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PubMedDate not supplied

Candidin in immediate hypersensitivity. Comparison of two antigens.

One hundred outpatients in a Clinic of Allergy were submitted to intradermic tests with two types of candidins. The main focus of the research was the comparison of two antigens obtained from the same strains of Candida albicans: one a suspension of yeast cells and the other, a polysaccharide. The readings, taken 20 minutes after the intradermic injections, with positive results were considered as hypersensitivity of the immediate type. Positive results were obtained in 74% of the patients with the yeast cell antigen and in 73% with the polysaccharide antigen. This research mainly deals with the advantages that can be obtained by using the polysaccharide antigen in intradermic tests for evaluating hypersensitivity of the immediate type.

Anti-Bacterial Agents↗
PubMed1996

Correlation of modified radioallergosorbent test scores and skin test results.

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.

Administration, Inhalation↗
PubMed2003

Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering.

The insulin analogues, aspart and lispro, have been considered safe alternatives for patients with insulin allergy, because of their decreased immunogenicity. However, recent several reports showed that neither of them was completely free from allergic reactions. We also experienced a patient with insulin allergy not only to human regular insulin but also to both of the insulin analogues. Interestingly, the insulin analogues, which readily dissociate from polymer to monomer, induced the most severe allergic reaction among several types of human insulin reagents in the present case. Allergy to crystalline zinc-insulin, the three-dimensional structure of which results in delayed dissociation and absorption, was negative on intradermal tests. However, its large subcutaneous injection caused local allergic reaction. These results suggested that the allergic reaction might depend on the rapidity of insulin monomerization and absorption, and thus that the immunogenic residue of insulin is concealed when insulin is polymerized. Based on the intradermal tests, we speculated that the antigenic epitope might be B30-Thr in the present case. We also report here the modified method of insulin desensitization using crystalline zinc-insulin with prednisolone tapering. This might be a simple and useful treatment for insulin allergy.

Amino Acid Sequence↗
PubMed2006

Diagnosis of iodinated contrast media hypersensitivity: results of a 6-year period.

BACKGROUND: Iodinated contrast media (ICM) hypersensitivity reactions represent a serious problem. Very few clinical data concerning systematic skin testing to ICM are available. OBJECTIVE: To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity. MATERIAL AND METHODS: All patients referred over a 6-year period for ICM hypersensitivity past reactions were skin tested for (a) the implicated ICM, or (b) a set of ICM if they were positive for the implicated ICM or if its name was unknown. RESULTS: Forty-four patients, with a median age of 56 years, were studied (15 males, 29 females). The ICM skin tests were positive in 10 patients (23%): one had a positive skin prick test, seven an immediate positive intradermal test (IDT) and two a delayed positive IDT. Skin tests were more often positive in patients with immediate (9/32) as compared with those with non-immediate reactions (1/11). The time interval between the reaction and skin testing was shorter for those patients with an immediate ICM reaction and a positive skin test result (3 months [2.5-174.0]) as compared with those with an immediate ICM reaction and a negative skin test (48 months [6.8-159.0]), (P<0.05). Respiratory allergy was more frequent in the positive group (6/10 vs. 7/34, P<0.05). CONCLUSIONS: Skin tests with ICM are positive in a subgroup of patients with ICM hypersensitivity and may play an important role in the diagnosis of ICM allergy.

Adult↗
PubMed1993

Some genetic, clinical and immunologic interrelations in schistosomiasis mansoni.

The aim of the present work was to study the possible association of some class I, II MHC gene products with variations in the clinico-pathological outcome of human schistosomiasis mansoni as well as with the variability in immune responsiveness. The study was carried out on 47 patients with schistosomiasis mansoni and 20 healthy volunteers served as control group for the immunological parameters and 200 subjects for the genetic studies. The following were determined: class I, II HLA typing, serum IgG, IgM, C3c, immediate intradermal test and passive haemagglutination using S mansoni worm antigen, T lymphocyte subsets, delayed intradermal test and leukocyte migration inhibition using phytohaemagglutinin (PHA) and soluble egg antigen (SEA) of S mansoni. A statistically significant association was found between HLA-B5 and DR3 and with the occurrence of hepatosplenic disease; this phenotype also correlated with changes in T lymphocyte subsets and high immune reactivity, both humoral and cell mediated. HLA-DQI was also associated with failure to develop hepatosplenic disease. The present study consolidates also the view of the important role of host immune reactivity in the clinical outcome of schistosomiasis mansoni and demonstrates the contribution of the genetic impact on both clinical and immunological heterogeneity of the disease.

Adolescent↗
PubMed1979

Antigenic relationships between polypeptides derived from plantar and hand wart viruses.

Guinea pigs immunized with polypeptides derived from plantar and hand wart viruses developed both humoral and cell mediated immunity. The specificity of the antiserum was determined by indirect immunofluorescence (IF) tests and cellular immunity by intradermal tests. While whole plantar and hand wart virus particles (PV and HV) appeared to be immunologically analogous, they had different polypeptide patterns as shown by analysis on acrylamide slab gels. In particular, the P2 polypeptide (major virus protein) with different mol. wt. for PV (56750) and HV (54500) induced the production of high antibody titres in the animals and the immune sera specifically labelled wart substrates as shown in thie IF test, demonstrating that no cross humoral reaction occurs between these two polypeptides. Furthermore, a delayed hypersensitivity reaction was observed in P2 polypeptide-inoculated guinea pigs when whole particles were introduced in skin tests, but a total cross reactivity between PV and HV was noticed at the cellular level. However, the study of the virus isolated from the lesions of a patient (Ri) bearing extensive common hand warts has shown that the virus particles possessed all the biochemical and immunological characteristics of PV, in particular with regard to the P2 polypeptide. Such a case may represent plantar-like warts located on the hands.

Animals↗
PubMed2000

Investigation of the anti-allergic activity of azelastine on the immediate and late-phase reactions to allergens and histamine using telethermography.

BACKGROUND: Due to the interest in azelastine's diverse modes of action, this study investigated its effects on immediate and late-phase cutaneous allergic reactions using visual methods and telethermography. OBJECTIVE: The aim of the study was to investigate the effect of azelastine on the immediate and late-phase skin reactions using both planimetric evaluation of weal and erythema and a telethermographic technique. METHODS: The study was a double-blind crossover study; medication consisted of one tablet per day for 7 days of either placebo or azelastine 4 mg. Eight allergic patients were assessed on five occasions: prior to treatment, at the end of the first 7-day treatment, after a 21-day washout period, following the second 7-day treatment period and finally following a 2-6 week washout period. Skin prick tests with timothy grass and intradermal tests with Alternaria allergens were performed on the patients' back. In addition, patients were tested with intradermal histamine as a positive control. Surfaces of weal, erythema and infiltration were calculated using computerized planimetry at 0, 20, 40 and 60 min, and 3, 6 and 8 h. Thermographic images were recorded and the thermographic area and the increase in average temperature (DeltaT) were calculated. RESULTS: The coefficient of variation within baseline reactions ranged from 3 to 32% for weal and erythema and from 5 to 25% for thermographically recorded reactions. The stronger the reaction, the more constant the baseline was. Treatment with azelastine (4 mg/os once daily) inhibited immediate reactions to allergens by 65% (range 55-74) and to histamine by 68% (range 47-82). The late-phase reactions to allergens were less well defined and showed larger individual differences in the degree of inhibition caused by azelastine, they were inhibited by 49% (range 32-67). Late-phase reactions to histamine were less intense and could only be detected with thermography; only thermographic units showed a decrease (26%) in response to azelastine. CONCLUSION: This study has confirmed azelastine's histamine-blocking activity. In addition, the late-phase results suggest that azelastine has anti-inflammatory activity. The reproducibility and sensitivity of the thermographic results confirm the usefulness of this technique in immunopharmacology.

Adult↗
PubMed1996

The prevalence of dermatophyte infection in well-controlled diabetics and the response to Trichophyton antigen.

The prevalence of dermatophyte infection was assessed in 100 patients with well-controlled insulin-dependent diabetes, and in a control group of 100 non-diabetics matched for age, sex, occupation and sporting activity. Immediate and delayed responses to intradermal testing with Trichophyton antigen were recorded in both groups. The overall infection rate (skin and nails) was 19% in diabetics and 17% in controls. There was a higher infection rate in the skin of diabetics (17%) than in controls (8%), but this was not significant. Nail infection was seen in 12% of diabetics and in 11% of controls. Intradermal testing with Trichophyton antigen gave a higher proportion of both immediate and delayed positive results in diabetics. However, more control patients showed only an immediate positive response or only a delayed one. There was no evidence of an increased infection rate in those with immediate positive responses or of diminished infection rates in those with delayed positive responses, and no correlation with oral Candida infection. These findings applied equally to diabetics and controls.

Adult↗
PubMed1995

Anaphylactoid skin reactions after intravenous regional anaesthesia using 0.5% prilocaine with or without preservative--a double-blind study.

Methylparaben, the preservative of various local anaesthetic solutions, is a potential allergen. In a double-blind study, 0.5% prilocaine with (Citanest, n = 100) or without (n = 100) methylparaben were compared for the occurrence of skin reactions after intravenous regional anaesthesia of the arm in surgical patients. Skin reactions were registered after the deflation of the tourniquet cuff, and intradermal tests were performed with 0.5% prilocaine, 0.1% methylparaben and saline in all patients. Seventeen patients in the Citanest group and four patients in the methylparaben-free prilocaine group developed erythematous skin reactions in the exposed arm after deflation of the tourniquet cuff (P < 0.05, between the groups). The skin symptoms disappeared within an hour and were always restricted to the region which had been anaesthetised. None of the affected patients had positive intradermal tests. The observed skin reactions are probably non-IgE-mediated anaphylactoid reactions in which the presence of methylparaben in the local anaesthetic solution plays a major role.

Adult↗
PubMed1976

Antibody persistence after surgical treatment of echinococcosis.

Studies on the persistence and levels of antibodies in 280 patients at different intervals following surgery for echinococcosis are described. Post-operative antibody levels were investigated by means of four immunodiagnostic methods, namely, the complement fixation, latex agglutination, indirect haemagglutination, and intradermal tests. After surgical removal of the cysts the tests became negative in some patients, whereas in others they remained positive for many years. As the post-operative period increased, the percentage of positive results fell and this fall was faster in lung echinococcosis than in liver echinococcosis. The titres obtained with the serological tests decreased at the same rate as the percentage of positive results, but the intradermal test remained positive, with an unchanged titre, for many years. In the case of secondary echinococcosis, medium and high titres predominated in all the tests. These immunological investigations during the post-operative period make it possible to evaluate the results of surgery and, to some extent, to clarify the prognosis.

Antibodies↗
PubMed1980

[Transfer factor in diffuse cutaneous leishmaniasis. Experience with one case].

Transfer factor was administered in one case of Diffuse Cutaneous Leishmaniasis ("DCL") with minimal therapeutical results after two courses of ten doses each. The patient was 34-year-old white man, born in the State of Pará --Amazon-- region, goldwasher, his disease started 9 years ago and consisted of disseminated papular and nodular lesions, some of them secondarily ulcerated and more closely clustered over the knees elbows and dorsa of the hands. Physical examination was normal except for the skin lesions and a perforation of the nasal septum. Some intradermal tests (Paracoccidiodin, Lepromin and PPD) were positive while the Montenegro (leishmanin) reaction was negative. Increased levels of IgG and IgM were found; IgA was normal even after the treatment. Transfer Factor was obtained from leishmanin positive and PPD strong reactors and the method of preparation is described. By the end of the first ten-doses course, lesions were reduced to dark atrophic residual macules but the histological sections displayed a surprising amount of parasites, predicting unavoidable relapse. For the second series, as the patient refused to be given Amphotericin B he was treated with hot baths and levamisole was administered in a 150 mg daily dosage and 45 days cycles. The leishmanin intradermal test did not became positive after the treatment and this fact is discussed.

Adult↗
PubMedDate not supplied

Recognising antibacterial hypersensitivity in children.

Adverse reactions to antibacterial agents are not uncommon in children. They are classified as 'immediate' or 'nonimmediate' according to the time interval between drug administration and onset. Immediate reactions occur within 1 hour and are manifested by urticaria and/or angioedema, bronchospasm and anaphylactic shock; immunological reactions are mediated by IgE antibodies. The main nonimmediate reactions (occuring after more than 1 hour) are maculopapular rash, urticaria and serum sickness; T lymphocytes may participate in maculopapular rash. Clinical assessment of such reactions is complex. The patient's history is fundamental; the allergological examination includes in vivo and in vitro tests selected on the basis of the clinical features and the phase of reaction. In the late phase, prick and intradermal tests are sensitive in evaluating beta-lactam allergy. Together with delayed-reading intradermal testing, patch testing seems to be useful in diagnosing maculopapular reactions to systemically administered aminopenicillins. Determination of specific IgE levels is the most common in vitro method for diagnosing immediate reactions. In the acute phase, serum tryptase and urinary N-methylhistamine assays are reliable in diagnosing type I pathogenic mechanisms in immediate reactions. Unfortunately, there are few in vitro tests for evaluating other reactions, and most are not fully validated. In selected cases, provocation tests should be performed.

Anti-Infective Agents↗
PubMedDate not supplied

Flare up to betalactams.

BACKGROUND: The flare up phenomenon has most frequently been described with nickel. Not many cases of flare up to drugs have reported in the literature, however we have reported it with different medications. METHODS AND RESULTS: A 31-year-old woman developed an adverse reaction with an antibiotic during her childhood. Prick test with penicillin (100,000 IU/ml), penicilloyl polylysine (PPL), minor determinant mixture (MDM), amoxicillin (200 mg/ml), ampicillin (200 mg/ml) and cephalotin (200 mg/ml), and intradermal test to the same substances diluted in saline were all negative immediately. We performed an oral challenge test with 500 mg of amoxicillin. Twelve hours later, the intradermal test to PPL and MDM became positive (PPL 10 x 10 mm, MDM 8 x 7 mm). All patch tests were positive after 72 hours with erythema, vesicles and infiltration and the patient also had exanthema with pruritus on her entire body. CONCLUSIONS: We present one patient with delayed allergic reaction caused by amoxicillin and penicillin, that we all know as Flare up. We suggest that this phenomenon of Flare up occurs by a Type IV mechanism mediated by T-cells without participation of IgE antibodies. The betalactam hypersensitivity mechanism which has usually been described is an IgE mediated reaction, but there are other not very well known mechanisms that are responsible for the delayed reactions.

Adult↗
PubMed2000

[Change in skin reactivity to common allergens in allergic patients over a 30-year period. Association with aeroallergen load].

Five-year changes in the percentage of positive intradermal test to allergens in patients with bronchial asthma (BA) and allergic rhinitis (AR) over a period of 30 years from 1969 to 1998 were analyzed, with consideration of their association with the yearly changes in the levels of airborne pollens and molds over 30 years. Allergens used throughout the period were house dust, pollens from various plants (Japanese cedar, pine, oak, Japanese alder, Zelkova, orchard grass, ragweed, mugwort and Japanese hop) and molds (Alternaria, Cladosporium, Aspergillus, Penicillium and Candida). Overall percentages to house dust were higher in BA patients than in AR patients, but those to pollens were distinctly higher in the latter. Those to molds were higher in BA patients, except that those to Alternaria were about the same in both BA and AR patients. Therefore, the clinical expression of allergy may differ according to the type of allergen to which subjects are sensitized. Over the course of 30 years, the increase in the percentage of positive intradermal test to all of the allergens used was noted in both BA and AR patients, although this did not always reflect the aeroallergen load. This includes the two extremes to pollens from Japanese cedar and pine, either of which is the most common source of allergen in Japan. Significant increases in the percentages to Japanese cedar pollen (from 12.5% to 54.4% in BA patients, and from 35.1% to 81.5% in AR patients) appeared to be roughly correlated to marked increases in pollen count. In contrast, that to pine pollen was kept low at about 2%, because of their weak allergenicity, but abruptly increased to 5-6% in the last decade, despite the almost invariable pollen count over the last 30 years. Therefore, the increased sensitivity to aeroallergens may also be associated with other factors besides their load in the air.

Adult↗
PubMed2006

Skin testing.

OBJECTIVE: To provide the reader with a relevant review of the literature regarding skin testing in the allergist's office. DATA SOURCES: A PubMed search for the years 1970 through 2005 was performed using the following keywords: allergy skin testing, skin prick testing, and intradermal skin testing. STUDY SELECTION: Articles that highlighted aspects of sentinel to clinical allergists' use of skin testing in the office, such as methods of skin testing, intradermal vs skin prick testing, skin test devices, and methods of expressing skin test results, were selected for further review. RESULTS: Skin testing remains the central test to confirm an allergic response. It is minimally invasive and when performed correctly has good reproducibility. Results are easily quantifiable and correlate well with end organ challenge. It is imperative however that technicians who perform the skin tests and the clinicians who order or interpret these tests understand the characteristics of the specific tests they are administering. It is also important that the clinician express skin test results in a manner that allows easy interpretation by another physician. CONCLUSIONS: Allergists must consider controllable variables that affect skin test results and their interpretation. When not considered, they may be responsible for some of the inaccuracies associated with allergy skin testing.

Humans↗
PubMed2001

Sensitivity to local anaesthetics among asthmatic children.

OBJECTIVES: Although true allergic reactions to local anaesthetics are rare in the general population, the importance of the problem among asthmatic children has yet to be documented. SAMPLE AND METHODS: Skin prick, intradermal and incremental challenge tests with lidocain were performed in 157 asthmatic children aged 8-15 years and compared with 72 nonasthmatic children of a similar age. All of the asthmatic subjects were allergic to at least one allergen, most frequently pollens and house dust mites. Prick testing began with an undiluted solution in patients without a history of allergy and with 1:100 dilution in those with a reaction history. Following negative prick testing, intradermal or incremental challenge tests were performed. RESULTS: A total of 125 patients (80%) had been given local anaesthetics in the past, only three children gave history of an adverse local reaction. At the end of the tests, none of the subjects including controls, were found to have immediate or delayed-type allergy to lidocain. CONCLUSIONS: Local anaesthetic allergy does not seem to be a serious problem among asthmatic children and testing in all asthmatic children is not warranted. Those with an adverse reaction history to local anaesthetics should be tested with these drugs.

Adolescent↗