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PubMed1997

Intradermal antigen tests and the Koebner phenomenon in psoriasis.

BACKGROUND: Psoriasis is one of several dermatologic conditions in which nonspecific irritation may elicit the disease where it was not previously present. In this study we aimed to assess the cutaneous cellular immune reaction with intradermal antigen tests and the relation between Koebner's phenomenon and intradermal antigens. METHODS: Thirty psoriasis patients and 20 control subjects were tested with 0.1 mL intradermal injections of purified protein derivative (PPD), Candida (C), mumps (M), mixed respiratory vaccine (MRV), and saline control solutions. Koebner status was also determined in the psoriatic patients. Injection sites were evaluated at 72 h and on the eighth, 12th, 16th, and 20th days for erythema, induration, and local development of psoriasis. RESULTS: Two patients were Koebner positive and developed psoriasis at all five injection sites. However, local psoriasis development was observed at one or more injection sites in five Koebner-negative patients. In addition, intensity of delayed hypersensitivity reaction and resolution times demonstrate no significant difference between psoriatic and nonpsoriatic subjects statistically (P > 0.05). CONCLUSIONS: These findings may indicate that intradermal antigens used in this study were more effective in inducing the Koebner phenomenon than injury alone. Furthermore, we observed that there is no meaningful difference between psoriatic and nonpsoriatic subjects in developing cutaneous cellular immune reactions.

Adult↗
PubMed2002

[Measles vaccination for children with allergic diseases].

To predict the side effects of vaccination, some skin tests are performed for patients with allergic diseases, though at present time there is no standard method. We have performed skin tests of measles vaccine by prick test with undiluted vaccine, 1 : 10 dilution, and/or intradermal test with 1 : 100 dilution. 75 cases of children with allergic diseases were assessed with more than two types of these skin tests. The cases with negative response for the skin tests were subcutaneously administered with 0.5ml of vaccine at once (normal method). On the other hand, the cases with positive or+/-response at least one skin test were subcutaneously administered with the vaccine in increments of 0.05ml (divided method). Including+/-response, intradermal test with 1 : 100 dilution showed highest sensitivity (88%) and relatively high specificity (75%) for the prediction of side effects in the 3 types of skin tests. Forty nine cases were vaccinated with the normal method, and 26 cases were vaccinated with the divided method. Compared with the cases with normal method, the cases with divided method showed higher frequency for patients with the elimination therapy of foods besides egg, and significantly higher value of total IgE, and specific IgE for egg white, cow's milk, wheat, and cat dander. Twenty five of 26 cases with the divided method showed specific IgE for egg white>3.5UA/ml, and 8 of 11 cases showed specific IgE for cat dander>0.35 UA/ml. In 8 cases who appeared side effects (one was administered by t he normal method, and 7 were administered by the divided method), 7 cases were local skin reaction only, and there were no cases of anaphylaxis. We recommend that the intradermal test of dilution 1: 100 should be performed to determine the vaccination method. The cases with the elimination therapy of foods besides egg, cases with specific IgE for egg white>3.5UA/ml, or cases with specific IgE for cat dander>0.35UA/ml, should be considered as high risk patients.

Child↗
PubMed1957

Effect of intradermal tuberculin tests on BCG-induced allergy.

Trials are going forward to determine whether intradermal tuberculin testing with 10 TU at yearly intervals after BCG vaccination may prevent waning of BCG-induced allergy in schoolchildren. Meanwhile, two experiments to the same purpose, carried out in guinea-pigs, are described. They show that waning allergy in guinea-pigs can be sustantially enhanced by intradermal injection of either purified tuberculin or Old Tuberculin, the effect lasting for at least 8 weeks, even with so small a dose as 5 TU. It is pointed out that this enhancing effect has been demonstrated only in BCG-vaccinated guinea-pigs and that it is not known whether the same phenomenon would occur in guinea-pigs infected with living human tubercle bacilli.

BCG Vaccine↗
PubMed1980

Conjunctival hyperemia and corneal infiltrates with chemically disinfected soft contact lenses.

For three cosmetic soft contact lens wearers who chemically disinfected their lenses, conjunctival hyperemia and anterior stromal infiltrates of the cornea developed. When the conjunctival hyperemia and corneal infiltrates resolved, two of the three patients were challenged with their chemically disinfected soft contact lenses, with reappearance of the conjunctival and corneal reactions. Bacterial cultures of the conjunctiva, lids, lens cases, lens solutions, and eye cosmetics were not helpful. Conjunctival cultures for adenovirus and chlamytdial titers were negative. Giemsa stain of conjunctival scrapings showed a few mononuclear cells, polymorphonuclear leukocytes, and rare eosinophils but no inclusion bodies. Occlusive patch tests and intradermal tests showed positive delayed hypersensitivity reactions to the chemical disinfectants in all three patients. Occlusive patch tests with thimerosal suggested that this preservative was responsible for the reactions. Delayed hypersensitivity to thimerosal may play a role in the development of the conjunctival hyperemia and corneal infiltrates described in these patients.

Adolescent↗
PubMed1976

Immunologic studies in a case of baker's asthma.

A 28-year-old baker with 13 years of occupational experience has developed, over the past several years, sinusitis, rhinitis, contact dermatitis, and asthma. Clinically, all of his symptoms were felt to be related to occupational exposure. Immunologic evaluation consisted of the following tests: intradermal skin testing, leukocyte histamine release, total serum IgE, PK transfer with immunoadsorption, and specific antigen bronchial challenge. Analysis of results would tend to implicate a type I, IgE-mediated immunologic reaction.

Adult↗
PubMed2006

Comparison of intradermal dilutional testing with the Multi-Test II applicator in testing for mold allergy.

OBJECTIVES: To compare and correlate wheal size using the Multi-Test II applicator with the endpoint obtained by intradermal dilutional testing (IDT) for common mold allergens. To validate the safety and efficacy of modified quantitative testing (MQT) for determining immunotherapy starting doses. STUDY DESIGN AND SETTING: Prospective study of 86 subjects with Multi-Test II and IDT for 6 common mold antigens. RESULTS: There was 84% concordance between IDT results and the results expected from the MQT method. When IDT and MQT results differed, the MQT algorithm predicted a safer endpoint for starting immunotherapy in all but 2 cases. CONCLUSION: The correlation between Multi-Test II and IDT is not strong enough to infer IDT endpoint from Multi-Test II results for molds. MQT is nearly as effective as formal IDT in determining endpoint. SIGNIFICANCE: MQT appears to be a safe method for determining starting doses for immunotherapy with fungal allergens.

Adult↗
PubMed1999

Reduced in vivo allergenicity of Bet v 1d isoform, a natural component of birch pollen.

BACKGROUND: The major allergen of birch pollen, Bet v 1, is present in structurally slightly different isoforms. It has been postulated that certain isoforms show a distinct ability to bind birch pollen-specific IgE, although the T-cell response remains similar. OBJECTIVE: We verified the hypothesis of a distinct allergenicity but similar T-cell immunogenicity of 2 isoforms in birch pollen-allergic subjects by in vivo tests and an in vitro assay for T-cell stimulation. METHODS: Forty-eight birch pollen-allergic, 11 grass pollen-allergic, and 10 nonatopic control individuals were tested with 10-fold increasing concentrations (0.01 to 10.0 microg/mL) of recombinant (r) Bet v 1a and rBet v 1d by skin prick test (SPT), intradermal test (IDT), and conjunctival provocation test (CPT). An allergen-specific proliferation assay was performed on 21 patients with the 2 recombinant and the natural birch pollen allergens. RESULTS: In each test system only birch pollen-allergic subjects but no controls reacted to the recombinant allergens. A positive in vivo response to 10 microg/mL of rBet v 1a was observed in 21 of 48 by SPT, in 48 of 48 by IDT, and in 33 of 48 by CPT. In contrast, the IDT response to 10 microg/mL of rBet v 1d was reduced by a factor of 100 because it was equivalent to the response to 0.1 microg/mL of rBet v 1a. rBet v 1d failed to elicit a positive reaction in SPT and CPT. The proliferative response of T cells was similar for both recombinant isoforms because 8 of 21 individuals reacted to rBet v 1a and 6 of 21 to rBet v 1d. Only 1 subject had a positive reaction to rBet v 1d alone. CONCLUSION: The natural isoforms rBet v 1a and rBet v 1d differ in their ability to bind IgE but are similar in their immunogenicity for T cells. Thus rBet v 1d might be a promising candidate for use in immunotherapy of birch pollen-allergic individuals.

Adult↗
PubMed2004

[Vaccine-induced urticaria: how to differentiate allergy (IgE) from pseudoallergy?].

BACKGROUND: The occurrence of allergic-type manifestations during the course of vaccination is relatively common, and in the majority of cases, these are benign reactions which are also known as "pseudoallergy". They are not immunological in nature and do not activate the effectors of specific immunity. OBJECTIVE: The aim of our work was to propose a practical diagnostic approach following an immediate and/or accelerated post-vaccination accident. PATIENTS AND METHODS: We report our experience in four adults who were referred for urticaria which appeared following vaccination and in two children who were allergic to eggs and were referred for assessment before administration of vaccines containing egg proteins. RESULTS: The immunoallergological examinations (prick-test and intradermal tests with immediate reading) confirmed the absence of immediate hypersensitivity to the vaccine in question and all the patients could be vaccined without incident. CONCLUSION: The majority of post-vaccination reactions with an allergic appearance is benign and do not contra-indicate further vaccination. If there is a suspicion of a true IgE dependent allergy, an immunoallergological investigation will differentiate true allergy from pseudoallergy.

Adolescent↗
PubMed2004

[Urticaria paradoxically aggraved by H1 antihistamines].

BACKGROUND: H1 antihistamines (anti-H1) are the treatment of choice in chronic urticaria. We report five cases of urticaria, induced or aggravated by H1 antihistamines. METHODS: The immunoallergological investigations included prick-tests and intradermal tests with the antihistamine responsible for acute urticaria. RESULTS: The skin tests confirmed the non-IgE dependent nature of the urticarial eruptions and anti-leukotrienes (montelukast, Singulair) were effective in controlling chronic urticaria in 3/4 patients. DISCUSSION: Two hypotheses are discussed to explain the paradoxical aggravating effect of H1 antihistamines on the urticaria: 1) the patients are sensitive to the toxic, pro-inflammatory effect of the drug, which is the source of nonspecific activation of mast cells; 2) the fact that the urticaria is sensitive to anti-leukotrienes suggests that histamine is not the principal mediator of urticaria in these patients.

Adult↗
PubMed2001

The ACVD task force on canine atopic dermatitis (XVI): laboratory evaluation of dogs with atopic dermatitis with serum-based "allergy" tests.

Serum-based in vitro "allergy tests" are commercially available to veterinarians, and are widely used in diagnostic evaluation of a canine atopic patient. Following initial clinical diagnosis, panels of allergen-specific IgE measurements may be performed in an attempt to identify to which allergens the atopic dog is hypersensitive. Methodology for these tests varies by laboratory; few critical studies have evaluated performance of these tests, and current inter-laboratory standardization and quality control measures are inadequate. Other areas where information is critically limited include the usefulness of these tests in diagnosis of food allergy, the effect of extrinsic factors such as season of the year on results, and the influence of corticosteroid treatment on test results. Allergen-specific IgE serological tests are never completely sensitive, nor completely specific. There is only partial correlation between the serum tests and intradermal testing; however, the significance of discrepant results is unknown and unstudied. Variation in test methodologies along with the absence of universal standardization and reporting procedures have created confusion, varying study results, and an inability to compare between studies performed by different investigators.

Animals↗
PubMed1999

[Epidemiology of anesthetic anaphylactoid reactions. Fourth multicenter survey (July 1994-December 1996)].

Since 1984 an epidemiological survey of anaphylactoid reactions occurring during anaesthesia has been obtained in France with regular repeated inquiries by the Perioperative Anaphylactoid Reactions Study Group (Gerap). The members of this group collected during the study period cases of patients having suffered from an anaphylactoid reaction and subsequently tested in their allergoanaesthetic outpatient clinic. The three previous surveys published in the Annales françaises d'anesthésie et de réanimation in 1990, 1993 (in English) and 1996 included 1,240, 1,585 and 1,730 patients respectively. The current survey concerned 1,648 patients, tested by the GERAP (38 diagnostic centres) from July 1994 to December 1996. The diagnostic tests for IgE anaphylaxis were cutaneous tests (prick tests and intradermal tests), which minimal dilutions for specific positive skin test were previously determined by comparison with control subjects. The cutaneous tests were performed by all the centres. These tests were associated, in 29 centres, with the detection of specific IgEs against quaternary ammonium compound and inhibition test, and detection of IgEs against propofol, thiopental and latex. Moreover, leukocyte histamine release test was performed in seven centres. The mechanism of the reaction was: anaphylaxis in 692 patients (characteristic clinical symptoms and positive allergological tests), anaphylactoid reactions in 611 patients (characteristic clinical symptoms and negative allergological tests), and other causes in 345 patients (unusual clinical symptoms and negative allergological tests). An immune mechanism was found in 53% of the reactions, with characteristic clinical symptoms occurring during anaesthesia. The 692 cases of anaphylaxis were due to 734 substances (double anaphylaxis in 42 patients): muscle relaxants (61.6%), latex (16.6%), antibiotics (8.3%), hypnotics (5.1%), colloids (3.1%), opioids (2.7%) and others (2.6%) among which aprotinin (four cases) ethylene oxide (five cases) local anaesthetics (two cases). The muscle relaxants implicated in anaphylactic reactions included: vecuronium (n = 130), atracurium (n = 107), suxamethonium (n = 106), pancuronium (n = 41), rocuronium (n = 41), mivacurium (n = 18), and gallamine (n = 9). These results reflected French anaesthetic practice, except for suxamethonium (5% of the French market share of curares). In 70% of the patients who were allergic to one muscle relaxant, cross-sensitivity was found with the other relaxants. The comparison with the three previous surveys confirms that the mechanism of about half of the anaphylatoid reactions occurring during anaesthesia is of immune origin, due to specific IgE antibodies. Muscle relaxants remain the most common cause of anaphylaxis, followed by latex whose incidence seems to decrease, whereas the incidence of anaphylaxis to antibiotics increases. Incidence of reactions to suxamethonium decreased, corresponding however to one quarter of all muscle relaxant anaphylaxis, similar with vecuronium and atracurium. For this survey, more clinical information was obtained in 583 patients, allowing the following conclusions: reactions were always more severe in case of anaphylaxis than nonspecific histamine release; reactions occurred more frequently in females (F/M = 2.5); 17% of patients allergic to a muscle relaxant were never anaesthetized beforehand; a history of reactions during previous anaesthetics was a risk factor for a reaction during subsequent anaesthetics; neither drug allergy nor atopy (except for latex allergy) were a predisposing factor for reactions with anaesthetic agents. Considering that in 1996, 8 million anaesthetics were administered in France, of which 2.5 million included the use of muscle relaxants, the overall incidence for anaphylactic reactions, all agents included, was evaluated as 1 in 13,000 anaesthetics, while the incidence of anaphylaxis to muscle relaxants was 1 in 6,500 anaesthetics.

Anaphylaxis↗
PubMed2001

Danish Anaesthesia Allergy Centre - preliminary results.

BACKGROUND: Anaphylactoid reactions in anaesthesia are rare and should ideally be investigated in specialist centres. At Gentofte University Hospital, we established such a centre in 1998 as a joint venture between the Departments of Anaesthesiology and Dermatology. We present the methodology, diagnostic algorithm and preliminary results from our centre. METHODS: We are open for referral of patients from all of Denmark. Reactions are classified using a three-grade severity scale and all reactions ranging from mild to severe are investigated. Investigations follow a standard step-by-step protocol of in vitro testing and skin testing. Blood samples for tryptase analysis are taken at the time of reaction and a control sample is taken together with samples for specific IgE analysis 2-4 weeks after the reaction. Subsequent skin testing comprises both prick tests and intradermal tests in most cases. Patients are tested with all substances they were exposed to, including antibiotics, colloids, latex and chlorhexidine. RESULTS: A total of 68 patients have been referred to date (July 2001) and 36 have completed investigations. Positive test results were mainly seen in patients with more severe reactions, and there were more men than women in the group with the most severe reactions. Six patients had positive specific IgE, three for penicillin, two for latex and one for thiopental. In all, 21 patients had positive skin tests to various substances, of whom four men with anaphylactic shock tested positive for chlorhexidine. Only one patient has tested positive to a neuromuscular blocking drug (NMBD) so far. DISCUSSION: Our preliminary results appear to differ in two ways from results usually found in this field. Firstly, only one patient has tested positive for a NMBD and secondly, we have had four patients with anaphylactic shock who have tested positive for chlorhexidine. Possible reasons for these differences are discussed.

Adolescent↗
PubMed1999

Hydatid cysts of the orbit in Xinjiang: a review of 18 cases.

PURPOSE To review the prevalence of orbital hydatid cyst in Xinjiang, China. METHOD. In the records of our hospital and in the issues of Chinese medical journals between 1956 and 1994, we found 18 cases of orbital hydatid cyst, including 10 cases from our hospital, two cases from the ShiHeZi Medical College, three cases from the YiLi local clinical hospital, and three other cases from the HeTian, WuSu and Changji local hospitals. All cases were verified by operation. RESULTS. In our hospital, a review of 3736 cases of hydatid cyst between 1957 and 1992 showed that hydatid cyst of the orbit accounted for 0.3%. Among the 18 cases, 7 were males and 11 females; the age ranged from 3 to 55 years and 15 cases were under 16 years of age (83%).The main symptom of orbital hydatid cyst was proptosis. Before the 1970s, the diagnosis depended on positive serological tests, X-ray examination and a history of infection of other parts of body with Echinococcus granulosus, with final confirmation by operation. In recent years, CT and ultrasonography have made possible a positional and qualitative diagnosis before surgery. With regard to the serological tests, the Intradermal test (ID) was positive in 77% of cases, while Indirect hemagglutination (IHA) and Counter-immuno-electrophoresis (CIEP) were positive in two cases and negative in two cases, respectively. No recurrence was seen when two cases were examined by CT six years after the operation, nor in eight other cases followed by letter for between 8 and 11 years. CONCLUSIONS. Hydatid cyst is an endemic disease in Xinjiang, but orbital hydatid cyst is rarely seen. The diagnosis is relatively easy to make in endemic countries, based on the clinical features, ultrasonography, CT-scan and serology. The main treatment for orbital hydatid cyst is surgery.

Journal Article↗
PubMed1986

The efficacy of mesenteric lymph node biopsy in the eradication of paratuberculosis from an infected dairy farm.

Lymph node biopsy was performed on animals older than nine months on a dairy farm which carried 223 animals and was severely affected by paratuberculosis. Biopsies were examined histologically and bacteriologically for the presence of M. paratuberculosis infection. In this way paratuberculosis infection was diagnosed in 29 animals, in which other diagnostic methods (serum complement fixation test, intradermal johnin test and microscopic examination of the faeces) produced negative results. The value of lymph node biopsy is the early detection of infected animals. In the two years after the biopsies, no further cases of clinical paratuberculosis were detected on the affected farm, although infection with M. paratuberculosis persisted.

Animals↗
PubMed1994

Self-reading of PPD skin tests.

Routine tuberculin skin testing (intradermal PPD test) at a university health service is carried out to fulfill requirements for students in healthcare and teaching programs. Currently, students must have the test done and return to the clinic 2 days later for a reading by a health professional. We performed a study to determine whether students could reliably interpret their own PPD tests. We found that student readings (based on written instructions) reflected reliable interpretations of their PPD skin tests.

Humans↗
PubMed1992

Life-threatening anaphylactoid reactions to propofol (Diprivan)

Fourteen patients who had had a life-threatening reaction within a few minutes after receiving propofol (Diprivan) were investigated for anaphylaxis 4-6 weeks after the incident. Three kinds of immunologic tests were carried out: skin tests (prick tests and intradermal tests with the drugs used and Intralipid, the solvent for propofol), a leukocyte histamine release test, and a radioimmunoassay (RIA) of immunoglobulin E (IgE) against propofol and muscle relaxants, when they had been given with propofol. It had been previously shown that these were always negative in patients anesthetized with propofol without any complications. Thirteen of the 14 patients had at least one positive test supporting hypersensitivity to propofol; 2 patients had three tests positive; 4 had two tests positive; and 7 had one test positive. The skin tests with Intralipid were negative in 4 patients whose tests with propofol were positive. Two patients who had been given muscle relaxants at the same time as the propofol had positive IgE-RIA to both drugs. In one patient, results of all the tests remained negative, and the mechanism involved in the reaction remained unidentified. It is note-worthy that 9 patients of 14 had allergic histories that were known before the anesthetic (atopy; allergy to antibiotics, muscle relaxants, lidocaine, colloids) and that none of the patients had ever received propofol or Intralipid before. It is possible that the IgE that linked abnormally with the propofol had specific binding sites for the phenyl nucleus and the isopropyl groups, which are present in propofol and many other drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Drug eruption caused by the nonionic contrast medium iohexol. "Recall-like phenomenon" appearing on an area previously affected by herpes zoster.

We report a case of "recall-like phenomenon" caused by nonionic contrast medium. A 62-year-old woman suffering from postherpetic neuralgia developed erythematous plaques 12 h after an intercostal nerve block under X-ray guidance using iohexol (Omnipaque) as contrast medium. The erythematous plaques were preferentially located in the sites where she had experienced herpes zoster 4 months previously. The lesions cleared spontaneously leaving no pigmentation. Both patch testing and intradermal testing with iohexol and ioversol were positive. We postulate that local immunological changes in the skin, such as an increased number and/or accelerated activity of Langerhans cells and mast cells in the herpes zoster lesions, were responsible for this phenomenon. This "recall-like phenomenon", occurring preferentially in skin previously affected by herpes zoster, could facilitate understanding of the pathology of drug eruptions.

Contrast Media↗
PubMed1990

Some diagnostic features of the pathogenesis of bovine paratuberculosis (Johne's disease) and serum biochemical changes after oral reinfection.

Ten bull-calves were infected with 10(8) viable cells of Mycobacterium paratuberculosis per os. During the 400-day period of observation faecal and blood samples were taken from animals at 30-day intervals. Faecal samples were examined microscopically, blood samples by the CFT, AGID and LST tests. Intradermal allergic tests were carried out at PI (post infection) days 92, 217, 336, using mammalian, avian and johnin PPD. In the period of study, these efficiency indices showed fluctuations characteristic of the given tests. In the period between PI day 160 and 400 fifteen biochemical parameters were measured monthly, TRP, ALP, TRIG and CHOL were reduced by day 400, pointing to disorders of digestion and absorption. Increased activities of CK, ALD, LDH, alpha-HBDH and ALT indicated skeletal muscle and/or liver damage in the first place. Serum CK, ALD activities and TRIG and TRP concentrations may serve as useful complementary values to the specific diagnosis of paratuberculosis, particularly in the advanced stage of the disease.

Animals↗