Studies on the diagnosis of canine filariasis with special reference to the comparison of hemagglutination test and skin test.
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The decision to set up a Committee on Skin Test Standardization was taken in 1985 at the spring meeting of the Netherlands Society of Allergology. The committee's terms of reference were to make recommendations about: (i) the standardization of skin-test techniques; (ii) ensuring the quality of skin-test techniques; (iii) determining whether tests should be carried out using serial dilutions and, if so, under what conditions; (iv) the adaptation of standard series or the use of minimum numbers of allergen extracts with adults and children. This committee cannot be viewed separately from the previously established Committee on the Standardization of Allergen Extracts. The availability of allergen extracts that are as highly standardized as possible is an essential condition for good skin-test diagnostics.
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The radioallergosorbent test (RAST) for alternaria was compared to skin tests and bronchial challenges in children suffering from chronic intractable asthma. In contrast to when such children were tested with a timothy grass pollen extract, the bronchial challenge and skin test results against alternaria did not correlate significantly. When alternaria allergens were coupled to cyanogen bromide-activated microcrystalline cellulose, the RAST correlated with the results of skin testing but not bronchial challenge. It was demonstrated by column immunabsorption that some allergic sera contained sufficient IgG antibody against alternaria to competitively inhibit the RAST. When Sepharose 2B was substituted for cellulose as the insoluble support, the inhibition by IgG antibody was largely overcome and then the RAST correlated with both skin test and bronchial challenge results. Glycopeptides contribute significantly to the allergenicity of alternaria, and when these materials were coupled to a Sepharose 2B conjugate by mild oxidation, the RAST correlated with bronchial challenge, but not skin test, results. It was concluded that in this group of steroid-dependent asthmatic children, the correlation of the RAST with the in vivo challenges was strongly influenced by the presence of IgG antibody in the allergic sera and the chemical nature of the mould allergens investigated.
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The authors have pointed out a monosodium-urate (MSU) skin test in vivo, showing a practical usefulness in short-time evaluation of effects of non-steroidal antiphlogistic drugs (NSAID) in man; the isotopic curves, in the area of the skin test, reproduce those obtained in endogenous articular phlogosis. THe authors have studied, at the same time, the actions of NSAID on other skin tests (SK-SD; PHA) which reproduce, in earlier phases of cutaneous reaction, some aspects (erythema, thermographic values, isotopic curves) of 'immediators' phlogosis. The results show that the MSU skin test is more useful in studying the effects of NSAID for the feature of other skin test reactions are affected by many factors.
Seventy-nine patients with acute or former reactions to penicillin were investigated by a benzylpenicilloyl (BPO)-specific RAST and/or by skin tests with penicilloyl-polylysine (PPL), benzylpenicillin and penicilloic acid and the results were correlated with the different clinical pictures. Positive RAST and skin test results could be found in patients with anaphylactic shock, urticaria and serum sickness-like reaction and sometimes in a special group of exanthems, which are characterized by the existence of many different lesions at the same time, therefore called 'polymorphic exanthems', and often observed after high-dosage penicillin therapy. In cases of scarlatiniform or morbilliform exanthems no positive results were found. The BPO-specific RAST showed an overall correlation of 95-I% with skin tests using PPL. However, some patients with positive skin tests to benzylpenicillin and penicilloic acid did no have detectable circulating IgE antibodies to BPO. This emphasizes the need for including these antigens in in vitro methods. The RAST was informative even at the allergic reaction or in the first 15 days afterwards and seems to be very valuable for early diagnosis of penicillin allergy especially in cases when many drugs have been given.
Fifty-five patients were skin-tested by Multi-Test (M) and needle prick test (NPT) to compare the reproducibility of the methods. We used 6 allergenic extracts: Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat pelt, American cockroach and mixed molds. A glycerosaline and a positive control (histamine 1 mg/ml) were performed in both methods. Statistically significant differences in histamine and Dermatophagoides farinae wheal reactions between the two methods (M > NPT) were found, with no differences with the other allergenic extracts. We concluded that the two methods are similar with respect to determining the immediate hypersensitivity, but the Multi-Test is better accepted by children.
Thirty children with atopic dermatitis were enrolled in our study to evaluate the food specific IgE antibody assay (RAST) and skin tests as a screening test for food hypersensitivity. Our results showed that eight food antigens (fish, shrimp, crab, soybean, milk, egg-white, peanut, wheat) frequently elicited positive hypersensitivity reactions. Twenty-four patients had at least a positive skin reaction to one of the foods tested. Of the 240 skin tests, 30% (72/240) yield positive reactions. Eighteen patients had at least a positive RAST reaction to one of the foods tested, 20.9% (50/240) yield positive reaction. The agreement between skin test and RAST was 79.6%. Crab and shrimp accounted for most frequent positive reaction in both tests. The skin tests produced more positive results in skin testing than RAST, but gave a higher frequency of false positive results. The diagnosis of food allergy may be suspected from the medical history or by food specific IgE antibodies together with skin test as a screening test. Furthermore, the double blind placebo controlled food challenge should be considered as standard for clinical investigations.
In addition to a significantly increased sensitivity as compared with the initial Phadebas radioallergosorbent test, a major advantage of the Fadal-Nalebuff modified RAST is its correlation with skin testing using skin end point titration. This correlation allows physicians to use both these modalities in the diagnosis and treatment of allergic disorders. However, it has been anecdotally believed that the correlation of radioallergosorbent test classes and skin test end points varied somewhat with different antigens. Fifty-three patients were tested by radioallergosorbent test for 12 inhalant antigens common to the North Texas region. These patients subsequently underwent confirmation of their radioallergosorbent test results by application of intradermal tests at a concentration of one fivefold step weaker than the corresponding radioallergosorbent test level (a "RAST minus one" dilution). The relationship between radioallergosorbent test and skin test results will be critically analyzed.
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Drug skin tests can be of value in investigating cutaneous adverse drug reactions (CADR). Guidelines have been recently published for drug skin tests to standardize the management of patients suffering from CADR in European dermatological departments. Three sorts of drug skin tests can be performed, each investigating specific immunological mechanisms: delayed cellular hypersensitivity with patch tests (PT), immediate hypersensitivity with prick tests and both immediate or delayed hypersensitivity with intradermal tests (IDT). The mechanisms involved in inducing CADR are not well elucidated. The results of the drug skin tests depend on the drug and the mechanisms i.e. the clinical features of the CADR. 164 patients developed a CADR that could be attributed to one drug. After a patch test and a negative prick and intradermal test, positive drug skin tests were nevertheless obtained in 72% of the cases. Some urticarias are due to an immediate IgE related hypersensitivity; in such cases prick tests and IDT performed with sequential dilutions can have immediate positive results. Vasculitis is related to circulating immune complexes and cannot be reproduced by skin tests. Delayed cellular hypersensitivity is involved in inducing maculopapular rashes, Baboon syndrome, localized or generalized eczema or acute generalized exanthematous pustulosis. In such CADR, drug PT or delayed positive reactions on IDT occur in more than 50% of the patients. Diluted drug patch tests can be positive in investigating drug rash with eosinophilia and systemic symptoms. As Stevens-Johnson and Lyell's syndromes are due to many both toxic and immunological mechanisms, drug skin tests are not of great value in investigating these severe CADR.