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Allergic contact dermatitis from topical fluorouracil.

An allergic contact dermatitis from fluorouracil developed in two patients 8 and 18 days respectively after institution of topical fluorouracil therapy. The character of the usual irritant dermatitis changed to that of an allergic dermatitis. Epicutaneous patch tests and intradermal tests with fluorourcil were reactive. Histologic specimens of positive test sites revealed the changes expected in allergic contact dermatitis. Twelve control subjects failed to react to intradermal fluorouracil tests.

Administration, Topical↗

[Comparative study of prick and intradermal cutaneous tests in allergic rhinitis].

A prospective clinical study to compare the skin prick test method e intradermal method as a diagnostic tool in allergic rhinitis: There were 100 patients with allergic rhinitis of both sexes in the study with ages ranging from 3 to 18. All of them received skin tests by the prick method to 10 common pollen extracts in Mexico City. If the patient showed positively was included in the control group, and if negative the intradermal method to the same extracts was performed. The intradermal method was utilized in 50 patients, of which only 12 (24%) showed positivity to the tests. This result doesn't showed a significant difference with the prick method, with a value of p greater than 0.05.

Adolescent↗

Schistosomiasis mansoni in the "Baixada Ocidental Maranhense", state of Maranhão, Brazil: cross-sectional studies performed in 1987 and 1993.

A cross-sectional study on the prevalence of schistosomiasis mansoni in three sites of the "Baixada Ocidental Maranhense" was carried out in 1993 in: Alegre (in the municipality of São Bento), Aliança (in Cururupu) and Coroatá II (in the municipality of São João Batista). Results were compared to those of another study performed at the same sites and in similar conditions, in 1987. The entire population of the three sites, with few exceptions, was submitted to fecal tests using the Kato-Katz method and immediate intradermal tests for schistosomiasis in both studies. Subjects with positive results in one of these tests were clinically evaluated by a physical examination. In 1993, the total of 827 subjects were submitted to fecal examination and 826 to intradermal test. Schistosoma mansoni eggs were found in the feces of 154 (18.6%) subjects, while 478 (57.9%) subjects presented a positive intradermal test. Stool examination was carried out in 367 subjects in Alegre with a positivity rate of 14.9%; the intradermal test, performed in 366 subjects, was positive in 47.5% of the cases. In Aliança, 277 subjects had their feces examined and were submitted to an intradermal test, with a positivity rate of 34.4% and 70.7%, respectively. Finally in Coroatá II, 183 inhabitants submitted to fecal and intradermal tests had positivity rates of 2.2% and 59.0%, respectively. When the present data were compared to those obtained in the survey performed in 1987, a significant decrease in the prevalence of infection by S. mansoni was observed in Alegre and Coroatá II, and a prevalence increase in Aliança.

Adolescent↗

Antibiotic-responsive generalized nonlesional pruritus in a dog.

A 15-year-old dog was evaluated for a nonresponsive generalized pruritic condition of 5 months duration. Routine diagnostic testing, including intradermal testing with 63 inhaled allergens and the feeding of a home-cooked hypoallergenic diet, failed to define the cause of the pruritus. An intradermal skin test with a staphylococcal cell wall/toxoid mixture and a skin biopsy of the skin test site suggested that the dog had a bacterial hypersensitivity. Antibiotic therapy eliminated the pruritus and the dog's pruritus was successfully managed for 3 years with the combined use of subtherapeutic dosages of antibiotics and a commercial staphylococcal vaccine.

Anal Sacs↗

Diagnosis of pyrazolone drug sensitivity: clinical history versus skin testing and in vitro testing.

Pyrazolone drug hypersensitivity (PDH) may manifest as angioedema, urticaria, and/or life threatening anaphylactic shock. Although it has been suggested that PDH is an immunologic, probably IgE-mediated reaction, the diagnosis of PDH is still based on clinical history because there is no reliable in vitro diagnostic method currently used in clinical practice. The goal of this study was to evaluate the reliability of various methods to confirm a diagnosis of PDH. Twenty-eight patients with prior history of 71 reactions to pyrazolone drugs were studied. In all patients, pyrazolone drugs induced urticaria and angioedema. In addition, laryngeal edema occurred in 14 patients and anaphylactic shock with loss of consciousness in five patients. Skin prick test and intradermal tests using increasing concentrations of noraminophenazone were performed in 25 patients. Sera of all 28 patients were negative for pyrazolone-specific IgE as determined by an immunoenzymatic method. Peripheral blood mononuclear cells proliferative responses to pyrazolone were studied by a lymphocyte proliferation test with 3H-thymidine incorporation. Incubation of peripheral blood mononuclear cells with increasing concentrations of noraminophenazone did not induce any significant proliferation responses. Our study demonstrated that 1) intradermal skin tests correlate poorly with the clinical history of hypersensitivity reaction; and 2) in vitro tests are not useful in establishing a diagnosis of PDH.

Adolescent↗

[Routine immunologic tests in atopic dermatitis].

The study comprised 100 examinees with atopic dermatitis and 50 examinees with chronic urticaria (adult patients and children), as well as 50 examinees in a control group. The parameters for monitoring included laboratory findings; values of eosinophiles, total lymphocytes, T and B lymphocytes, serum immunoglobulin (IgG, IgA, IgM) total IgE and specific IgE; results of cutaneous tests: prick and intradermal test to inhalative and nutritive allergens, scratch test to preservatives and additives, and epicutaneous (patch) test to contact allergens. In detection and monitoring of patients with atopic dermatitis, several methods were applied with different diagnostic success. The values of total number of lymphocytes and T and B lymphocytes were mainly within the normal limits, therefore these were not good diagnostic parameters. Eosinophiles were mainly higher and were useful in determination of AD. Mainly normal values of IgE, IgA and IgM were found by radial immunodiffusion, but the ELISA method, as well as the RIST method, showed high values of total IgE. Of the applied skin tests, the most important was intradermal test which gave most of the positive results in the patients with atopic dermatitis (97.7%), then followed scratch test (83.3%), patch test (64.3%), and finally epicutaneous test (57.1%).

Adolescent↗

[Skin tests in the study of drug eruptions with suspected immuno-allergic mechanism].

Skin testing (patch tests, prick test and intradermal tests) with the suspected compound has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (ADRs), but the value and specificity of these tests need to be determined. In a previously published study involving 72 patients, we observed positive results in 72% of the cases, in 43%, 24% and 67% in patch, prick and intradermal skin tests, respectively. The results of skin tests varied with the clinical type of cutaneous ADR, as a significantly higher number of positive patch tests was observed in maculopapular rashes (59%) than in urticarial reactions (13%) or in eythrodermic ADR (80%). The results of patch tests varied with the drug tested as frequent positive results were obtained with amoxicillin, pristinamycin, carbamazepine, pseudoephedrine, heparinoids... This study and the analysis of the literature support the value of careful sequential drug skin testing in establishing the cause of cutaneous ADR. Guidelines are proposed for performing these tests, and these include the use of appropriate negative control patients to avoid false-positive results, the determination of the relevance of positive patch tests, a contact sensitization to drug being able to elicite a positive result on patch tests with a preserved oral tolerance to the same drug. These tests have to be performed with a strict medical survey as they can induce a relapse of the cutaneous ADR.

Drug Eruptions↗

Anaphylaxis to erythromycin.

BACKGROUND: Erythromycin and its salts belong to the larger class of macrolides. Erythromycin is well tolerated. The most common side effects are gastrointestinal distress, nausea, and vomiting, which are dose related. Allergic and pseudoallergic reactions due to macrolide antibiotics are uncommon. Anaphylaxis and acute respiratory distress appear in the literature as case reports. METHODS: We report a 24-year-old man who presented 12 years ago a systemic allergic reaction to penicillin, confirmed by skin tests and detection of specific IgE (RAST). Since then he had tolerated erythromycin on several occasions. Nine months ago, his general practitioner prescribed erythromycin orally as treatment for a respiratory infection. Thirty minutes after taking the first dose, 500 mg, he developed an anaphylactic reaction. The episode subsided with treatment with high dose corticosteroids, antihistamines, and epinephrine. Skin prick tests and intradermal tests were performed with erythromycin at different concentrations. We also measured total IgE and specific IgE to erythromycin by CAP and Phadezym RAST (Pharmacia, Uppsala, Sweden), respectively. We also performed a Prausnitz-Küstner test (PK test), and oral challenge test. RESULTS: Skin testing to erythromycin was not helpful because of cutaneous hyperreactiviness. No significant levels of specific IgE to erythromycin were detected. The oral challenge and the Prausnitz-Küstner test were positive. CONCLUSIONS: The positive history and oral challenge test suggested an anaphylactic reaction to erythromycin. The positive Prausnitz-Küstner test demonstrated the presence of specific IgE to erythromycin.

Adult↗

[Contact allergies to corticosteroids. Prevalence, cross-reactions and methods of detection].

Topical corticosteroids (CS) are frequently used to treat of allergic contact dermatitis, so that their own potential for sensitization is rarely detected. However, increasing numbers of hypersensitivity reactions to corticosteroids have been reported during the last 10 years, and allergic skin reactions to over 50 particular compounds have been observed. CS must now be regarded as a rather frequent contact allergen, the prevalence being twice as high in women as in men. Contact allergy to CS is clinically characterized by a chronic and persistent, corticosteroid-resistant dermatitis. In general, hypersensitivity to CS is a type I and/or type IV mediated allergic reaction. Cross-sensitivity between individual corticosteroid preparations has been described owing to their closely related chemical structures (e.g. hydrocortisone and tixocortol pivalate). Contact allergy to CS can be confirmed by patch-tests, intradermal injection tests or application tests; because of the delayed appearance of positive skin reactions a prolonged evaluation period of up to 120 h is recommended. For routine screening the use of the patient's own material and of tixocortol pivalate and budesonide as test marker substances seems appropriate. The development of further marker substances is a target for ongoing research.

Administration, Topical↗

Response of the badger (Meles meles) to infection with Brucella abortus.

Three badgers exposed to conjunctival instillation of Brucella abortus strain 544 developed a mild subclinical infection accompanied by the production of agglutinating and complement fixing antibodies. Six months after inoculation, the infection could not be detected in one badger and was confined to lymphoid tissue in the other two. No cell mediated immune response to B abortus antigens could be detected by in vitro lymphocyte transformation tests or intradermal tests for delayed hypersensitivity during the observation period.

Animal Population Groups↗

Anaphylactic shock induced by gadoterate meglumine (DOTAREM).

The use of contrast agent for magnetic resonance imaging improves the effectiveness of this diagnostic examination. Complexes of godolinium, which appear to be well tolerated, are used for this purpose. A few cases of anaphylactic shock have been attributed to these agents. We report a case of anaphylactic shock due to gadoterate meglumine (DOTAREM). While undergoing a magnetic resonance imaging examination, a 33-year-old nonatopic female patient became severely hypotensive, lost consciousness, and had generalized erythema immediately after the intravenous injection of this product. She recovered rapidly after she was given injection of epinephrine and her blood volume was restored with intravenous fluids. That DOTAREM had caused this immediate hypersensitivity reaction was proven by the positivity of prick-test and intradermal test at 10-3 (0.37 mg/ml) and in vitro leukocyte histamine release test. The results of these tests indicated that it was the gadoteric acid rather than the meglumine component of DOTAREM that was responsible: positivity of IDR at 10 mg/ml. Skin tests and leukocyte histamine release test to gadopentetate dimeglumine (MAGNEVIST) were negative. In addition of the exceptional character, this observation provides evidence for an immediate hypersensitivity without cross reactivity with gadopentetate dimeglumine.

Adult↗

Evaluation of multi-allergen dipstick screening test.

In order to determine the diagnostic performance of the Quidel Allergen Screen (QAS), 43 patients characterized by standard skin prick test and intradermal testing for atopic sensitivity were evaluated, in parallel, using Phadebas RAST and QAS to detect the presence of serum IgE. The Quidel Allergen Screen and RAST were compared with the investigator's clinical assessment. The differences between QAS and RAST are not statistically significant. The QAS appears to be equal to the Phadebas RAST in sensitivity and specificity and thus offers a rapid, easily interpreted in vitro method for the detection of specific serum IgE.

Allergens↗

Influence of sedative and anesthetic agents on intradermal skin test reactions in dogs.

To determine the effects of 9 sedative/anesthetic drug protocols on intradermal skin testing, an experimental state of type-I hypersensitivity was created. Intradermal skin tests were performed on 6 dogs, using positive and negative controls and a series of tenfold dilutions of Asc-1 allergen prior to drug administration. Approximately 4 hours later, the dogs were given 1 of the following drugs: acepromazine (low dose and high dose); ketamine hydrochloride with diazepam; thiamylal; oxymorphone; halothane; methoxyflurane; or isoflurane. The intradermal skin test then was repeated, and was scored objectively and subjectively. Objective scores were unaffected by any of the drugs. Subjective scores were affected in that acepromazine decreased wheal size and the induration of the intradermal skin test reaction sites.

Anesthetics↗

Intradermal antigen tests in psoriasis.

To assess whether elicitation of delayed hypersensitivity may be superior to trauma in inducing the Koebner reaction in psoriasis, 12 affected patients and 9 control subjects were tested with 0.1 ml intradermal injections of streptokinase/streptodornase (20 mu/5 mu per 0.1 ml), PPD (1 in 1000) and saline control solutions in a double-blind study; Koebner status was also established in the psoriatic patients. Injected sites were examined at 48 h and 7, 14, 21 and 28 days for local development of psoriasis, erythema and induration (diameter). One patient was Koebner-positive and developed psoriasis at all three injection sites. The other, Koebner-negative psoriatic subjects did not develop psoriasis locally. However, compared with non-psoriatic controls they showed a marked delay in resolution of the delayed hypersensitivity reaction to the PPD antigen and a similar but less marked phenomenon was observed for streptokinase/streptodornase. These findings indicate that intradermal antigen, of the nature and amount used in this study, is no more effective in inducing the Koebner phenomenon than injury alone. However, the ability of psoriasis patients to switch off cell-mediated immune reaction appears to be impaired.

Adult↗

THE 5 TU versus the 10 TU intradermal tuberculin test.

With the growing demand in practical tuberculin-testing work for an effective single-dose intradermal test to replace the serial-dose procedures, the 5 TU and 10 TU doses have both been used for single-dose tests in recent years. The present study was undertaken for the purpose of determining the difference in the effects of these two doses.The material was collected by testing large general population groups participating in the Danish mass campaign in two areas in Jutland; 5 TU and 10 TU were given to alternate persons. Results are presented for 3,764 adults, none of whom gave a history of previous BCG vaccination.With either dose, the population groups were clearly separated into two groups, reactors and non-reactors. The average diameter of reactions for 10 TU was larger by about 2-3 mm than for 5 TU, and the frequency of bullous reactions was only slightly greater with the stronger dose.The two known sources of tuberculin sensitivity in Denmark, apart from BCG, are infection with human and with bovine tubercle bacilli. As both appear to result in a degree of sensitivity demonstrated about equally well with either 5 TU or 10 TU, either dose would seem to be suitable as a single-dose test for tuberculin-testing surveys in similar general populations.

Adult↗

Recent advances in diagnostic techniques in filariasis.

Accurate diagnosis of human filarial infections still remains a problem for clinicians and co-ordinators of filariasis control programs. Diagnosis of filariasis is based on parasitological, histopathological, clinical and immunological approaches. No significant advances have been made for the first three approaches although some refinements in their use and interpretation of results have occurred. For the immunological approach, intradermal tests and antibody detection assays using crude parasite extracts generally lack specificity and/or sensitivity to discriminate between past and present filarial infections in humans. Antigen detection assays would therefore provide a more accurate indication of active filarial infections. Several monoclonal antibodies to various stages of lymphatic filarial parasites have been developed and appear potentially useful for filarial antigen detection.

Animals↗

Tolerance of the human brucellosis vaccine and the intradermal reaction test for brucellosis.

The aim of the present study was to determine the tolerance and efficacy of human brucellosis vaccine as well as the tolerance and sensitivity of the intradermal reaction test for brucellosis. A total of 1,121 subjects initially consented to participate in the study. Following clinical examination, 762 were tested with the intradermal reaction test (IDR Test, Pasteur Merieux, France), of whom 576 with no previous or current brucellosis infection were accepted for vaccination. Two hundred seventy-one were vaccinated with brucellosis vaccine and 305 with tetanus vaccine, the latter group serving as a comparative control group. The vaccinated persons were monitored monthly for at least nine months. Although brucellosis vaccine caused some unpleasant side effects in about one-fourth of the vaccinated persons, it appears safe for large-scale use in prevention programs. In addition, the results indicate that the intradermal reaction test is safe and sensitive for large-scale use in prevention programs. The test was positive in 28 of 30 individuals with previous infection, representing a sensitivity of 93.33%.

Adolescent↗

Atopy patch test reactions to house dust mites in patients with scabies.

It is well known that the house dust and the scabies mites are related phylogenetically. We therefore performed atopy patch tests with house dust mite antigens (Dermatophagoides pteronyssinus (Dp) and/or Dermatophagoides farinae (Df)) in scabies patients without atopy and healthy controls. We studied 25 men with active scabies and 25 healthy controls. Skin prick tests with standardized house dust mite extract were performed for all patients and controls. An intradermal test procedure was carried out in skin prick test-negative patients, and for controls showing positive atopy patch test to Dp and/or Df. While atopy patch tests were performed directly in all healthy controls, patients with scabies were first treated and on the next day, atopy patch tests were performed. Twenty-two of 25 patients with scabies (88%) had skin prick test and/or intradermal test positivity against house dust mites, whereas 17/25 patients (68%) had atopy patch test positivity against house dust mites (Dp and/or Df). There was no statistically significant difference between skin prick test and/or intradermal test positivity and atopy patch test positivity in a regression analysis (p=0.222). The only statistically significant correlation was between atopy patch test positivity and the extent of scabies involvement (p<0.05). Only few of the healthy controls had positive tests. In this study, we have shown that a positive atopy patch test to house dust mite antigens is not specific for patients with atopic dermatitis, but also occurs in scabies patients without a history of atopic dermatitis.

Adult↗