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PubMed2001

Suppression of the early and late cutaneous allergic responses using fexofenadine and montelukast.

BACKGROUND: The relative contribution of histamine and the cysteinyl leukotrienes to the early and late cutaneous allergic responses (ECAR and LCAR) can be studied using antagonists of these mediators. OBJECTIVE: To determine the relative suppression of the ECARs and LCARs using standard doses of an H1-receptor antagonist, a cysteinyl leukotriene1-receptor antagonist, and the two antagonists administered concurrently. METHODS: We carried out a prospective, randomized, double-blind, placebo-controlled, four-way crossover study in 12 highly allergic participants. Intradermal tests with standardized allergen, and with histamine phosphate, LTD4, and saline controls were performed on 5 different test days as follows: pretreatment baseline and at steady state immediately after the seventh and last dose of a 1-week course of treatment with once-daily fexofenadine, 120 mg; montelukast, 10 mg; fexofenadine and montelukast administered concurrently; or placebo. On each test day, the skin test results were read at intervals from 0.25 to 24 hours after the intradermal injections were performed. RESULTS: After allergen injection, compared with baseline, all treatment regimens significantly decreased the ECAR and LCAR. After allergen injection, compared with placebo, fexofenadine significantly decreased the ECAR and the LCAR from 0.25 to 2 hours and at 8 hours. Montelukast did not significantly decrease the ECAR or LCAR. Fexofenadine and montelukast administered concurrently were not more effective than fexofenadine alone at any time. In the control skin tests, compared with placebo, fexofenadine, but not montelukast, significantly decreased the histamine-induced response, and montelukast, but not fexofenadine, significantly decreased the LTD4-induced response. CONCLUSIONS: Fexofenadine and montelukast administered concurrently were not significantly more effective than fexofenadine alone in decreasing the ECAR and LCAR. Montelukast does not need to be discontinued before allergen skin testing. Further studies of the effect of concurrent treatment with higher doses of a histamine antagonist and a leukotriene modifier on the allergic response in the skin are needed.

Acetates↗

PubMed1979

Clinical comparison of skin testing and the radioallergosorbent test in dog-sensitive patients using mixed and breed-specific antigens.

A study of clinical history, intradermal test end points and RAST values with six different dog antigens was made in 20 patients and 5 control subjects. Skin testing was found to be more useful clinically than the RAST. Considerable variability among mixed epidermal extracts was noted. There was no apparent advantage to testing with three individual-breed extracts studied, compared to the most potent mixed epidermal antigen. The results of this study suggest that further efforts toward standardization of potency, methods of preparation and, possibly, breed composition of dog allergenic extracts are required to develop improved allergens for clinical use.

Animals↗

PubMed1980

Skin test for gluten-sensitive enteropathy using subfractions of gluten.

Fractions and subfractions of gluten were used for intradermal testing in 14 patients with GSE and in 22 control subjects. Twelve out of 14 GSE patients gave positive skin reactions to one or more of the subfractions of gluten. Ten gave a positive reaction between three to eight hours after skin testing; two gave positive tests 20 minutes after injection. Only two out of the 14 had negative skin tests at all times tested. All 22 control subjects were negative to all the subfractions at all times tested. The control subjects consisted of 15 patients with GI disorders other than GSE, three patients with skin disorders other than dermatitis herpetiformis and four healthy controls. Of the three subfractions tested, subfraction B1 appeared most potent in evoking positive skin reactions as judged by the number of GSE patients who responded (11 of 14). Thus, skin testing individuals with this particular portion of gluten subfraction BA may prove to be a useful diagnostic test for GSE.

Adolescent↗

PubMed2006

Trichophyton allergy: review of 89 cases.

A serie of 89 cases (55 men 34 women) of Tricophyton allergy is presented. All the patients had a clinical history and in 86 out of 89 lesions of dermatophytosis urticaria/angioedema was present in 57, eczema in 8, rhinitis in 12, conjunctivitis in 1 and asthma in 12. Skin prick tests to Tricophyton were positive in 53 (59,6%) of the patients and intradermal test in all. Specific IgE was found in 45 (69,3%) out of 70 patients. Antifungal treatment was effective at mean term in 18 cases. Specific immunotherapy was evaluated in 54 with good or very good results in 41 (83,3%). Tricophyton dermatophytosis must be looked for in all the cases of urticaria/angioedema and most cases of respiratory allergy without clear allergy to inhalants.

Antifungal Agents↗

PubMedDate not supplied

Epileptic attacks associated with wasp sting-induced anaphylaxis.

We report the case of a patient who suffered two epileptic attacks, each one associated with an anaphylactic shock due to wasp venom. He had no history of atopy nor any known diseases. Previous wasp stings had been well tolerated. An IgE-mediated hypersensitivity to the venom was shown both by cutaneous and immunologic tests. Specific IgE against Polistes spp. venom was 0.86 kU/I (RAST method), and intradermal tests with Polistes spp. venom were positive at a concentration of 1 microgram/ml. Cutaneous tests and serum specific IgE against Vespula spp. and Apis mellifera venoms were negative. In addition to that, wasp venom immunotherapy has been a highly effective treatment. Although convulsions may occur as a complication of anaphylaxis, only a few cases have been reported in the literature because of wasp venom. In our patient, it seems more likely that the epileptic attacks were due to anoxemia due to hypotension caused by vasodilatation and cardiac involvement in anaphylaxis.

Anaphylaxis↗

PubMed1990

Prevalence of Paragonimus westermani in some Ulchin school children.

In order to estimate the prevalence of Paragonimus westermani among the school children in Ulchin county, Kyungpook Province, five primary schools were selected for sampling. The children were first examined using an intradermal test with Paragonimus antigen, Lot No. 890417, and then examined for Paragonimus eggs from sputa and stools collected from the intradermal-positive cases. In a total of 382 children examined, 53 cases or 13.9 percent revealed positive reactions for Paragonimus westermani. The sex specific rate of infection was a little higher in boys than in girls. The age specific rate of Paragonimus westermani infections varied from age to age. Paragonimus westermani was most prevalent in the 8-year-old group in both sexes and showed about the same proportion among boys and girls of each age group. A comparison of the reliability for the detection of Paragonimus eggs from intradermal positive cases in this study showed that the sputum test was more sensitive than the stool test. Summarizing the results, this study indicates that the prevalence for Paragonimus westermani is still high and the endemic foci of the fluke exists in Ulchin county, Kyungpook Province, Korea.

Animals↗

PubMed1985

A new device for delayed hypersensitivity skin testing.

A new device for assessment of delayed cutaneous hypersensitivity using seven standardized antigens (Multitest CMI) was compared to conventional intradermal testing with two recall antigens in 83 patients referred for nutritional support. Sixteen patients (19.3%) were anergic to Multitest CMI while four (4.8%) were anergic to conventional testing. Patients anergic to Multitest CMI had a higher complication (intraabdominal abscess, prolonged ileus, sepsis, pneumonia) than those who were immunocompetent by this test suggesting a group at greater risk. This interpretation is consistent with an increased specificity of Multitest CMI over conventional testing in the identification of clinically important anergy.

Adult↗

PubMedDate not supplied

Management of patients at risk for adverse reactions to local anesthetics: analysis of 386 cases.

Local anesthetics are among the most used drugs in clinical practice. Various types of reactions have been reported and many patients are told that they are allergic to caines or are at risk of allergic reactions. We report our experience with 386 patients using skin test and progressive subcutaneous challenge in order to select a local anesthetic that could be safely used. The patients underwent specific protocol including clinical history, prick and intradermal tests, and subcutaneous incremental challenge with a local anesthetic from the amide group which was free of preservatives and vasoconstrictors. Thirteen patients showed a positive skin test: 10 with positive prick test underwent the subsequent challenge with no reactions; the three who were also positive by the intradermal route were carefully evaluated with a different drug. Eight of the patients with negative skin tests complained of various clinical symptoms after the challenge. All the patients found the local anesthetic to be well tolerated and nobody reported reactions after the clinical use. These results show that skin tests and subcutaneous challenge are safe and sufficient to reliably identify a local anesthetic that patients with a prior history of adverse reaction or at higher risk could tolerate.

Administration, Cutaneous↗

PubMed2001

Purified protein derivative anergy in Kawasaki disease.

It was previously reported from Italy that all patients with Kawasaki disease had a positive tuberculin intradermal test. In this study from Seattle, WA, nine patients with Kawasaki disease showed no reaction to intradermal tuberculin. The difference in results might be caused by the different tuberculin products.

Child↗

PubMed1989

[Prospective preoperative survey of 300 patients using prick tests with muscle relaxants].

It is now well established that the retrospective diagnosis of anaphylaxis to muscle relaxants may be based on skin prick testing. These tests, which use undiluted solutions of muscle relaxants, are as sensitive, specific and reproducible as intradermal tests for the diagnosis of IgE related adverse reactions to muscle relaxants. The rate of muscle relaxant anaphylaxis (1/1 500 to 1/5 000) justifies its prevention based on a possible latent sensitization. A prospective investigation was carried out in 300 surgical patients scheduled for general anaesthesia. Prick tests were carried out using the 6 available muscle relaxants: suxamethonium, gallamine, alcuronium, pancuronium, vecuronium and atracurium. The wheal the drug might produce was compared with that obtained with codeine phosphate (a histamine releasing drug). Thirty-seven patients (13%) were considered to be atopic; 262 (87%) had undergone a previous anaesthesia. Three percent (n = 11) of tests were positive for atracurium. The wheal produced by atracurium was in favour of non-specific histamine release. One test was found positive for suxamethonium. Confirmation of this probable latent sensitization was unfortunately not possible. There were no other positive skin tests. Muscle relaxants were subsequently used in 58 patients (80% vecuronium) without any problem. Skin prick testing should be used on a larger scale to detect latent sensitization. However, predictive skin tests with atracurium should be avoided, as wheal reactions with this drug are probably due to non-specific histamine release.

Adolescent↗

PubMedDate not supplied

Patch tests for diagnosis of delayed hypersensitivity to cephalosporins.

BACKGROUND: Few studies have reported delayed hypersensitivity reactions to systemically administered cephalosporins. The diagnostic procedures and extracts for these reactions are not standardized, and little is known about the extent of cross reactivity among different cephalosporins. CASES REPORT: We report 2 cases of delayed hypersensitivity reactions due to cephalosporins presenting as erythrodermia. Case 1. An 80-year-old man developed generalized pruritus and erythema 2-3 days after starting treatment with cefuroxime. The drug was stopped and antihistamines and corticosteroids were administered. The patient improved 5-6 days later, and mild superficial desquamation was observed. Case 2. A 66-year-old woman experienced similar symptoms 4-5 days after beginning cefazolin. She reported a similar reaction with ceftazidime 8 years previously. METHODS AND RESULTS: Skin prick tests and specific IgE against penicillin G and V, amoxicillin, ampicillin and cephalosporins were negative. Intradermal tests with ceftazidime and cefazolin were positive in case 2 at delayed reading. Patch tests using benzylpenicillin, ampicillin, amoxicillin, several cephalosporins, aztreonam and imipenem were positive to all the cephalosporins tested (at 48 and 96 hours) and were negative to the other betalactams. Controlled administration of amoxicillin, benzylpenicillin, aztreonam and imipenem was well tolerated by both patients. CONCLUSIONS: 1) We report 2 cases of delayed hypersensitivity reactions due to cephalosporins presenting as erythrodermia. 2) Epicutaneous tests were useful for diagnosis. 3) Both patients tested positive to all cephalosporins and negative to other betalactams.

Aged↗

PubMed1981

Application of micro-ELISA in serodiagnosis of Human paragonimiasis.

To observed whether the specific IgG antibody test using ELISA was useful in diagnosis of presently ill patients of paragonimiasis, a total of 95 sera were tested. The sera were collected from 21 egg positive cases, 8 from positive reactors of intradermal test, 7 from Clonorchis infected, 9 from other parasitic diseases and 50 from apparently non-infected cases. By the result, the sensitivity of the test was 86% and the specificity was 100%. There were no cross reactions between Paragonimus antigen and other parastic infections. Specific IgG antibody test by micro-ELISA was concluded to be useful for mass screening of the presently ill paragonimiasis in the field.

Journal Article↗

PubMed2005

Clindamycin skin testing has limited diagnostic potential.

We examined the role of clindamycin prick and intradermal skin testing in a tertiary care clinic population. Experience with diagnostic modalities such as prick and intradermal testing has been limited with clindamycin. A retrospective chart review was conducted for patients with immunologic reactions temporally associated with clindamycin who were referred to the Drug Safety Clinic (Toronto, Ontario). A total of 31 patients were identified who had undergone prick and intradermal skin testing. All 31 negative immediate prick and intradermal tests were followed by a 150 mg oral dose of clindamycin. 10/31 (32%) subjects had significant reactions to the oral clindamycin provocation. 2 patients reported delayed reactions at the clindamycin intradermal test sites. Our experience suggests that prick and intradermal skin testing is not adequate in identifying patients with previous allergic reactions associated with clindamycin. Oral provocation tests can be used in patients with histories of clindamycin adverse reactions; however, it should be offered on a risk-benefit basis.

Administration, Oral↗

PubMed1987

Effect of praziquantel on certain immune responses of schistosomal Egyptian patients. II. Cell-mediated lymphoproliferative response.

The lymphoproliferative blastogenic responses to mitogens, PHA and Con A, and to schistosome-derived antigens. S. mansoni worm and egg, were tested in 35 schistosomal patients and 10 healthy controls. Of the former group, 18 patients had intestinal mansoniasis and 17 had mansoniasis with hepatosplenomegaly. The test was repeated 2 weeks and 1 and 2 months after treatment with praziquantel. The delayed intradermal test for schistosomiasis was performed on 25 of the schistosomal patients and was repeated 1 month after treatment. Statistical analysis of results of lymphoproliferative blastogenic responses showed no significant differences between the control and the two schistosomal groups in response to mitogens. The group with intestinal mansoniasis responded significantly to both schistosomal antigens, compared to the control and hepatosplenic groups. Their proliferative responses showed a significant rise 2 weeks after treatment, then a gradual drop at 1 and 2 month intervals. The hepatosplenic group responded significantly to worm antigen before treatment; their proliferative responses to both schistosomal antigens showed a significant rise 2 weeks after treatment and remained raised thereafter. No relationship was established between either of the two schistosomal groups for age, intensity of infection or positive delayed intradermal reaction.

Adolescent↗

PubMed1982

[Anaphylactic shock induced by suxamethonium].

The authors have studied 18 cases of anaphylactic shock due to suxamethonium which occurred in eastern France during the period 1972-1980. The drug responsible was succinyl iodide in 15 cases and succinyl chloride in 3. Significant contributing factors were previous drug allergy, spasmophilia and skin hypersensitivity to histamine. Five subjects had never been previously anaesthetized. The predominant clinical symptoms were cardiovascular collapse (72 p. cent), cutaneous and mucous symptoms (72 p. cent) and bronchospasm (33 p. cent). Cardiac arrest was observed in 5 patients; it was postanoxic in 3 cases and primary in 2. The diagnosis of anaphylaxis was based on the simultaneous positivity of at least two of the specific immunoallergic tests: intradermal reaction to a 10(-5) to 10(-3) dilution of the drug; Prausnitz-Küstner test with Parish's variant and human basophil degranulation test. If only one test was positive, this had to be confirmed on two or even three occasions. Thus, 6 patients were tested once, 9 patients were tested twice and 3 patients were tested 3 times. In case of genuine anaphylaxis, suxamethonium must definitely be avoided, and the subject should be provided with an allergy card.

Adolescent↗

PubMed1979

The booster phenomenon in serial tuberculin testing.

To determine the frequency, magnitude, and causes of the booster phenomenon in tuberculin testing, a total of 1,478 employees from 10 hospitals throughout the United States received sequential intradermal tests using PPD-T. In addition, approximately 70 per cent were initially tested with PPD-G. Boosting was found in all age groups tested, but increased with age. It occurred as soon as one week after an initial tuberculin test, but rarely before that time. The boosted reactions were apparently caused either by remote tuberculous infection or recent or remote sensitization by one or more of the nontuberculous mycobacteria. In areas endemic for nontuberculous mycobacteria, they are the most likely cause of the sensitivity that may be boosted. On the basis of these findings, it is recommended that when repeated tuberculin testing is required as part of a hospital control program, a second identical tuberculin test be given one week after the first. When subsequent tests are given, this should permit separation of boosted reactions from reactions caused by new infections. Persons who do not boost when giben repeat tests at one week, but whose tuberuclin reactions change to positive after one year, should be considered to have newly acquired tuberculous infection and managed accordingly.

Adult↗

PubMed1980

Epidemiological study of Paragonimus westermani in Wiseong County, Kyungpook Province, Korea.

This survey was undertaken to determine the recent prevalence of lung fluke, Paragonimus westermani, in the three localities of Wiseong county, Kyungpook Province, Korea and to compare the prevalence among the residents in the same areas between 1924 and 1980. The three localities, Ku-seong, Sam-chun, and Um-ji villages (dong) have been known as the endemic areas of Paragonimus westermani. The surveys were made on the general population. They were examined using intradermal test with Paragonimus westermani antigen, and the diagnosis of paragonimiasis was made depending on the positive intradermal reaction. The sputum examination could not be performed beacause the residents were inaccessible. The prevalence of Paragonimus westermani among the residents in the three communities varied from 1.4 % to 7.9 per cent, with an average of 4.0 per cent. Whereas, the average reported by Ichinomiya in 1924 was 4.7 %. There are no significant differences in the sex and age specific rates of infection between 1924 and 1980. With the abundant density of Semisulcospira snails and crayfish in Sam-chun stream and the high rate of infection with Paragonimus westermani among the residents in the village, it is found that Sam-chun village, one of the three localitied in Wiseong county, where Ichinomiya (1924) surveyed, was still the endemic focus of Paragonimus westermani.

Journal Article↗

PubMed1980

[Diagnosis of respiratory allergic diseases].

Personal experience acquired at the allergology polyclinic of the Zurich University dermatological clinic is referred to in an account of the path leading from the provisional diagnosis of respiratory syndrome (rhinopathy and bronchial asthma) to a specific aetiological diagnosis, and hence to treatment of the cause (elimination of the allergen, hyposensitisation management). Careful investigation of the allergological history and skin tests (prick test) and scarification, using the patient's environmental allergens, such as household and occupational dusts, or intradermic tests, are the mainstay of diagnosis, especially in sensitisation to pneumoallergens, in spite of the introduction of RIST or PRIST radioimmuological assay of total IgEs, or specific sensitisation to known allergens (RAST method). The RAST, however, has become a sound and indispensable secondary aid, to be carried out before provocation tests, these being not entirely free of risk. Knowledge of the local pollen calendar is a necessary prerequisite to a diagnosis of pollinosis.

Asthma↗