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PubMedDate not supplied

[Cross reactivity among proton pump inhibitors: does it exits?].

BACKGROUND: There has been little research into adverse reactions to proton pump inhibitors (omeprazole and its analogs) of suspected allergic etiology. We found nine studies in the medical literature and only two of these describe cross reactivity between proton pump inhibitors detected by skin prick tests. CASE REPORT: We present a 24-year-old woman who twice developed total body pruritus and urticaria with facial angioedema 1-2 hours after ingesting an omeprazole capsule. In the second episode the patient also reported the sensation of having a lump in her throat. METHODS: Skin prick and intradermal tests were performed with omeprazole, pantoprazole, and lansoprazole, which were positive for the three proton pump inhibitors. For ethical reasons, oral challenge testing was not performed. CONCLUSION: The clinical picture and the positive skin test results suggest an IgE-mediated mechanism. Skin prick tests may be useful for the diagnosis of cases of suspected allergy to omeprazole and its analogs. We found cross reactivity between three proton pump inhibitors detected by skin tests.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

Ultra rush bee venom immunotherapy does not reduce cutaneous weal responses to bee venom and codeine phosphate.

BACKGROUND: The rapid administration of bee venom in cumulative doses exceeding the quantity contained in one bee sting is well tolerated by most of the patients during 3.5 h of ultra-rush bee venom immunotherapy (VIT). The mechanism of this tolerance is unknown. OBJECTIVE: The aim of the study was to verify the hypothesis that either slow mediator depletion of mast cells or blockade of their surface receptor mechanisms by increasing doses of allergen might be the major mechanisms of tolerance induced by ultra-rush VIT. METHODS: Nine bee venom allergic patients with a history of severe systemic reactions after a bee sting, positive skin tests and bee venom specific serum IgE antibodies were treated as follows: on the first day a cumulative dose of 111 micrograms was administered over 3.5 h under intensive care conditions. Further injections were given on day 7, day 21 and thereafter at 4 week intervals. Intradermal tests with codeine phosphate (non-specific mast cell degranulation) and bee venom were performed before the initiation of VIT and 30 min after the last injection on the same day as well as before the subsequent bee venom injections. RESULTS: No significant changes of skin reactivity to both codeine phosphate and bee venom were observed on day 1 (before initiation of VIT and after the last injection on the same day). CONCLUSIONS: Ultra-rush VIT does not induce mediator depletion or surface receptor blockade in skin mast cells.

Bee Venoms↗
PubMed1978

Delayed hypersensitivity to retrobulbar injections of methylprednisolone acetate.

A patient with chronic cyclitis developed hyperemia of the episcleral and bulbar conjunctival vessels after retrobulbar injections of methylprednisolone acetate suspension. Intradermal testing revealed the responsible allergen to be methylprednisolone acetate; hypersensitivity could not be demonstrated by patch testing, despite use of increased concentrations.

Adult↗
PubMed1977

Evaluation of RAST in atopic dermatitis.

Eighty-two patients with atopic dermatitis were examined for specific IgE antibodies by RAST. A higher number of positive RAST reactions were found in patients with high serum IgE values and with coexisting asthma and/or allergic rhinitis. Positive RAST reactions against mite and house dust were found in many of these patients and even in about one-half of patients with atopic dermatitis only. The comparisons between intradermal tests and RAST were made with various allergens and the mite extract showed the best agreement between these two tests.

Adolescent↗
PubMed2003

Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique.

BACKGROUND: Muscle relaxants are believed to be responsible for 2/3 of the cases of anaphylactic reactions during anesthesia. This assumption is based mainly on positive skin tests obtained in individuals that have experienced anesthesia-related anaphylaxis. A positive skin test is supposed to be associated with mast cell degranulation of vasoactive amines. In the present study we tested the frequency of positive skin tests with two commonly used muscle relaxants, rocuronium and cisatracurium, in a selected group of volunteers with low potential for allergic reactions. METHODS: Thirty healthy volunteers without known allergy or previous exposure to muscle relaxants were studied. Low potential for allergic reactions was determined prior to inclusion in the study, using various allergy tests. Each individual was tested with intradermal and skin prick tests, and molar drug concentration thresholds for positive skin reactions were determined using a dilution titration technique. The presence or absence of mast cell degranulation was tested by electron microscopic investigation of skin biopsies obtained from positive and negative skin reactions. RESULTS: None of the volunteers had a positive skin prick test. More than 90% of the volunteers had a positive intradermal test with both rocuronium and cisatracurium. The highest molar drug concentration that was not associated with a positive intradermal test was 10(-6) M (rocuronium) and 10(-7) M (cisatracurium), equivalent to vial dilution 1 : 1000 for both drugs. In none of the volunteers was mast cell degranulation detected. CONCLUSION: Non-mast-cell-mediated positive intradermal skin reactions are frequently occurring with rocuronium and cisatracurium, even at vial dilution 1 : 1000. A clinically applicable test technique is needed that is able to separate positive skin tests associated with mast cell degranulation from non-mast-cell-mediated reactions.

Adolescent↗
PubMed1984

Virulence factors of Haemophilus ducreyi.

We investigated the susceptibility of virulent and avirulent strains of Haemophilus ducreyi to the bactericidal activity of normal human serum and to phagocytosis and killing by human polymorphonuclear leukocytes (PMNL). Strains were defined as virulent if intradermal inoculation into a rabbit produced a typical necrotic lesion. Nonvirulent strains produced no cutaneous lesions in rabbits. Virulent strains were resistant to the complement-mediated lethal action of normal human and rabbit sera, whereas avirulent strains were susceptible (greater than 95% kill, 60 min). Virulent strains were relatively resistant to phagocytosis and killing by human PMNL, in contrast to the avirulent strains. In past studies polymyxin resistance has been correlated with virulence in H. ducreyi. In our studies, polymyxin resistance could not be correlated with virulence, since polymyxin-sensitive mutants obtained from polymyxin-resistant parent strains remained virulent for rabbits and resistant to bactericidal action of normal serum and phagocytosis and killing by human PMNL. Similarly, polymyxin-resistant mutants obtained from polymyxin-sensitive parent strains remained avirulent for rabbits and susceptible to bactericidal action of normal serum and PMNL. The acquisition of polymyxin resistance was accompanied by the loss of a 47,000-molecular-weight protein. The association of serum resistance and resistance to phagocytosis and killing by human PMNL with virulent strains, as defined by the rabbit intradermal test, suggests that these factors may mediate the pathogenicity of H. ducreyi.

Animals↗
PubMedDate not supplied

Anaphylaxis to paracetamol.

We hereby present a patient suffering several episodes of anaphylaxis (generalized urticaria, dyspnea, wheezing and intense cough) a few minutes after taking different drugs containing paracetamol. Intradermal test with pure paracetamol (100 mg/ml) was positive. It was negative in six controls. Serum specific IgE anti-paracetamol (by RIA) was negative. Anaphylaxis from paracetamol is rare but has been reported. Positive skin test with paracetamol have only been rarely described.

Acetaminophen↗
PubMed1992

Montenegro skin tests for American cutaneous leishmaniasis carried out on school children in Rio de Janeiro, Brazil: an indicator of transmission risk.

Montenegro skin tests were carried out in 1985 and 1987 on two groups of school children in the city of Rio de Janeiro. Group A consisted of 449 children residing in the Jacarepagua district, in areas where transmission of human and canine American cutaneous leishmaniasis (ACL) has been high; this group was considered to be the one at greatest risk of acquiring the infection through L. braziliensis. Group B consisted of 282 children from Bonsucesso, a suburb of Rio de Janeiro that is at a considerable distance from any area where ACL is endemic; this was a lowest risk group, and was thus used as a control. Analysis of the cutaneous test results showed that in Group A, 8.9% of the sample tested positive, whereas in Group B the result was only 2.1%. In group A there were no significant differences in the proportion of positives when analysed according to sex, age and the year when the tests were carried out. A study of the effects associated with place of residence together with other variables was carried out using log-linear regression analysis. It showed that effects arising from place of residence were maintained; that this was the only significant effect; and that it was independent of other variables. The testing of school children using the Montenegro intradermal test was shown to be a useful procedure in the characterization of localities in which there is a risk of ACL infection.

Adolescent↗
PubMed2003

Is there a risk of sensitization and allergy to chlorhexidine in health care workers?

BACKGROUND: In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure. METHODS: Two hundred and forty-eight doctors, nurses and auxiliary staff were invited to participate in the study. One hundred and four individuals took part in the full study including skin tests and a questionnaire and a further 74 individuals filled in the questionnaire giving a total of 178 questionnaires (72%). Patch tests with chlorhexidine gluconate 1% and chlorhexidine acetate 1% were performed looking for type IV (delayed type) allergy. A prick test with chlorhexidine gluconate 0.5% and an intradermal test with chlorhexidine 0.0002% were performed looking for type I (immediate type) allergy. RESULTS: There were no positive tests in any of the 104 individuals tested (99% confidence interval 0-4.9%). There was a predominance of females in both groups and the overall median age was 42 years (28-63). No one in the group not tested reported to have a verified or suspected allergy to chlorhexidine. CONCLUSION: In this first study to examine the risk of type I and type IV allergy to chlorhexidine in health care workers with daily exposure to chlorhexidine, we did not identify allergies to chlorhexidine in any of the 104 individuals tested or in the additional 74 individuals who completed the questionnaire. We conclude that an allergy to chlorhexidine in health care workers is likely to be rare.

Adult↗
PubMed1975

Leukocyte migration test in a modified agarose medium.

The medium used for the leukocyte migration test contained 1% agarose, 0.003 M HEPES, TC medium 199, and 10% horse serum. The pH was adjusted to 7.3 with 2 N NaOH. The leukocyte migration test in this medium correlated with the intradermal test in 36 subjects when PPD was used as antigen, and the results were comparable to those of the reference technic. Addition of HEPES to the original medium enables the test to be performed in a standard incubator.

Cell Migration Inhibition↗
PubMed1981

Allergic reactions to local anesthetics.

The majority of adverse reactions to local anesthetics are due to high plasma levels from excessive quantities of a drug. These are often blamed on idiosyncrasy, sensitivity, or allergy. The incidence of reactions due to allergy to local anesthetics is low compared to that with other drugs. Allergic reactions may be systemic or local. More than 80% of reactions are cell mediated, resulting in contact dermatitis. The remainder are caused by circulating antibodies that give rise to systemic anaphylaxis. Acute anaphylactic reactions are rare but invariably fatal unless promptly treated. Localized systemic anaphylactic reactions manifested by urticaria, laryngeal edema, and extrinsic asthma are less serious and amenable to treatment. There is no foolproof test for screening of susceptible persons. The intradermal test is of no value for detecting possible systemic sensitivity. The patch test is useful for detecting contact allergy. Systemic reactions are treated with epinephrine, antihistamines, and steroids. Contact dermatitis responds to topical steroids.

Anaphylaxis↗
PubMedDate not supplied

[Value of delayed skin test in elderly patients].

BACKGROUND: Retarded cutaneous hypersensitivity to several antigens has been studied in human of different ages and in people older than 60 years a diminishment in response to tests measuring retarded hypersensitivity has been observed. OBJECTIVE: To determine the pattern of response to tests of retarded hypersensitivity in an apparently healthy sample of Cuban population resident at La Habana City, by application of a group of cutaneous tests with national antigens. MATERIAL AND METHODS: Intradermal tests were applied to 87 subjects (69 women and 18 men) between 60 and 89 years old, without frequent infection antecedents. All subjects were submitted to clinical history and analysis in order to discard diseases that may alter the study proposal. Response grade was determined by summing media of induration diameters, which was denominated total media punctuation. RESULTS: In all age groups total media punctuation was lightly higher in women, in both control and study groups, excepting age group of 80-89 years. CONCLUSION: By virtue of there are few indicators of health for old people, the group of tests proposed in this article may be a good predictive indicator of morbidity and mortality in old patients.

Age Factors↗
PubMed1987

Allergenicity of alum-precipitated grass pollen extracts with different RAST activity.

The biological potency of therapeutic allergen extracts is fundamentally important in terms of maximal security of immunotherapy, especially when changing batches. As regards pyridine-extracted alum-precipitated allergen preparations, the potency is commercially controlled by the RAST technique. In the present study, titrated intradermal tests were performed in thirty-three adult grass-pollen rhinitis patients with three ten-fold dilutions of two batches of Allpyral 5-grass mix with different RAST activity. The difference in potency was estimated as the horizontal distance at the midpoint of the two dose-response curves after performing linear regression on the log-dose/log-weal area response, and as the concentration of each batch eliciting a weal equal to the histamine HC1 0.1 mg/ml reference. The difference in potency as estimated by RAST was a factor 5.0 vs a factor 8.3 and 7.2 (median) estimated by the horizontal distance and histamine-equivalent reaction, respectively. Considering the biological variation, the RAST-estimated difference in potency is in the same order as that found by skin test. It is, therefore, concluded that the routine control of new production batches by RAST is acceptable with the use of standardized reference sera as regards alum-precipitated grass pollen allergen extracts.

Humans↗
PubMed1992

Preliminary observations on inhalation and intradermal challenges of horses with oil seed rape.

Horses with asymptomatic or symptomatic chronic obstructive pulmonary disease (COPD) and control horses were challenged with oil seed rape either by exposure to a field of flowering Brassica campestris for six days, or by an inhalation challenge with freshly collected pollen from Brassica napus, or by inhalation challenge with a commercial extract of B napus pollen. Clinical and bronchoscopic examinations showed that the challenges did not induce detectable pulmonary disease in the control or asymptomatic COPD affected horses and did not significantly affect their pulmonary mechanics, arterial blood gas tensions, arterial pH or the cytology of bronchoalveolar lavage fluid. However, the challenges with fresh B napus pollen and the commercial extract of B napus pollen exacerbated the pulmonary disease in some of the symptomatic horses, possibly owing to non-specific toxicity or non-specific bronchial hyperresponsiveness. Intradermal testing with the commercial extract of B napus pollen suggested that none of the horses were hypersensitive to this agent.

Allergens↗
PubMed1975

Immune responses to treatment with natural and synthetic ACTH in bronchial asthma.

Two comparable groups of asthmatics each with 10 patients were treated during 2 years at scheduled intervals with either natural or synthetic ACTH up to a total dose of 2000-95-- IU. All patients had previously been given the natural but never the synthetic hormone. Intradermal tests with natural and synthetic ACTH were performed before treatment and after 1, 12 and 24 months. Serum samples were also taken on these occasions and analysed for antibodies against ACTH, vasopressin and porcine gamma-globulin. No sign of clinical allergy to ACTH was noted in any of the patients during the 2-year period. The incidence of intradermal reactions against natural ACTH was high at the onset of treatment but was not increased by treatment with either synthetic or natural ACTH, while the reactivity rate against synthetic ACTH was increased after both types of treatment. The incidence of IgE reactions against synthetic ACTH at the 20 U/ml level was significantly increased after 12 months' treatment with either natural or synthetic hormone. A high incidence of low-titered agglutinating antibodies against natural or synthetic ACTH was demonstrated before treatment in both the groups, but no significant change in incidence or mean titre against natural or synthetic ACTH or porcine gamma-globulin was noted during treatment with the natural or the synthetic preparation. A few patients, however, did display an increased agglutinating titre against ACTH after 12 months' treatment. Rather unexpectedly, most sera reacting with ACTH were found to react also with vasopressin and a significant increase of the incidence of these reactions and of the titres occurred during the treatment with synthetic as well as with natural ACTH. Two cases have been examined in detail, one because of a fulminant shock after synthetic ACTH and the other because of very high antibody titres without clinical symptoms of ACTH allergy.

Adrenocorticotropic Hormone↗