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At least 595 records · Page 33Linked to original sources
PubMed2000

[Penicillin allergy as a diagnostic problem. Overview and personal studies].

BACKGROUND AND OBJECTIVE: Penicillin allergy is a common clinical problem. The distinction between penicillin and para-infectious exanthems is difficult. We investigated the reliability of the history, as well as the sensitivity and specificity of skin tests and specific IgE levels. PATIENTS/METHODS: 160 patients with a history of penicillin allergy were retrospectively evaluated in the outpatient department of a dermatological clinic. RESULTS: Nearly 50% were diagnosed as allergic to penicillin by detection of specific IgE or skin test. About 60% of the patients with immediate type reactions, and 72% with maculo-papular erythema showed positive reactions in skin tests. Significantly more patients were diagnosed as allergic to penicillin by intradermal testing than by prick testing (p < 0.05). The sensitivity of the specific IgE RAST was 17.9%; the specifity, 89.5%. For the prick test the sensitivity was 8.2%; the specificity 90.8%. For the intradermal test the sensitivity was 26%; the specifity 69.7%. CONCLUSIONS: We suggest a step by step procedure to detect penicillin allergy making the diagnostic results as valid as possible.

Antibody Specificity↗
PubMed2006

Accidental needle sticks, the Occupational Safety and Health Administration, and the fallacy of public policy.

BACKGROUND: Current Occupational Safety and Health Administration (OSHA) guidelines mandate the use of safety needles when allergy injections are given. Safety needles for intradermal testing remain optional. Whether safety needles reduce the number of accidental needle sticks (ANSs) in the outpatient setting has yet to be proven. OBJECTIVE: To determine the rate of ANSs with new (safety) needles vs old needles used in allergy immunotherapy and intradermal testing. METHODS: Allergy practices from 22 states were surveyed by e-mail. RESULTS: Seventy practices (28%) responded to the survey. Twice as many ANSs occurred in practices giving immunotherapy when using new needles vs old needles (P < .01). The rate of ANSs was roughly the same for intradermal testing with new needles vs old needles. CONCLUSIONS: These findings further question whether OSHA's guidelines for safety needle use in outpatient practice need revision and if allergy practices might be excluded from the requirement to use safety needles.

Accident Prevention↗
PubMed1979

Nickel, cobalt and chromium sensitivity in patients with pompholyx (dyshidrotic eczema).

Sixteen patients with negative routine patch tests were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, and 2.5 mg chromium given as salts of the respective metals. All of the patients had symmetrical, vesicular hand dermatitis and in some cases also foot involvement. The dermatitis of two patients flared after challenge with cobalt; in two patients flare occurred following chromate ingestion. Prior to the oral challenge all the patients were patch tested with nickel sulphate, cobalt chloride and potassium dichromate after adhesive tape stripping. Solutions of the same metal salts were used for intradermal testing. The intradermal test sites were read after 20 minutes and 48 hours, the patch tests after 48 h. Skin test reactivity correlated poorly to the results of the oral challenge, possibly due to nonspecific skin test reactivity. It is concluded that oral challenge is a valuable adjunctive diagnostic procedure in patients with pompholyx who have negative routine patch tests.

Chromium↗
PubMed1999

Hilar adenopathy in allergic bronchopulmonary aspergillosis.

BACKGROUND: A 20-year-old male student developed allergic bronchopulmonary aspergillosis (ABPA). Computed tomography (CT) of the thorax done to detect central bronchiectasis (CB) for confirmation of diagnosis revealed, in addition, right hilar lymphadenopathy. Hilar adenopathy is thought to be rare in ABPA and has been documented only once before. Because of the finding of hilar adenopathy, the earlier reported patient had to undergo an invasive surgical procedure. OBJECTIVE: To report a case of true hilar adenopathy in ABPA. METHODS: This is a single case report. Contrast enhanced CT of the thorax was done. Serum precipitating antibodies against Aspergillus fumigatus were tested using gel diffusion technique, and intradermal testing with antigens of Aspergillus species was performed. Specific IgG antibodies against A. fumigatus and total IgE levels were measured by ELISA. RESULTS: A review of serial chest radiographs over a period of 3 years demonstrated transient pulmonary infiltrates and right hilar prominence. Computed tomography of the thorax revealed right hilar lymphadenopathy along with bilateral central bronchiectasis and patchy infiltrates. Strong bands of precipitins were detected against A. fumigatus. Intradermal testing with antigens of Aspergillus species elicited strong type I (immediate) and type III (Arthus-type) hypersensitivity reactions to A. fumigatus and A. niger. Specific IgG antibodies against A. fumigatus was positive and total IgE level was significantly elevated. Peripheral blood eosinophilia was also detected. CONCLUSIONS: Although extremely rare, ABPA should be considered in the differential diagnosis of hilar adenopathy.

Adult↗
PubMed2001

Sensitization to the fungus Hemileia vastatrix (coffee leaf rust).

BACKGROUND: The aim of the present study was to determine the existence of sensitization to the fungus Hemileia vastatrix (coffee leaf rust) in a sample of the Brazilian population. This fungus attacks coffee plantations, and in some regions of Brazil the concentration of its spores in the air can be very high. METHODS: A total of 378 individuals underwent skin tests (prick and intradermal tests) with H. vastatrix extract. The subjects were divided into four groups according to the occurrence of atopy and the region where they lived (coffee-growing or non-coffee-growing regions), and another group (V) consisted of 50 rural workers employed on coffee plantations. The presence of specific IgE against the fungus H. vastatrix in sensitized individuals was demonstrated in vitro by immunoblotting. RESULTS: There was no statistical difference in comparing the results with intradermal or prick tests. The incidence of positive tests was significantly higher among atopic individuals residing in coffee-growing regions (14.7%). Among rural workers, 10% showed positive tests. Immunoblotting revealed specific IgE against 20 protein bands of H. vastatrix. CONCLUSION: The fungus H. vastatrix may be an important allergen in coffee-producing countries. The sensitization is more frequent among atopic individuals residing in coffee-growing regions.

Antibody Specificity↗
PubMed2005

Allergic reactions to antibiotics, mainly betalactams: facts and controversies.

Allergic reactions to antibiotics are commonly reported. They can be classified as immediate or non-immediate according to the time interval between the last drug administration and their onset. Immediate reactions occur within the first hour and are manifested clinically by urticaria and/or angioedema, rhinitis, bronchospasm, and anaphylactic shock; they may be mediated by specific IgE-antibodies. The main non-immediate reactions (occurring more than one hour after drug administration) are maculopapular exanthems; specific T lymphocytes may be involved in this type of manifestation. The diagnostic evaluation of hypersensitivity reactions to antibiotics is usually complex. The patient's history is fundamental; the allergologic examination includes in vivo and in vitro tests selected on the basis of the clinical features. Prick and intradermal tests are sensitive in evaluating betalactam hypersensitivity. Together with delayed-reading intradermal testing, patch testing is useful in diagnosing maculopapular reactions to systemically administered aminopenicillins. Determination of serum specific IgE is the most common in vitro method for diagnosing immediate reactions, while the lymphocyte transformation test can be performed for evaluating both immediate and non-immediate ones. In selected cases, provocation tests should be performed.

Anti-Bacterial Agents↗
PubMed1975

[Allergentesting in children with asthma bronchiale (author's transl)].

The results of altogether 938 intradermal tests and 298 bronchial challenges with 14 allergens are presented. 67 non selected asthmatic children from 5 1/2 to 14 years of age were studied in symptom free period: 1.298 intradermal tests( 31.8% of all tests) were positive. Of these positive reactions 61.2% were positive to grasses; 55.2% to rye; 50.7% to wheat; 44.7% to house-dust, 40.3% to cat; 37.3% to horse; 19.4% to molds and 24.4% to feathers.--2. We performed the bronchial inhalation tests by the allergens, which had positive reactions in the skin (n = 298). 193 of these bronchial inhalation tests were negative (no obstruction of the bronchies), this is 2/3 of all intradermal tests with positive reactions.--3. 105 of the 298 bronchial inhalation tests were positive, that means an increased total lung resistance during inhalation of the allergen. These 105 positive reactions of the bronchies were shown in only 44 of the 67 children: in 23 children with positive intradermal reactions it was not possible to provoke a bronchus obstruction after inhalation of the corresponding allergens. Of the 44 children with bronchusobstruction during allergen inhalation 55% had a reaction to grasses; 43.2% to rye; 31.8% to horse; 31.8% to cat; 29.5% to wheat; 11.4% to house-dust and 6.8% to molds. No child reacted by bronchus-obstruction after inhalation of feathers.--4.13 of the 67 children showed a severe hyperirritability of the bronchies after inhalation of histamin: threshold below 1000 y/ml of histamin. In 9 children, the threshold for histamin was not diminished in comparison to healthy children.--The method fo the so-called controlled bronchial inhalation test is described and compared to other methods. We did not observe any incidents. In 8 of 105 cases the provoked bronchus obstruction was not completely reversible after inhalation of a bronchodilator, but now severe clinical symptoms of bronchial obstruction remained evident. We observed "late" reaction in the following 8-24 hrs after inhalation of house-dust in more than 50% of the positive tests, after inhalation of the other allergens only in 2%. By bronchial inhalation tests we select of all allergens with a positive reaction in the skin only those, which provoke a bronchus obstruction. The hyposensitization is performed by these selected allergens only.

Adolescent↗
PubMedDate not supplied

[The use of skin testing in the investigation of toxidermia: from pathophysiology to the results of skin testing].

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.

Drug Eruptions↗
PubMed1999

Skin test evaluation of genetically engineered hypoallergenic derivatives of the major birch pollen allergen, Bet v 1: results obtained with a mix of two recombinant Bet v 1 fragments and recombinant Bet v 1 trimer in a Swedish population before the birch pollen season.

BACKGROUND: More than 95% of birch pollen-allergic subjects react with the major birch pollen allergen, Bet v 1, and almost 60% of them are sensitized exclusively to this allergen. OBJECTIVE: The aim of this study was to compare the in vivo biologic activity of genetically engineered hypoallergenic derivatives of Bet v 1 (an equimolar mixture of 2 recombinant [r] Bet v 1 fragments and of rBet v 1 trimer) with that of rBet v 1 wild-type by skin prick and intradermal testing. METHODS: Birch pollen-allergic patients who had not received immunotherapy (n = 23), a group of allergic patients without birch pollen allergy (n = 12), and nonatopic persons (n = 8) from northern Europe (Sweden) underwent skin prick and intradermal testing with different concentrations of the recombinant allergens and commercial birch pollen extract before the birch pollen season. Immediate and late-phase reactions were recorded and allergen-specific IgE and IgG subclass responses were determined by CAP radioallergosorbent test and ELISA, respectively. RESULTS: Atopic persons without birch pollen allergy and nonatopic individuals did not have skin reactions to rBet v 1 wild-type and genetically engineered hypoallergenic derivatives. By intradermal testing, 8 of 23 and 13 of 23 birch pollen-allergic patients did not react with the highest concentration (1 microg/mL) of the rBet v 1 fragment mix and rBet v 1 trimer, respectively, compared with 1 with rBet v 1 wild type. Likewise, the highest concentration (100 microg/mL) of fragment mix or trimer failed to elicit a positive skin prick test in 18 of 23 and 15 of 23 patients in comparison with 0/23 with the monomer. No late reactions were observed. CONCLUSION: The recombinant hypoallergenic birch pollen allergens can probably be used for patient-tailored immunotherapy with a reduced risk to induce anaphylactic reactions.

Adolescent↗
PubMed1996

Serological and skin-test diagnosis of birch pollen allergy with recombinant Bet v I, the major birch pollen allergen.

BACKGROUND: Type I allergy represents a severe health problem in industrialized countries where up to 20% of the population suffer from allergic rhinitis, conjunctivitis and allergic asthma bronchiale and in severe cases from anaphylaxis, leading to death. OBJECTIVE: The aim of this study was to evaluate recombinant Bet v I, the major birch pollen allergen for in vivo and in vitro diagnosis of birch pollen allergy. METHODS: A group of 51 birch pollen allergic patients and eight non-allergic control individuals were tested for birch pollen allergy by skin-prick and intradermal testing, comparing commercial birch pollen extracts with recombinant Bet v I. Quantitative and qualitative serological testing was done with natural and recombinant allergens by radioallergosorbent test (RAST), enzyme-linked immunosorbent assay (ELISA) and immunoblotting. RESULTS: Recombinant Bet v I allowed accurate in vivo and in vitro diagnosis of tree pollen allergy in 49/51 patients tested. No false positive results were obtained in any in vitro assay system (ELISA, Western blot) or by skin testing (skin-prick, intradermal test) with recombinant Bet v I. CONCLUSION: Our results document that recombinant Bet v I produced in bacterial expression systems allows accurate in vitro and in vivo diagnosis of birch pollen allergy in > 95% of birch pollen allergic patients.

Adult↗