosis is low or where the environmental burden of saprophytic, nontuberculous mycobacteria is high. Inaccuracy of the tuberculin skin test often reflects a low diagnostic specificity due to the presence in tuberculin of antigens shared by many mycobacterial species. Thus, a skin test specific for tuberculosis requires the development of new tuberculins consisting of antigens specific to M. tuberculosis. We have formulated cocktails of two to eight antigens of M. tuberculosis purified from recombinant Escherichia coli. Multiantigen cocktails were evaluated by skin testing guinea pigs sensitized with M. bovis BCG. Reactivity of multiantigen cocktails was greater than that of any single antigen. Cocktail activity increased with the number of antigens in the cocktail even when the same amount of total protein was used for cocktails and for each single antigen. A cocktail of four purified antigens specific for the M. tuberculosis complex elicited skin test responses only in BCG-immunized guinea pigs, not in control animals immunized with M. avium. These findings open the way to designing a multiantigen formulation for a skin test specific for tuberculosis.

Animals↗
PubMed2002

[Allergen skin tests. Asthmatic infants and young children].

Skin tests represent a major tool in the diagnosis of IgE mediated-allergy. The main indication is the measure of atopy during infancy and early childhood, as a predictive factor of the development of asthma. When atopic eczema is present, skin testing can provide a diagnosis of food allergy. Skin tests are easily done, without absolute contraindications. The epidemiological knowledge helps to choose the allergens to test. The skin-prick test method is well standardized and must be rigorous because of the hyporeactivity of the infant skin. Results are always confounded with positive and negative control solutions. The interpretation of pricks tests must be careful, standing out a clinical allergy (when clinical allergic symptoms are presents) from a sensitization (atopy). The predictive value of a positive skin test is discussed: predisposition to asthma, association with severe asthma, predisposition to acute bronchiolitis during an epidemic of respiratory virus. A positive skin test to food allergen would predict a later pneumallergen sensitization.

Asthma↗
PubMed1985

Determination of immunity to varicella-zoster virus by means of an intradermal skin test.

An intradermal varicella skin test, utilizing heat-inactivated noninfectious viral antigen, was evaluated in 16 adults known to be immune or susceptible to varicella and in 109 adults with no history of varicella. The skin test was well tolerated, compared favorably with established methods of determining immunity to varicella, and accurately predicted which subjects would develop clinical varicella after close exposure.

Adult↗
PubMed1986

Antigen specific stimulation of immune responses during long-term repeated skin testing with multiple antigens.

Delayed-type hypersensitivity (DTH) skin testing as an assay of immune competence is a widely used technique. Accordingly, clinical situations frequently occur which require that skin tests be performed many times on the same patient. In the present investigation, in vivo and in vitro immune responses were studied over a 7-month period in 22 normal human volunteers, each of whom were skin tested 6 times at monthly intervals with multiple antigens. Patterns of responses to the 7 specific skin test antigens observed during repeated skin testing in vivo indicated non-significant, but detectable, declines in skin test reactivity to tetanus, diphtheria and streptococcus antigens and increases in reactivity to trichophyton, tuberculin, candida and proteus antigens. In vitro lymphocyte transformation assays (LTAs) of cell-mediated immune (CMI) activities revealed that repeated skin testing, e.g., 3-5 serial skin tests, induced significantly increased levels of CMI reactions with 3 of the 4 skin test antigens used as challenge antigens. Since no significant changes in in vitro CMI responses were detected using 3 control "non-skin test" antigens, the effects observed were confirmed to be antigen specific. Increased IgG antibody responses were detected for only the toxoid antigens during the skin testing period. For the group of 22 normal volunteers, positive statistical correlations were not observed between any individual skin test antigen and the immune reactions assayed specifically for that antigen, including DTH responses and levels of circulating antigen-specific antibodies. Short term differences were detected between tetanus, diphtheria and streptococcus antigens in their LTA response patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Interpretation of the tuberculin skin test reaction by pediatric providers.

BACKGROUND: The tuberculin (TB) skin test is widely used, but it is not easy to read. There are few data on how well pediatric care providers interpret the TB skin test or on the success of various methods used to read the skin test reaction. OBJECTIVE: To determine the ability of pediatric care providers to correctly read a positive TB skin test reaction and to identify the most successful method of measuring a TB skin test reaction. METHODS: Twenty nurses, 16 staff pediatricians, 13 residents and 8 medical students who were working in a large pediatrics clinic were asked to read a 15-mm TB skin test reaction of a known converter. The study participants read the skin test using any technique they wished. The primary outcome measure was the percentage of providers who read the TB skin test as > or = 10 mm (considered a correct reading). RESULTS: Seventy-seven percent (44 of 57) of the participants interpreted the TB skin test as > or = 10 mm, but 18% (10 of 57) of them read the skin test as negative (< or = 5 mm). The participants used a variety of interpretation techniques with 18 using the ballpoint pen technique. Participants who used the pen technique were significantly more likely to read the skin test as > or = 10 mm compared with those who used other methods (94% vs. 69%; P = 0.04). Pen technique users were also significantly less likely to measure the reaction as < or = 5 mm (0% vs. 26%; P = 0.02). CONCLUSIONS: Many providers, regardless of professional training and experience, read a 15-mm TB skin test reaction as > or = 10 mm, but a significant minority interpreted it as negative. Use of the pen technique may decrease the number of false negative readings. Specific instruction on use of the pen technique to read TB skin tests should be incorporated into medical training curriculums.

Child, Preschool↗
PubMed1978

Diagnosis of penicillin allergy by skin testing: the Manitoba experience.

The reliability of skin testing in the diagnosis of penicillin allergy was studied in 86 adults and 167 children with a history of possible hypersensitivity reactions to penicillin. Skin testing was done with the major antigenic determinant of benzylpenicillin and minor determinants of benzylpenicillin, ampicillin, cloxacillin, methicillin and cephalothin. The overall frequency of positive skin reactions was 11.5%. Among the patients with positive skin reactions about half had a history of immediate or accelerated reactions to penicillins, but 2 of 11 adults and 50% of the children in this group had a history of maculopapular rash of delayed onset. There was a low frequency of positive skin reactions when there was a long interval between the times of clinical reaction and skin testing. Of 169 patients reacting negatively to skin testing who received a specific drug challenge only 2 manifested mild urticaria; this indicates the reliability of the skin tests in predicting penicillin allergy. The major and minor determinants of benzylpenicillin were the most useful reagents. One fifth of the patients with penicillin hypersensitivity would have been missed if the major determinant of benzylpenicillin alone had been used for skin testing. The additional use of the minor determinants of other penicillin derivatives, however, did not increase substantially the clinical reliability of the skin testing procedure.

Adult↗
PubMedDate not supplied

Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children.

CONTEXT: Universal tuberculin skin testing of children has been shown to be costly and inefficient. In response, several authorities have recommended targeted screening based on epidemiological risk. In 1996, the New York City Department of Health (NYCDOH) developed questions to identify children who require a tuberculin skin test. OBJECTIVE: To determine the sensitivity, specificity, and predictive validity of the NYCDOH tuberculosis risk assessment questionnaire. DESIGN: Prospective criterion standard study in which tuberculin skin tests and the NYCDOH questionnaire were administered simultaneously between August 1996 and January 1998. Specific questions asked about contact with a tuberculosis case, birth in or travel to endemic areas, regular contact with high-risk adults, and human immunodeficiency virus infection in the child. SETTING: Ambulatory clinic in South Bronx, New York, NY. PARTICIPANTS: Consecutive sample of 2920 children aged 1 to 18 years. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of the questionnaire, and odds ratio (OR) of reactive skin test results. RESULTS: The NYCDOH questionnaire identified 413 children (14%) as having at least 1 risk factor. Of these, 23 (5.6%) had a positive skin test result; 4 (0.16%) of the 2507 without risk factors had a positive result. Results for the full NYCDOH questionnaire were sensitivity, 85.2%; specificity, 86.0%; negative predictive value, 99.8%; positive predictive value, 5.4%; and OR, 35.2 (95% confidence interval, 12.1-102.4). CONCLUSION: The NYCDOH questionnaire is a valid instrument for identifying children for tuberculin skin testing.

Adolescent↗
PubMed2001

Immunization of the elderly to boost immunity against varicella-zoster virus (VZV) as assessed by VZV skin test reaction.

The utility of the VZV skin test in detecting individual susceptibility to varicella and zoster was determined. Its specificity particularly with regard to herpes simplex was also established. The VZV skin test was negative or weakly positive during the early stage of herpes zoster, and strongly positive during recovery from that disease. A small-scale clinical trial to immunize elderly individuals has been performed for the purpose of preventing herpes zoster, and, perhaps, severe post-herpetic neuralgia as well. Sixty individuals > or = 50 years old were screened for VZV antibodies by IAHA test and were given a VZV skin test for cell-mediated immunity. All were seropositive, but eight were skin-test negative. Thirty-seven individuals including the eight with negative skin tests were immunized with one dose of varicella vaccine (3.0 x 10(4) PFU/dose). After 5-7 weeks, the skin test reaction showed increased positivity, with a change in score from (-) to (+, ++) in 7/8 subjects, from (+) to (++, +++) in 3/5 subjects, and from (++) to (+++) in 6/10 subjects. Enhancement of the VZV antibody titer (defined as twofold or greater) was observed in all 15 vaccine recipients with a prevaccination titer of < or = 1:16, and in 19 of 24 subjects with a prevaccination titer of > or = 1:32. These results indicate that giving live varicella vaccine with a high viral titer can induce a good boost immunity particularly cell-mediated immunity to VZV in the elderly.

Aged↗
PubMed1976

Selection of skin tests in childhood asthma.

Skin tests have been applied to 161 asthmatic children seen consecutively at a paediatric respiratory clinic. To demonstrate whether a child's asthma is associated with a positive skin test it is suggested that only four extracts need be applied: house dust, house dust mite (D. farinae), grass pollens and a control.

Allergens↗
PubMedDate not supplied

[Skin tests in allergy].

Allergen skin testing is one of the preferred in vivo methods for assessing the presence of specific IgE antibodies against an allergen. This article review the clinical applications, techniques, reagents, evaluation, and safety of skin testing to help the allergologist to its better clinical use.

Allergens↗
PubMed2004

Use of the tuberculin skin test in children.

The tuberculin skin test, originally developed by Koch over a century ago as a means to treat tuberculosis, has emerged as the definitive means to identify infection with Mycobacterium tuberculosis. Its value was first demonstrated in studies of student nurses in Norway where it correctly identified uninfected students at greatest risk of dying of tuberculosis during the course of their training. The test was used to investigate contacts of active cases of tuberculosis, especially children. Cohort studies of such children undertaken in the 1950s and early 1960s showed that those who developed an induration in response to the tuberculin test of 10mm or greater were most likely to go on to develop tuberculosis in the future and that, if they were treated with isoniazid for a prolonged period (with maximal effect after 12 months of treatment), they were substantially less likely to develop tuberculosis. Since that time, the tuberculin skin test has been used extensively to identify individuals who have been infected with Mycobacterium tuberculosis and who would most likely benefit from treatment of latent tuberculous infection. Subsequently, international experts recommend that all children under five years of age who are in contact especially with sputum smear positive cases of tuberculosis should all be tested with tuberculin if it is available. Those found to have a significant reaction should be treated with isoniazid if they do not have active tuberculosis. Moreover, the tuberculin skin test has been used as a reliable means to monitor the progress of tuberculosis in the community through the means of surveys of school children to determine prevalence (and estimate incidence) of tuberculous infection in the community. The tuberculin skin test is not easy to administer or to interpret and requires careful application and interpretation. Tuberculin consists of a mixture of material produced by Mycobacterium tuberculosis as it is growing. It is prepared in a form termed 'purified protein derivative (PPD)' but is neither pure nor consists entirely of protein. Reference material has been developed to standardise it. The reading of the result of tuberculin testing requires experience and care. Inexperience leads to error (terminal digit preference). Tuberculin also detects the presence of antigens from other Mycobacteria species the most important of which is environmental Mycobacteria. Previous vaccination with BCG has less effect on the results of the test. The tuberculin test is useful to detect infection in children.

Child↗
PubMed2004

Pharmacist-managed service providing penicillin allergy skin tests.

PURPOSE: A penicillin allergy skin-testing service run by pharmacists is described. SUMMARY: A board-certified allergist trained pharmacists at a tertiary care teaching hospital to administer penicillin allergy skin tests and interpret the results. A major objective of the service was to avoid unnecessary use of vancomycin and quinolones in patients claiming but not actually having a penicillin allergy. Patients with a severe type I reaction to penicillin during the preceding five years, patients with a confirmed history of a type II-IV reaction to penicillin, and severely immunosuppressed patients were not eligible for testing. As of July 2003, 26 patients had been enrolled in the service. A type I penicillin reaction was ruled out by the drug allergy history for 3 patients. The results were negative in 22 of the 23 patients who received skin testing, and in 1 the result was indeterminate. A penicillin or a beta-lactam antibiotic was administered to all 26 patients. No patient had a significant adverse reaction to skin testing or drug administration. CONCLUSION: A pharmacist-managed penicillin allergy skin-testing service was well received by physicians and showed potential to avoid unnecessary use of alternative antibiotics.

Academic Medical Centers↗
PubMed1991

A 19-year follow-up of tuberculin reactors. Assessment of skin test reactivity and in vitro lymphocyte responses.

Tuberculin skin test reactivity decreases with time such that repeat PPD skin testing may result in reactions of less than 10 mm. This reactivity may be boosted in some individuals with a second tuberculin skin test. The immunologic basis of these observations remains unclear. We studied the relationship between skin-test reactivity and in vitro blastogenic response to PPD in a cohort of 22 individuals (aged 28 to 81 years) known to be tuberculin reactors (induration greater than or equal to 10 mm) in 1970. In 1989, 18 subjects remained reactive to PPD on the first skin test and responded to PPD in vitro (mean incorporation of 3H-thymidine by peripheral blood mononuclear cells, 22,650 cpm). Three subjects reverted (induration in response to PPD less than 10 mm) and lost in vitro reactivity to PPD (mean incorporation of 3H-thymidine, 2,205 cpm). One subject boosted (increase of induration of at least 6 mm to greater than or equal to 15 mm) on the second skin test and showed a concomitant in vitro boost in the blastogenic response to PPD (from 1,008 cpm to 47,837 cpm). In this cohort, interpretation of the two-step tuberculin skin test correlated closely with in vitro proliferative responses. Over a 19-year period, the majority of individuals maintained skin test reactivity and strong in vitro responses to PPD despite a lack of ongoing exogenous exposure to Mycobacterium tuberculosis. The immunologic basis for reversion appears to depend in part on a loss of lymphocyte blastogenic capacity. In the one individual who exhibited the booster phenomenon, repeat antigen stimulation resulted in a dramatic increase in the in vitro blastogenic responses.

Adult↗
PubMed1978

Possible role of IgG4 in discordant correlations between intracutaneous skin tests and RAST.

Comparison of intracutaneous skin tests and RAST in 2 groups of patients, one consisting of 16 individuals having multiple allergies to pollen, mold and animal dander and the other of 10 patients allergic to mold only, revealed that skin tests were more sensitive than RAST. Skin reactions of 3+ to 4+ were frequently associated with negative RAST results. This was observed more so in mold-allergic patients. In a few cases (6%) RAST showed 2+ reactions while the skin tests were negative. Leukocytes from allergic individuals who had positive skin tests and negative RAST released a significant amount of histamine upon challenge with specific allergen as well as antihuman IgG4, suggesting that this immunoglobulin is a functional component of some immediate hypersensitivity reactions.

Adult↗