The intradermal sarcocystin test.
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Animals↗
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RELATIONSHIP OF MUMPS TO ENDOCARDIAL FIBROELASTOSIS: COMPLEMENT-FIXATION, HEMAGGLUTINATION-INHIBITION AND INTRADERMAL SKIN TESTS FOR MUMPS IN CHILDREN WITH AND WITHOUT ENDOCARDIAL FIBROELASTOSIS.
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Child↗
Skin testing in predicting response to nasal provocation with alternaria.
OBJECTIVE: Examine the efficacy of epicutaneous and intradermal testing in predicting response to nasal provocation with Alternaria antigen. STUDY DESIGN AND SETTING: Prospective study. Subjects were tested with the Multi-Test II (MT) epicutaneous testing device. Subjects with negative wheals were then tested with a 1:500 weight:volume intradermal injection of Alternaria. They had baseline assessment of nasal cross-sectional area (CSA) using acoustic rhinometry and underwent nasal provocation with increasing Alternaria concentrations. CSA was assessed at each concentration. A nasal allergen provocation score (NAP) of nasal symptoms as well as a nasal visual analogue scale (VAS) were also completed with each concentration. RESULTS: Sensitivity and specificity of MT in predicting nasal response to Alternaria were poor at 42% and 44%, respectively. The addition of intradermal testing increased sensitivity only modestly to 58%. hierarchical linear modeling analysis demonstrated that subjects positive to Alternaria on skin testing did not show a significant reduction in nasal CSA on acoustic rhinometry or significant elevations in two nasal symptom scores with direct nasal provocation. CONCLUSION AND SIGNIFICANCE: Skin testing with either epicutaneous or intradermal testing may not be an accurate or sufficient technique in the assessment of Alternaria reactivity. These results suggest that mold allergies may involve more complex immune mechanisms than simply an immunoglobulin (Ig)E mediated type I immediate hypersensitivity response alone. An alternate model for mold sensitivity, as well as modifications in testing methods, may be required in the evaluation of mold allergy.
Adolescent↗
An intradermal skin test for determination of immunity to varicella.
AIMS: To evaluate the usefulness of a diluted, inactivated solution of attenuated varicella vaccine in predicting susceptibility to varicella and its correlation with specific antibody titre to varicella. METHODS: In a prospective blinded study, 63 healthy subjects (aged 2-43 years) were studied. Skin test solution was prepared from vials of OKA strain virus which was inactivated by exposure of the vials to room temperature for 10 days; solution was diluted at 1/50 with normal saline and kept at 4 degrees C until used for skin testing. The material was injected intradermally. Serum samples were drawn prior to skin testing and kept at -70 degrees C until analysis for antibody assay by the indirect fluorescent antibody (IFA) method. RESULTS: Forty three patients were IFA antibody positive; 41 of them reacted to the skin test. One of the 20 IFA negative patients reacted to the skin test. Sixteen patients had two serological tests performed, one month apart. Four out of these 16 patients tested negative with the skin test. All four had negative serology on both samples. Six of the 12 IFA positive patients showed a boost in the antibody titre one month after application of the skin test. The specificity and sensitivity of the skin test compared to the IFA assay were both 95%, and the positive and negative predictive values were 97% and 90% respectively. CONCLUSIONS: Results suggest that a varicella skin test prepared using this simple and relatively cheap method is a safe, sensitive, and specific tool by which to assess immunity to varicella.
Adolescent↗
Canine atopic disease: the prevalence of positive intradermal skin tests at two sites in the north and south of Great Britain.
Results of intradermal skin test responses to the same panel of 53 allergens were compared in 118 dogs with atopic disease presented at two geographical centres, Edinburgh (87 cases) and London (31 cases). The allergens most commonly positive at both centres were human dander and Dermatophagoides farinae, but positive tests to all of the allergens used occurred in at least one case. The mean number of allergens to which positive tests resulted in atopic dogs was 5.126 (Edinburgh) and 5.129 (London). The majority of animals were sensitive to allergens from more than one group. A significantly higher number of positive reactors to house dust allergen was observed at London than at Edinburgh (P < 0.05), while a significantly higher number of positive reactions to grass pollens was detected at Edinburgh than in London (P < 0.05). Sensitivity to Dermatophagoides pteronyssinus, in the absence of sensitivity to D. farinae, was uncommon and therefore both of these mite allergens should be incorporated in intradermal skin testing panels in Great Britain.
Animals↗
Correlation of serum theophylline levels with inhibition of allergen and histamine-induced skin tests.
The purpose of this study was to determine if clinically effective serum levels of theophylline have an inhibitory effect on intradermal tests for allergic hypersensitivity. Intradermal testing using the threshold-dilution technique was performed in 9 patients, 7 of whom were sensitive to 2 antigens. Testing was performed over a 6-hour period after theophylline administration and compared with the control results. Inhibition of the end-point was demonstrated with 12 of 16 antigens tested associated with serum theophylline levels ranging from 7 to 20 microgram/ml. Marked inhibition of the intradermal tests, that might have clinical significance, only occurred with 4 antigens.
Allergens↗
Hypersensitivity reactions to anthranilic acid derivatives.
Anthranilic acid derivatives are a group of nonsteroidal antiinflammatory drugs that include glafenine and fenamates. We report a woman who had immediate adverse reactions to glafenine and meclofenamate sodium. Skin prick and intradermal tests were performed with solutions of glafenine and meclofenamate in phosphate-buffered saline (PBS) and with the drugs bound to human serum albumin (HSA). Prick and intradermal tests with PBS solutions were negative for both drugs as were prick tests with HSA solutions. Intradermal tests with HSA-glafenine, however, were positive at 20 minutes, and at 6 and 24 hours. Intradermal tests with HSA-meclofenamate elicited a positive response at 6 and 24 hours. These tests were negative when performed in control subjects. A leukocyte histamine release test and a RAST assay were negative for both drugs. The patient was challenged following a double-blind placebo-controlled oral procedure and tolerated therapeutic doses of aspirin, indomethacin, ibuprofen, dipyrone, diclofenac, piroxicam, and acetaminophen. The oral challenge with glafenine and meclofenamate reproduced the reactions (eliciting doses: 50 mg and 15 mg, respectively), and the patient also reacted to 30 mg of mefenamic acid, an anthranilic acid derivative she had never previously received. This is an exceptional case of selective adverse reactions to glafenine and fenamates, anthranilic acid derivatives, in a patient tolerating aspirin and other cyclooxygenase inhibitors. Our study implicates an immunologic mechanism, and the existence of cross-reactivity between the drugs (or some active metabolite generated in vivo).
Drug Hypersensitivity↗
Anaphylaxis to muscle relaxants: cross sensitivity between relaxants.
Two patients are described who had clinical anaphylaxis due to muscle relaxants. One patient had systemic hypersensitivity and positive intradermal tests to d-tubocurarine and alcuronium. The second had systemic hypersensitivity to d-tubocurarine and positive intradermal tests to d-tubocurarine, alcuronium, and pancuronium. It is suggested that positive intradermal tests to more than one relaxant may mean allergy to more than one relaxant rather than false positive test. Cross sensitivity between alcuronium and d-tubocurarine occurs and a similar situation may exist for suxamethonium and gallamine. When intradermal testing is carried out after anaesthetic reactions all relaxants should be tested.
Adult↗
Tests to establish the diagnosis in cholinergic urticaria.
Methods for establishing the diagnosis in cholinergic urticaria are reviewed and compared. Provocation by exercise or hot bath is more effective than local provocation by intradermal tests. Of the intradermal tests, responses to nicotine acid tartrate and acetyl beta methylcholine chloride are positive only in patients with the more severe, readily induced eruptions. Furthermore, intradermal testing is not always reproducible in the same patient. In our patients, exercise proved the simplest, most effective diagnostic test.
Adolescent↗
[Value of intradermal skin test and serum sIgE detection in diagnosing artemisia pollinosis].
OBJECTIVE: To evaluate the value of intradermal skin test (IDT) and serum sIgE detection in diagnosing Artemisia sensitivity in Chinese patients with autumnal hay fever. METHODS: 1150 patients with autumnal rhinitis or asthma, 504 males and 646 females, aged 5 approximately 77, were evaluated by experienced physicians, then underwent IDT by using 20 kinds of aeroallergen extracts. The concentrations of Artemisia and Ragweed extracts employed in skin test were 1:1000 (W/V) and the concentrations of other aeroallergens were all 1:100 (W/V). Then all patients underwent detection of Artemisia sIgE. Diagnostic standards were established based on the results of IDT and sIgE results respectively. A reference standard was established according to the typical history, symptoms, and an wheal with a diameter >or= 5mm and a sIgE level >or= 0.35 kU(A)/L, an wheal with the diameter >or= 10 mm alone; or a sIgE level >or= 0.70 kUa/L alone. RESULTS: When using the reference standard as criteria, using IDT had better sensitivity (96.2%), specificity (74.2%), positive predictive value (+PV, 93.5%), negative predictive value (-PV, 85.7%), and efficiency (91.6%) than using sIgE >or= 0.35 kUa/L alone as the criteria of IDT; sIgE detection had better sensitivity (97.6%), specificity (94.9%), +PV (98.7%), -PV (91.1%), and efficiency (97.0%) than using wheal diameter >or= 5 mm alone as the criteria of sIgE detection. The false positive rate of IDT and sIgE detection decreased from 35% and 22.7% to 25.6% and 5.1% respectively when using the wheal diameter >or= 10 mm or sIgE >or= 0.70 kUa/L as a positive criteria. CONCLUSION: IDT and sIgE detection are correlated with each other well in diagnosing Artemisia pollinosis, both of them have the possibility of being false positive, but IDT has higher false positive rate than sIgE detection. The false positive rates of IDT and sIgE detection can be decreased by increasing the positive criteria to higher grading reaction.
Adolescent↗
Use of intradermal dilutional testing and skin prick testing: clinical relevance and cost efficiency.
OBJECTIVES/HYPOTHESIS: The objective was to determine the agreement of the positive results from a multiple skin prick test (SPT) device with the ability to determine a definable endpoint through intradermal dilutional testing (IDT) to compare semiquantitatively the degree of positivity of SPT results with quantitative results from IDT and to analyze the cost of immunotherapy based on SPT compared with IDT guided by SPT. STUDY DESIGN: Retrospective review of clinical data (random accrual). METHODS: One hundred thirty-four patients underwent allergy screening using a multiple SPT device. Antigens testing positive by skin prick device were tested using IDT on a separate day. Antigens testing negative by SPT were not evaluated by IDT. Regional allergy testing practice patterns were determined, and a cost analysis using Medicare rates was performed RESULTS: There was good agreement between an antigen testing positive by SPT and the determination of a definable endpoint (93.33%, n = 1,334 antigens). The degree of positivity from the SPT correlated poorly with the final endpoint concentration (r = 0.40, P < .0001). Blended testing techniques were similar in cost when compared with several commonly used allergy testing protocols. CONCLUSIONS: Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.
Adult↗
[Values of intradermal skin test and serum sIgE detection in diagnosing Humulus scandens pollinosis].
OBJECTIVE: To evaluate the values of intradermal skin test (IDT) and serum specific IgE detection in diagnosing Humulus scandens sensitivity in Chinese patients with autumnal hay fever. METHODS: 1150 patients, 504 males and 646 females, aged 5 approximately 75, were evaluated as with autumnal rhinitis and asthma by experienced physicians. Then the patients underwent IDT by using 20 kinds of aeroallergen extracts, at the concentration of 1:1000 (w/v) for Artemisia spp. and ragweed or at the concentration of 1:100 (w/v) for Humulus scandens and others. The Humulus sIgE level was performed in all patients. A diagnosing criteria was established according to typical history, symptoms, and any one of the following findings: (1) wheal > or = 5 mm in diameter by IDT and sIgE to Humulus of the concentration > or = 0.35 kUa/L at same time; (2) wheal > or = 10 mm in diameter by IDT alone; and (3) sIgE to Humulus of the concentration > or = 0.70 kUa/L alone. RESULTS: When using the above diagnosing criteria as the reference standard, IDT had better sensitivity (97.2%), positive predictive value (PV+) (77.9%), negative predictive value (PV-) (90.6%) and efficiency (80.4% than using sIgE > or = 0.35 kUa/L alone as the reference criteria of IDT, however, had a lower specificity (49.8%); and sIgE detection had better sensitivity (89.0%), specificity (97.5%), PV+ (98.8%), PV- (88.0%) and efficiency (92.0%) than using wheal > or = 5 mm in diameter alone as the reference criteria of sIgE detection. The false positive rate of IDT decreased from 59.9% to 17.4% when using wheal diameter > or = 10 mm as the positive criteria. In the 288 patients with a negative sIgE result and a positive IDT result 84 cases had stronger positive IDT result (with the wheal diameter > or = 10 mm). CONCLUSION: IDT is correlated well with sIgE detection in diagnosing Humulus scandens pollinosis, but the false positive rate of IDT is higher than that of sIgE test. The false positive rate of IDT can be decreased by increasing the positive criteria to higher grading reaction. The immunotherapy according to the lower grading positive result of IDT alone or sIgE alone should be avoided.
Adolescent↗
[TUBERCULIN SENSITIVITY CHANGES AND GRADED INTRADERMAL TUBERCULIN TESTS].
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Drug Therapy↗
Investigation on the effects of topical therapy with 0.1% tacrolimus ointment (Protopic) on intradermal skin test reactivity in atopic dogs.
Tacrolimus ointment (TAC) is an effective treatment for atopic dermatitis in humans and dogs. The purposes of the present study were to evaluate the effect of 4 weeks of TAC on intradermal skin testing (IST), and in case of suppression, to investigate if reactivity returned to baseline by 2 or 4 weeks post treatment. Intradermal skin test was performed using saline, histamine, lipopolysaccharide (LPS, 0.4 mg mL(-1)), house dust (25 PNU mL(-1)) and house dust mite (1 : 40 000 w/v) at weeks 0, 4, 6 and 8 on nine dogs enrolled in a blinded, crossover, clinical trial, using 0.1% TAC or placebo once daily for 4 weeks. Reactions were evaluated at 15 min, and at 4 and 6 h. Ointment was applied after the 15-min evaluation on weeks 0 and 4. Data were analysed using the statistical software SAS System for Windows. At week 4, TAC did not affect 15-min IST, but some reactions in the TAC group were suppressed at 6 h compared to baseline. In the TAC group, 4-h IST reactivity was reduced 2 weeks after discontinuation but returned to baseline by 4 weeks. In conclusion, TAC has no effect on immediate reactions but decreased some late-phase reactions. Therefore, no withdrawal is recommended to evaluate only immediate reactions, but a 4-week withdrawal may be necessary for evaluation of late-phase reactions.
Administration, Cutaneous↗
The use of compound 48/80 and codeine phosphate as positive controls for intradermal skin testing in dogs.
The mast cell secretagogues compound 48/80 and codeine phosphate were evaluated as potential positive controls for intradermal skin testing in dogs. Wheal responses to both agents were compared with responses to histamine and saline in 11 normal dogs, and were strong and not significantly different from histamine responses in nine dogs (P < 0.01), and significantly weaker than histamine in two dogs (P < 0.05). Wheal responses to compound 48/80 (1 mg mL-1) were evaluated in 82 suspected atopic dogs and were similar to histamine in 79 dogs and markedly weaker than histamine in three dogs. Of nine confirmed atopic dogs with weak responses to injected allergens, seven had strong responses to compound 48/80, and eight had strong responses to histamine. Compound 48/80 and codeine phosphate appear unreliable positive controls for skin testing in normal dogs. Compound 48/80 (1 mg mL-1) may be a reliable positive control in atopic dogs but is a poor indicator of skin reactivity to allergens.
Animals↗
NSAID intolerance in chronic idiopathic urticaria: A study of its relationship with histamine-releasing activity of patients' sera.
BACKGROUND: about one fourth of patients with chronic idiopathic urticaria (CIU) experience flares of hives after taking chemically unrelated nonsteroidal anti-inflammatory drugs (NSAID). The reasons for such intolerance are still elusive. OBJECTIVE: this study aimed to investigate NSAID intolerance in patients with CIU in view of the in vivo and in vitro histamine releasing activity of their sera. METHODS: 117 adults (M/F 41/76) with CIU underwent intradermal test with autologous serum, and the ability of their sera to induce histamine release from normal blood donors was evaluated. NSAID intolerance was ascertained by careful interview. RESULTS: overall, 32/117 (27 %) patients reported NSAID intolerance. The prevalence on NSAID intolerance did not differ in the three subgroups: negative on both in vivo and in vitro tests (9/36; 25 %), positive or intradermal test but negative on basophil histamine release assay (16/58; 28 %), or positive on both in vivo and in vitro tests (7/23; 30 %). CONCLUSION: in patients with CIU intolerance to NSAID does not depend on the mechanism of histamine release.
Anti-Inflammatory Agents, Non-Steroidal↗
Lymphocyte blastogenic responses to inciting food allergens in dogs with food hypersensitivity.
Lymphocyte blastogenic responses against food allergens in dogs with food hypersensitivity were evaluated in this study. Eleven dogs with food hypersensitivity, based on food elimination and oral food provocation tests and allergic responses to food allergens, were examined by various tests such as intradermal testing, antigen-specific IgE testing, and lymphocyte blastogenic responses. The number and kinds of food allergens identified as positive by these tests were compared with the offending food allergens that were found in an oral food provocation test. In 9 (82%) of the 11 dogs with food hypersensitivity, there was close agreement for positive allergens between the results of lymphocyte blastogenic responses and oral food provocation test; however, there was little agreement for intradermal and IgE testing of the positive allergens with those of the oral food provocation test (11% and 31%, respectively). In the 9 dogs, the stimulation indices of lymphocyte blastogenic responses increased to 2.0-10.1 upon food provocation but decreased significantly to 0.7-1.4 upon feeding the elimination diet until clinical signs disappeared. These results indicate that lymphocyte blastogenic responses may fluctuate because of exposure to offending food allergens in dogs with food hypersensitivity. Lymphocytes reactive to food allergens may play an important role in the pathogenesis of food hypersensitivity in dogs.
Allergens↗
[The evaluation of cellular immunity in the aged by skin tests].
UNLABELLED: Cellular immunity of persons over 60 years of age was evaluated by intradermal testing with ubiquitous antigens, such as PPD, Trichophytin, Candidine and Varidase (SK, SD-40-10 U/ml) and by skin sensitization with DNCB. The group consisted of 290 individuals, 95 men and 195 women, without any signs of disease other than the usual geriatric disturbances, such as osteoporosis, ostearthritis and mild systolic hypertension. No medication was used that could interfere with the results of the tests. The patients were divided into 2 groups, group I, 190 cases between 60 and 75 years of age, and group II, 100 cases over 75. RESULTS: Intradermal tests with all ubiquitous antigens were negative in 7,4% of group I and 13% of group II, while in a control of younger adults each had at least had 2 positive tests. This difference was mainly due to a lower sensitivity to PPD in the elder persons. 16% of group I and 23% of group II did not sensitize with DNCB. All skin tests, intradermal and DNCB, were negative in 1,1% of group I and 4% of group II. Our results suggest a decreasing immunological activity according age which could explain the higher incidence of infections, neoplasms and autoimmune diseases in old people. Also periodical repetition of the test in elderly people could evaluate immunological competence and, consequently, susceptibility to these diseases. Patients with negative tests or only one positive test, should be carefully investigated in order to exclude the existence of pathology. Our results and considerations also suggest the possibility that, by increasing immunological reactivity, the occurrence of certain diseases could the prevented.
Age Factors↗