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PubMed1993

Eczematous skin reaction from patch testing with aeroallergens in atopic children with and without atopic dermatitis.

To determine whether aeroallergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 and 14 years of age. Patch testing with five aeroallergens--housedust, mite, cockroach, mold mix, and grass mix--was done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with atopic dermatitis, patch testing with aeroallergens induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions in 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis (P < 10(-6)). Intradermal skin tests in both groups were not significantly different. This study supports previous reports that aeroallergens plays an important role in causing eczematous skin lesions.

Adolescent↗
PubMed1993

Allergy to systemic and intralesional corticosteroids.

In this study, allergic reactions to systemic or intralesional corticosteroids were characterized, and skin tests utilized in the diagnosis of corticosteroid allergy. Five patients who had developed a rash when treated with systemic or intralesional hydrocortisone, methylprednisolone, prednisolone or betamethasone, were challenged with oral or intra-articular corticosteroid preparations, and skin tested. Upon provocation the patients reacted with diffuse erythema principally on the trunk or on the face. The erythema appeared within a period ranging from a few hours to 24 h and faded in 1-3 days. On patch testing, one patient reacted to prednisolone and methylprednisolone, which induced a positive response upon provocation, and two patients were positive to Pivalone. Patients who were sensitive to hydrocortisone or methylprednisolone, as judged by anamnestic data and provocations, reacted to these corticosteroids in the intradermal tests. Allergy to betamethasone could not be verified by intradermal or patch tests. A combination of intradermal and patch tests is recommended when allergy to systemic or intralesional corticosteroids is suspected. If these skin tests remain negative, provocation is the method of choice.

Administration, Oral↗
PubMed1985

[Comparison of the drop and capillary technics of the leukocyte migration inhibition test in the detection of sensitization to candidin].

15 test persons with a positive and 3 with a negative intradermal test of candidin were examined with two modifications of the migration inhibition test. In these cases the agarose droplet test proved to be somewhat more sensitive in comparison to the capillary method. There were no correlations between the size of the cutaneous test reaction and the adequate migration index. The droplet test using culture residues (lymphokin assay) was less evident in comparison to the direct method. The two techniques (droplet test, capillary method) are well suited for the proof of cell-mediated immune reactions to candidin and other comparable antigens, respectively.

Anti-Bacterial Agents↗
PubMed1989

DNA skin tests in patients with definite or suspected systemic lupus erythematosus and in dermatological control patients. A long-term follow-up study.

This study presents a long-term clinical and immunological follow-up of 62 patients during 1971 and 1973, tested intradermally with DNA derived from calf thymus. The DNA skin test is positive in almost all clear-cut cases of SLE. In addition, the DNA skin test was positive in 16 patients, but the criteria for SLE were not met at the time of testing. During the follow-up, 7 out of these 16 patients developed definite SLE, 2 developed subacute cutaneous LE and 3 developed ANA-negative SLE. This suggests that a positive DNA skin test may precede the development of SLE or some of its subtypes. All our SLE patients with skin test reactivity presented cutaneous disease manifestations suggesting that similar pathogenetic mechanisms may be involved in DNA tests and natural SLE skin lesions. Because the positive DNA skin test showed correlation with ANA, anti-DNA antibodies, cryoglobulins, lupus anticoagulant and depressed C3 and C4 values, humoral factors may be partly responsible. However, DNA skin test reactivity was also positive in ANA-negative SLE, suggesting that other mechanisms may also be involved.

Adolescent↗
PubMed2006

Immediate hypersensitivity to rifampicin in 3 patients: diagnostic procedures and induction of clinical tolerance.

BACKGROUND: Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with beta-lactam antibiotics and cotrimoxazole in HIV infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant Staphylococcus aureus, desensitization may be indicated in some patients. OBJECTIVE: Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. METHODS: We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. RESULTS: Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. CONCLUSIONS: Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. In vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.

Adult↗
PubMed2004

A comparison of skin endpoint titration and skin-prick testing in the diagnosis of allergic rhinitis.

Among the many methods of allergy diagnosis are intradermal testing (IDT) and skin-prick testing (SPT). The usefulness of IDT has been called into question by some authors, while others believe that studies demonstrating that SPT was superior might have been subject to bias. We conducted a study to compare the validity of SPT and IDT--specifically, the skin endpoint titration (SET) type of IDT--in diagnosing allergic rhinitis. We performed nasal provocation testing on 62 patients to establish an unbiased screening criterion for study entry. Acoustic rhinometric measurements of the nasal responses revealed that 34 patients tested positive and 28 negative. All patients were subsequently tested by SET and SPT. We found that SPT was more sensitive (85.3 vs 79.4%) and more specific (78.6 vs 67.9%) than SET as a screening procedure. The positive predictive value of SPT was greater than that of SET (82.9 vs 75.0%), as was the negative predictive value (81.5 vs 73.0%). None of these differences was statistically significant; because of the relatively small sample size, our study was powered to show only equivalency. The results of our study suggest that the information obtained by the SET method of IDT is comparable to that obtained by SPT in terms of sensitivity, specificity, and overall performance and that both SET and SPT correlate well with nasal provocation testing for ragweed. Therefore, the decision as to which to use can be based on other factors, such as the practitioner's training, the desire for quantitative results, the desire for rapid results, and the type of treatment (i.e., immunotherapy or pharmacotherapy) that is likely to be chosen on the basis of test results.

Adult↗
PubMed1977

Tetracycline asthma--a case report.

A mechanic working in the antibiotic capsuling section of a pharmaceutical company developed asthmatic attacks 1 year after starting work. His occupation involved exposure to a variety of chemical agents including tetracycline. He developed immediate weal and flare reaction to the intradermal test and an immediate (type 1) asthmatic response to intradermal, inhalation and oral challenge tests with tetracycline. On leaving the tetracycline plant he became symptom free.

Adult↗
PubMedDate not supplied

Effects of local corticosteroids on acute experimental urticaria.

Corticosteroids are often used in the treatment of acute or chronic urticaria. However, their effects on mastocyte activation as well as on the histamine-induced dermal oedema remain poorly investigated. The aim of the present study was to investigate the effects of corticosteroids (CS) on the development of acute experimental urticaria induced by prick-tests with histamine and codeine. This experimental model corresponds to the common form of urticaria. CS were administered at the site of the histamine and codeine prick tests in order to test for a direct effect on the development of acute urticaria. Two types of experiments were performed: 1) after a 48-hour period of topical CS application on the forearm, 7 healthy volunteers were skin prick-tested with histamine and codeine simultaneously in duplicate, one series in the pretreated area and the other in a non-treated area. 2) six other volunteers were prick-tested with histamine and codeine on their forearm, in duplicate. Immediately after testing, intradermal methyprednisolone was injected at the site of the prick-tests in the last series. Skin wheal and flare responses were measured after 20 mns and statistically compared with and without CS treatment. Whereas short-term CS topical application did not appear to modify cutaneous reactivity to histamine and codeine, local CS injection was associated with a significant increase in the flare induced by histamine and codeine (respectively + 18 +/- 3% and + 38 +/- 3%; P = 0.05). The wheal tended to be increased after injected CS. In conclusion, these results show that CS are neither able to prevent nor to improve experimental urticaria, i.e. wheal and flare, and even increase the histamine and codeine-induced erythema. That a similar result could apply to patients with chronic urticaria and with systemic CS remains to be studied.

Acute Disease↗
PubMed1976

Bronchopulmonary aspergillosis. An epidemiological study in a hospital population.

In order to determine the incidence of bronchopulmonary aspergillosis in patients with other types of pulmonary pathology, 586 in-patients, out-patients and controls were examined during the period 1968-1970 in Baguley Hospital, Manchester, England. It was found that from the 344 in-patients and out-patients with other pulmonary pathology, 6 had a definite diagnosis of allergic aspergillosis. 1 had pulmonary aspergilloma while 53 other patients demonstrated some evidence of bronchopulmonary aspergillosis. These 53 patients had insufficient criteria to be classified in one of the recognised forms of aspergillosis. The number of controls examined was 242, none of whom were found to have allergic or other forms of aspergillosis. Eleven of these had a positive immediate skin test the other test being negative. In addition to the above groups 534 patients with bronchial asthma attending the out-patient department, were investigated with multiple intradermal tests, including Aspergillus fumigatus. Positive intradermal Aspergillus test was found in 130 of the patients with bronchial asthma. This investigation showed that the bronchopulmonary asperigillosis is more prevalent in patients with a pulmonary disease than in persons without this pathology.

Aspergillosis↗
PubMed1977

Diagnosis of encephalitozoonosis in experimentally infected rabbits by intradermal and immunofluorescence tests.

The indirect immunofluorescence antibody test was performed on serial blood samples from eight young New Zealand White rabbits with experimental encephalitozoonosis. The test showed seroconversion in six of the eight infected rabbits by the 8th day after inoculation and in all rabbits by the 15th day. Antibody titers reached a peak by about the 36th day after inoculation and remained significantly elevated until the termination of the experiment at 84 days after inoculation. None of four sham-inoculated rabbits showed an immunofluorescence response by the 60th day after inoculation. Immunofluorescence and intradermal test responses were compared before infection and at the 60th day after inoculation in a total of 32 experimentally infected rabbits. Both tests were equally effective (100%) in detecting infected animals. Six of eight (first group) and 22 of 24 (second group) experimentally infected rabbits were confirmed histologically to have lesions compatible with encephalitozoonosis. No cross reactions were observed between Encephalitozoon cuniculi and Toxoplasma gondii, Eimeria perforans, or Eimeria stiedai by intradermal test or immunofluorescence test.

Animals↗
PubMed2006

Patch test responses to Malassezia pachydermatis in healthy dogs.

The effects of the patch test application of Malassezia pachydermatis extracts to normal canine skin were evaluated in eight healthy beagle dogs. Antigens (4 and 0.4 mg/ml) and saline controls were applied for 48 h using filter paper discs in Finn chambers. At the first test, two dogs showed patch test reactivity 20 min and 24 h after patch removal. Four out of six dogs that did not react to the first patch test showed reactivity when re-tested on day 8. Two remaining dogs were patch tested for a third time on day 15, after 7 days of cutaneous challenge with suspensions of M. pachydermatis cells, but failed to display reactivity. Positive patch test reactions were characterized histologically by mild epidermal hyperplasia, superficial dermal oedema and mild to moderate perivascular, periadnexal and interstitial infiltrates of neutrophils and CD3+ lymphocytes. Four dogs showed delayed intradermal test reactivity to M. pachydermatis antigens but intradermal and patch test reactivity did not correlate. This study indicates that patch test reactivity to M. pachydermatis antigen occurs in some healthy dogs exposed to the yeast, or may develop after a short period of antigen exposure. Further studies of patch test reactivity are warranted in dogs with disease associated with this cutaneous yeast.

Animals↗
PubMed1976

IgE-mediated adverse reactivity to a radiographic contrast medium.

In a patient with a previous history of a serious reaction after intravenous injection of the cholangiographic agent ioglycamic acid (Bilivistan), intravenous cholangiography appeared to be necessary. Therefore intradermal tests were performed in the patient and four controls with three radiographic contrast media closely related in chemical structure. In addition a Prausnitz-Kustner test with heated and unheated patient serum was performed. These tests demonstrated the presence in this patient of selective immediate-type reactivity to ioglycamic acid which was probably IgE mediated. Intravenous cholangiography with iodipamide seemed justified and resulted in no adverse reactions. Although this case may be exceptional, the results suggest that intradermal skin tests at proper concentrations may be useful in choosing the administration of radiographic contrast medium to patients with a history of prior adverse reactions.

Cholangiography↗
PubMed1994

Cockroach allergy in Kentucky: a comparison of inner city, suburban, and rural small town populations.

The cockroach has been reported as a major allergen in inner city asthmatic patients. The retrospective chart review of 799 patients tested over a 10-year period (1981-1991) derived from a private allergy practice and a university allergy clinic is reported. Patients from both groups were divided geographically by home zip codes into inner city, suburban, or rural small town populations. Criteria for positive skin tests were wheal greater than 5 mm for prick and greater than 10 mm for intradermal tests with flare. Overall, 36.9% (295/799) of all patients surveyed were positive by either prick or intradermal skin testing. Cockroach reactivity was observed in 38.6% (95/246) of the private patients tested with 36.2% (200/553) of the university patients showing positive results. The inner city populations in both groups of patients were similar with 43.7% and 40.3% of the private and university patients, respectively, testing positive, with an overall positivity of 41% for all inner city patients. Inner city and rural small town populations for both study groups demonstrated almost identical reactivity with 41% and 43% overall positivity, respectively. Of the suburban group, 37.5% of the private patients and 28.8% of the university patients had reactive skin tests results with an overall rate of positivity of 30.1%. This rate (30.1%) is significantly less than the rate for either inner city (41.0%, P < .05) or rural small town (43.6%, P < .01) populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Comparison of the intradermal and prick tests for diagnosis of allergy in the dog].

The diagnosis of allergic dermatitis and respiratory disease is increasing in veterinary practice. Searching for the initiating allergen(s) can be done with several kinds of dermal tests. In four healthy dogs and in 18 patients with a dermal or respiratory allergy problem the intradermal and prick tests were compared. Intradermal test reactions were readily identifiable and correlated well with anamnestic investigations. The prick tests generally did not give easily interpretable reactions.

Animals↗
PubMed1986

Possible role of diet in delayed pressure urticaria--preliminary report.

Late cutaneous reactions preceded by an immediate wheal-and-flare reaction have been described after allergen skin testing, intradermal 48/80 injection, and skin testing with heterologous antihuman IgE. We report the finding of delayed cutaneous reactions after prick food skin testing in a subgroup of five patients with delayed pressure urticaria. This subgroup is also defined by symptomatic clearing after fasting. We demonstrate a correlation of food challenge with skin test response in this same subgroup. Some patients who had previously required prednisone for control of urticaria were able to be managed without it while they were receiving the exclusion diet. In addition, their pressure symptoms and challenge disappeared while they were receiving the restricted diet. These findings suggest that an underlying food sensitivity may be an important precipitating factor in some patients with delayed pressure urticaria.

Adult↗
PubMed1994

Effect of a neurokinin-1 (NK1) receptor antagonist on oedema formation induced by tachykinins, carrageenin and an allergic response in guinea-pig skin.

The effect of the neurokinin-1 (NK1) receptor antagonist RP67580 in modulating inflammatory oedema formation has been investigated in guinea-pig skin. Oedema formation was measured over 30 min by the extravascular accumulation of intravenously-injected 125I-albumin in the anaesthetised guinea-pig. RP67580 was injected intradermally with the agents under test. Intradermal RP67580 (10 nmol/site) inhibits oedema formation induced by substance P (30 pmol) and neurokinin A (100 pmol), but not that induced by bradykinin (10-1000 pmol) or histamine (10 nmol). Substance P-induced oedema formation is similar in control (saline) and mepyramine (histamine H1 receptor antagonist) pretreated guinea-pigs suggesting a minimal involvement of histamine in substance P induced oedema formation in guinea-pig skin. Oedema formation induced by intradermal carrageenin (0.2%) was not inhibited by RP67580 (1-10 nmol). A significant but partial inhibition of oedema formation induced in a passive cutaneous anaphylaxis (PCA) response was observed. The oedema formation in the PCA was inhibited 50% by mepyramine pretreatment but in the presence of mepyramine no further inhibition of the PCA response by RP67580 was observed.

Animals↗
PubMed2004

Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media.

Delayed reactions to radio-contrast media (RCM) with positive skin tests are rare. We report the study of a series of 15 patients who presented delayed reactions to RCM, with an analysis of the clinical features and the results of standardized drug skin tests. Patch tests were performed with RCM and iodized antiseptics (IAs). If negative, prick tests were performed, followed by intradermal tests (IDTs), then intravenous administration under hospital surveillance. The main clinical features were maculopapular rashes or a macular rubella-like rashes. Patch tests were positive with RCM in 2 of 15 cases and with IAs in 4 of 15 cases. All the prick tests were negative. IDTs were positive at 24 h in 8 of 15 cases. 5 of 12 patients had a non-severe relapse of the rash upon receiving an RCM despite clearly negative skin tests with the readministered RCM. Visipaque cross-reacted with Iopamiron, Iomeron, Telebrix, Omnipaque, Xenetix and Hexabrix. Omnipaque cross-reacted with Hexabrix and Iopamiron. IDTs with delayed readings are of better value than patch tests in such patients. The readministration of RCM with negative IDTs must be performed with progressive amounts under hospital surveillance. Cross-reactions between various classes of RCM are frequent. The responsible epitopes are unknown. Iodine itself could be involved.

Adult↗
PubMed2004

Fondaparinux: a suitable alternative in cases of delayed-type allergy to heparins and semisynthetic heparinoids? A study of 7 cases.

Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthetic heparinoids were investigated for (cross)-reactivity to fondaparinux, a new pentasaccharide with selective factor Xa inhibition. All patients showed delayed-type reactions to heparins and some additional cross-reaction to a heparinoid on intracutaneous testing. 6/7 tolerated fondaparinux on intradermal testing as well as on subcutaneous challenge testing. However, the 7th patient developed a characteristic delayed-type reaction to both skin tests with fondaparinux. Fondaparinux is a new synthetic pentasaccharide with a molecular weight of 1.728 Da. In some patients with cross-reactivity between various heparins and semisynthetic heparinoids, lepirudin, a recombinant hirudin, may be a safe and effective alternative. However, combined allergy to hirudin and heparins has been reported. Sometimes, intravenous administration of heparins or heparinoids may be tolerated. However, these patients are at risk of developing a systemic reaction. The pathogenesis of heparin hypersensitivity is not fully understood. Heparins may act as haptens by binding to dermal and/or subcutaneous structural proteins. The chemical structures of heparins and fondaparinux are different concerning their alpha- and beta-configuration and the molecular weight. However, some of their functional groups are nearly identical and therefore similar chemical and pharmacological reactivity is to be expected. Fondaparinux seems to be a valuable alternative in most cases of heparin and hirudin hypersensitivity. The clearly rare cross-reaction between fondaparinux and heparins, now confirmed by us, may be due to differences in the response to haptens.

Adult↗