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PubMed1995

Delayed systemic allergic reactions to corticosteroids.

From the limited number of reports in the literature, it would appear that various types of delayed reactions from systemically, intralesionally, and intra-articularly administered corticosteroids are rare, particularly given their widespread use. The purpose of this literature review is to summarize in table form the reported cases of generalized delayed systemic corticosteroid reactions with respect to patient presentation, methods of evaluation, and conclusions reached. In total, 24 cases of generalized delayed systemic corticosteroid reactions have been reported in the literature. Clinical presentation (timing and cutaneous manifestations) as well as evaluation of these patients has been variable; reactions reported include eczematous or exanthematous eruptions, with or without bullae or purpura. In 16 cases, the diagnoses have been supported by positive patch or intradermal testing. Overall, it appears that generalized delayed systemic reactions to corticosteroids show considerable variability and are infrequently reported. Patch and intradermal tests with standardized allergens appear to be the most useful tests currently available to support this clinical diagnosis.

Dexamethasone↗
PubMed1968

Tuberculin test in children with malnutrition.

Tuberculin tests with Heaf's multiple-puncture method, as well as intradermal tests with varying strengths of old tuberculin, were carried out on 402 children with severe malnutrition. From the radiological and bacteriological findings 51 children (12.5%) were considered to have active tuberculosis. The Heaf test was positive in only 11 of these children, but the intradermal test using 100 tuberculin units was positive in a further 18. This confirms previous findings that tuberculin sensitivity is impaired in malnourished children, and suggests that a higher dose of tuberculin is more likely to elicit a positive response.

Child↗
PubMed1993

Ramie (Boehmeria nivea) pollen-induced bronchial asthma and allergenic cross-reactivity of ramie and Parietaria.

Ramie (Boehmeria nivea), a plant of the Urticaceae family, is widely distributed in the Nagasaki area, and has been established to be a cause of asthma. The rate of positive reactions to ramie in intradermal tests was 11.7% among adult asthmatic patients in the Nagasaki area. In this study, 10 patients were positive in provocation tests using ramie pollen. Ramie pollen-specific IgE antibodies were measured by ELISA, with the positive provocation test group showing higher O.D. values than the positive intradermal test group (p < 0.05). Ramie is of the same family as Parietaria, an important allergen in Europe. The cross-reactivity of ramie and Parietaria was examined by an ELISA inhibition test using P. officinalis and P. judaica (Pj10), but no cross-reactivity was found, suggesting that ramie may be a new independent allergen. As ramie is widely distributed throughout Japan and South-east Asia, further study is needed to determine whether it is an important allergen of the Urticaceae family in this region, as is Parietaria in Europe, and Urtica in America.

Adolescent↗
PubMed2003

Expanded experience with an intradermal skin test to predict for the presence or absence of carboplatin hypersensitivity.

PURPOSE: Carboplatin-associated hypersensitivity is increasingly recognized as a potentially serious toxicity when this agent is administered for more than six total cycles. PATIENTS AND METHODS: Our group has used a predictive skin test in women with gynecologic cancers who have previously received more than six cumulative cycles of platinum-based chemotherapy. Thirty minutes before all subsequent carboplatin courses, a 0.02-mL aliquot from the solution prepared for treatment is injected intradermally. A positive test is considered to be a > or = 5-mm wheal, with a surrounding flare. RESULTS: From October 1998 through March 2003, 126 patients received a total of 717 carboplatin skin tests (median per patient, four tests; range, one to 54 tests). Of the 668 negative tests (93% of the total performed), 10 were associated with evidence of carboplatin hypersensitivity (1.5% false-negative rate; 95% CI, 0.6% to 2.4%), none of which were severe (eg, dyspnea, hypotension, cardiac/respiratory compromise). Of the 41 positive tests, the decision was made to not deliver the drug to 32 patients, although seven women ultimately underwent a future attempt at re-treatment with a platinum agent using a desensitization program. In seven episodes where patients received the carboplatin despite the finding of a positive test, six were associated with the development of symptoms of anaphylaxis (none severe). CONCLUSION: A negative carboplatin skin test seems to predict with reasonable reliability for the absence of a severe hypersensitivity reaction with the subsequent drug infusion. The implications of a positive test remain less certain, but limited experience with continued treatment suggests this approach must be undertaken with considerable caution.

Adult↗
PubMed2000

Frequency of systematic reactions to penicillin skin tests.

BACKGROUND: Penicillin skin testing is generally considered to be safe when performed sequentially with puncture and intradermal testing although fatalities have been reported. OBJECTIVE: We analyzed the rate of systemic reactions to penicillin skin tests for a period of seven and two-thirds years. METHOD: This retrospective study used a computerized database at the Mayo Clinic. Altogether 1710 patients were skin-tested to penicillin from January 1992 to September 1999. All patients tested had a history of penicillin allergy. Patients were tested with benzylpenicilloyl polylysine (Pre-Pen) (6.0 X 10(-5) M), freshly prepared penicillin G (10,000 units/ml), and penicilloate (0.01 M). Prick tests were done first and if negative then intradermal tests. Systemic reactions were evaluated and treated by physicians. RESULTS: Eighty-six patients had positive penicillin skin tests of which two had systemic reactions. Our systemic reaction rate for all patients tested was 0.12%; and 2.3% for the penicillin skin test-positive group, with no fatalities. CONCLUSION: The incidence of systemic reaction to penicillin skin tests is low. Skin prick tests should always be done first. If there is a history of a previous serious reaction, the skin tests-if done-should be diluted to start with. Those doing penicillin skin tests should be prepared to treat a systemic reaction.

Aged↗
PubMedDate not supplied

Improved diagnostic procedures in allergic RAST negative rhinitis.

Patients affected by cutinegative, RAST negative, chronic hyperreactive rhinitis showed in 15/28 cases positive intradermal tests, nasal provocation test and RAST on nasal fluids. In 13/28 cases high IgE on nasal samples could be observed and seldom were the intradermal tests positive, but in no case were the nasal provocation or nasal RAST positive. Delayed and late positive provocation tests showed different features from early reactions. Criteria of positivity and checks during provocation tests look critical. The occurrence of sinusitis and polyposis can change clinical features. Mediators released from tissues lead to bronchial hyperreactivity.

Eosinophils↗
PubMedDate not supplied

Vasculitis during immunotherapy treatment in a patient with allergy to Cupressus arizonica.

UNLABELLED: Allergen immunotherapy dates back to 1911 and has been used successfully to treat large numbers of patients throughout the last century. CASE REPORT: a 66-year-old woman presented with symptoms of allergic rhinitis and asthma due to sensitization to Cupressus arizonica. Specific immunotherapy was prescribed as a continuous 2-year treatment with a depot preparation of standarized and characterized allergen extracts of Cupressus arizonica pollen. Forty-eight hours after one maintenance dose of 0.8 cc, the patient presented palpable violaceous purpuric lesions and pruritus on both legs. We performed skin prick and intradermal tests with Cupressus arizonica. Twenty-four hours later, the 1/1 dilution intradermal skin test was positive. Biopsy showed leukocytoclastic vasculitis. CONCLUSIONS: A middle-aged woman experienced cutaneous non-necrotizing vasculitis after 2 years of maintenance immunotherapy. The interval between injections and the first appearance of cutaneous lesions suggests a type III hypersensitivity immune reaction. Skin biopsy of the positive intradermal test also supports this hypothesis.

Aged↗
PubMed2006

Immunologic responses against hydrolyzed soy protein in dogs with experimentally induced soy hypersensitivity.

OBJECTIVE: To assess whether dogs with experimentally induced type I hypersensitivity against soy protein would respond to soy hydrolysate and develop cutaneous or gastrointestinal tract reactions after intradermal and oral challenge exposure. ANIMALS: 12 naïve Beagle pups (9 sensitized and 3 control dogs). PROCEDURE: 9 dogs were sensitized against soy protein by administration of allergens during a 90-day period. After the sensitization period, serum concentrations of soy-specific IgE were determined and an intradermal test was performed to confirm the dogs were sensitized against soy protein. An intradermal challenge test and an oral challenge test with native and hydrolyzed soy protein were conducted on 6 sensitized and 2 control dogs. RESULTS: High serum concentrations of soy-specific IgE and positive results for the intradermal test were observed for the 9 sensitized dogs after completion of the sesitization process. Sensitized dogs challenge exposed with hydrolyzed soy protein had a reduced inflammatory response after intradermal injection and no clinical response after an oral challenge exposure, compared with responses after intradermal and oral challenge exposure with native soy protein. CONCLUSIONS AND CLINICAL RELEVANCE: Soy-sensitized dogs did not respond to oral administration of hydrolyzed soy protein. Thus, hydrolyzed soy protein may be useful in diets formulated for the management of dogs with adverse reactions to food.

Animals↗
PubMed2000

[Anaphylactic reactions to aprotinin: intradermal diagnostic tests] .

A 66-year-old patient, undergoing heart surgery, developed an anaphylactic reaction following the first administration of a test-dose of aprotinin. Skin tests were performed six months later. Prick-tests with 10(-2) and 10(-1) aprotinin dilutions were negative but intradermal reaction with a 10(-3) dilution was clearly positive. The level of aprotinin specific IgE was high, both in the serum obtained before surgery and in the one sampled on the day of the testing. As no reaction was observed during the tests, skin-testing and specific IgE appear to be an interesting alternative to a potentially dangerous test-dose, but they both need further evaluation.

Aged↗
PubMed1995

Contact allergy to topical corticosteroids and systemic contact dermatitis from prednisolone with tolerance of triamcinolone.

We report the case of a 27-year-old female who had an allergic contact dermatitis to topical corticosteroids belonging to the corticosteroid groups A and D. Upon oral treatment with prednisolone a disseminated exanthema began within 24 h. Patch tests revealed sensitization to corticosteroids of group A, C and D, including prednisolone-21-acetate and betamethasone valerate, but not of group B corticosteroids such as triamcinolone. After intradermal testing of corticosteroids the exanthema flared again and the patient was treated with oral triamcinolone, with rapid improvement of her symptoms. A literature review revealed that exanthematous reactions after systemic treatment with corticosteroids have been rarely reported. Since corticosteroids are essential emergency drugs, a safe corticosteroid should be identified for such patients. Patch and intradermal tests may be used for that purpose.

Administration, Topical↗
PubMed2001

The ACVD task force on canine atopic dermatitis (VI): IgE-induced immediate and late-phase reactions, two inflammatory sequences at sites of intradermal allergen injections.

Intradermal testing is a common diagnostic procedure used in the evaluation of dogs with suspected atopic dermatitis (AD). To do this, most investigators assess the appearance of wheals that develop at the sites of intradermal allergen injections. However, wheals are rarely seen in dogs with naturally occurring AD. Furthermore, infiltration of inflammatory cells into the injection sites can occur 6-24h later, a phenomenon known as the late-phase reaction. The histological appearance of these late-phase reactions closely approximates that seen in the natural disease, suggesting that they might be more relevant than the immediate reactions. In this paper, we review the literature on immediate and late-phase reactions and re-assess the evidence for using current intradermal testing procedures as a diagnostic test in dogs.

Allergens↗
PubMedDate not supplied

Anaphylactic shock after intra-articular injection of carboxymethylcellulose.

BACKGROUND: Sodium carboxymethylcellulose (SCMC) is the sodium salt of a polycarboxymethyl ether of cellulose. SCMC is widely used in pharmaceutical and food industries. We present the case of a 47-year-old man who suffered an anaphylactic shock after an intra-articular injection of Trigon depot. METHODS AND RESULTS: Prick and intradermal tests with Trigon depot and its components (triamcinolone acetonide, Tween 80, benzylalcohol, SCMC), mepivacaine 2% and latex were performed. Challenge test with mepivacaine 2% was also realized. RESULTS: Showed a positive intradermal test to Trigon depot and carboxymethylcellulose, with negative results to the rest (including challenge test to mepivcaine 2%). CONCLUSIONS: Our results support the diagnosis of anaphylactic shock after intra-articular injection of carboxymethylcellulose and we consider necessary to emphasize that excipients must be taken into account as a potential source of adverse reactions to drugs.

Anaphylaxis↗
PubMed2002

[Netherton syndrome with recurrent herpes of facial skin].

In this paper the author presents the case of a girl with the typical Netherton's syndrome associated with herpes simplex recidivans. There was no relevans family history. In the first of life her skin appeared erythrodermic and diagnosis of atopic dermatitis was established. The bronchial asthma developed at age of four years. Total IgE and number of cosinofiles were elevated. The intradermal tests with pollen grass, house dust, eggs and milk were positive. Intradermal tests cellular immunity (PPD, Trichophytin) were negative. The number of T cells and B cells in the peripheral blood were normal, but NK cells were slightly decreased. Once or twice a year she suffers since 5 years of life exacerbation of herpes recidivas on her right site of the face. Microscopic examination of hairs revealed the typical appearance of trichorrhexis invaginata. Erythroderma persisted until the age of 12 years. Since then polycyclic and serpiginous lesions appeared.

Child↗
PubMed1997

Intradermal compared with prick testing in the diagnosis of anaesthetic allergy.

We have tested the hypothesis that intradermal testing is a more effective method for determining the drug responsible for anaesthetic anaphylactic reactions than prick testing in 212 consecutive patients, aged more than 10 yr, referred to an anaesthetic allergy clinic over a 4-yr period. The study was a prospective, non-randomized design. Intradermal testing was conducted using a previously described method and diluted drugs, and prick testing using undiluted drugs (with the exception of opioid analgesics which were diluted 1:10). The tests were performed on individual patients' forearms on the same occasion. Patients were followed-up to determine the results of subsequent anaesthesia and the difference between tests was analysed using kappa and tau statistics. There was 93% agreement overall between the paired tests. Which test detected the drug responsible was dependent on diagnostic criteria for positivity. The differences between the tests were not statistically significant. Using both tests improved predictability by 67% (tau = 0.67, P < 0.001). We conclude that in the absence of data to support one test being superior, other factors influence the choice of test. Prick testing was cheaper, and the reduction in pain and trauma with prick testing makes it more suitable for children. However, there are no data available on the safety of subsequent anaesthesia based on the results of prick testing alone, and reliability with time has not been assessed. Intradermal testing may be easier for the infrequent user. Skin testing is valuable in the investigation of anaesthetic anaphylaxis whichever test is chosen. When there is doubt both tests should be performed.

Adult↗
PubMed1998

Mast cell tryptase in anaesthetic anaphylactoid reactions.

Increased concentrations of mast cell tryptase are a highly sensitive indicator of anaphylactic reactions during anaesthesia. We obtained serum specimens from 350 patients after possible anaphylactic reactions during anaesthesia. Serum was collected from patients in our own institution (27), and transported by mail and courier from other hospitals in response to a request in the medical literature (323). Concentrations of mast cell tryptase were measured in 416 specimens. Intradermal testing was performed in 217 patients and radioimmunoassay for drug-specific antibodies with serum in 198 patients. Mast cell tryptase concentrations were increased in 158 patients, equivocal in 10 and not increased in 182. There was a significant difference in the incidence of positive intradermal tests, radioimmunoassay tests and evidence of an IgE-mediated reaction in patients whose mast cell tryptase concentrations were increased. Seven of 143 patients whose mast cell tryptase concentrations were not increased at appropriate sampling times had positive tests for IgE antibodies, and in 33 of 158 patients with increased mast cell tryptase concentrations no IgE antibodies were detected. We conclude that increased mast cell tryptase concentrations are a valuable indicator of an anaphylactic reaction during anaesthesia. Their presence favours an IgE-mediated cause but does not always distinguish between anaphylactoid and anaphylactoid reactions, and patients in whom mast cell tryptase concentrations are not increased still require skin testing.

Anaphylaxis↗