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PubMedDate not supplied

[Prick tests using RM steel lancets].

There exist several technics of application for allergy skin tests: intradermal in which the antigen is injected in the dermis: mean while in the other puncture method (PRICK), the antigen is applied on the skin and it is introduced with a device in the epidermis which there exist several technics of application. Realizing an analysis of different methods it's known that in the patients in which are indicated to realize direct skin test, we should practice first the puncture test, which are easy to apply with less or a minimum systemic and local reactions. To facilitate its application and reduce costs, we suggest the modified method, in a tray Multiwell with antigen, where are put sterilized reusable steel lancets previous sterilization to realize the punctures. We analyze different costs in materials that are used so they would be of easy acquisition.

Costs and Cost Analysis↗
PubMed1988

Canine American cutaneous leishmaniasis: a clinical and immunological study in dogs naturally infected with Leishmania braziliensis braziliensis in an endemic area of Rio de Janeiro, Brazil.

Clinical and immunological findings from 35 dogs infected with Leishmania braziliensis braziliensis are described. The majority of the dogs had ulcerated single lesions on the ears. Sera from all infected dogs showed detectable Leishmania-induced antibodies using an indirect fluorescent antibody test. Antimonial therapy resulted in prompt healing of the lesions in 80.9% of the animals followed by a significant reduction in the anti-Leishmania antibody titers. However, treatment follow-up showed recurrences at the site of the primary lesion in 42.8% of the cases. These data were correlated with a persistence of the parasite in clinically healed lesions as well as with a negative intradermal test (leishmanin-delayed type hypersensitivity) observed in all animals but one.

Animals↗
PubMed1987

Reaginic and homocytotropic IgG antibody response of Mastomys natalensis in experimental infections of filarial parasites (Litomosoides carinii, Dipetalonema viteae, Brugia malayi, B. pahangi).

Reaginic and homocytotropic IgG antibodies in sera using passive cutaneous anaphylaxis (PCA) test and antigen from Litomosoides carinii were followed in Mastomys natalensis, infected with L. carinii, Dipetalonema viteae, Brugia malayi or B. pahangi. Groups of animals with infections of various ages so as to cover a total infection period of up to 300 to 420 days post-infection (p.i.), depending on the species of parasites, were bled at 1- to 3-week intervals over periods of 50-112 days. In addition, intradermal tests were performed on animals infected with L. carinii to detect immediate type hypersensitivity. Reaginic antibodies were usually first detected in the 3rd week after infection. Thereafter, a marked increase of PCA titres was observed in the 4th week p.i. leading to maximum titres 4 weeks after infection with D. viteae and B. pahangi and 6 weeks after B. malayi infection. Mean maximum titres were between 1:40 and 1:160. Following the peak response, titres decreased markedly until the beginning of patency in infections with D. viteae, B. malayi and B. pahangi whereas a constant course was observed at this time in animals infected with L. carinii. A further rise in PCA titres occurred in all infections around the beginning of patency, resulting in maximum reagin levels in L. carinii infections (mean titre 1:80) and moderate titres in the other infections. During early patency there was an inverse relationship between microfilaraemia density and levels of reaginic antibodies. However, in the phase of decreasing parasitaemia in L. carinii infected animals, microfilariae counts and PCA titres were directly correlated. Homocytotropic IgG antibodies showed relatively constant PCA titres of about 1:20 in L. carinii infected Mastomys throughout the observation period. In D. viteae infections they were demonstrated at 30 days p.i., reaching titres of about 1:40. B. malayi infected animals showed a maximum titre of 1:40 40 days p.i.. Thereafter, titres decreased continuously and homocytotropic IgG antibodies were absent at 110 days p.i.. High titres were observed at day 150 but thereafter sera were negative. B. pahangi infected animals showed moderate titres (1:5) 35 days p.i.. Thereafter, antibodies were found at low titres until 115 days p.i.. Intradermal reactions in L. carinii infected animals generally increased in size from 30-60 but decreased when microfilariae appeared in the blood.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Clinical evaluation of in vitro leukocyte histamine release in allergy to muscle relaxant drugs.

We have evaluated the in vitro leukocyte histamine release tests for the diagnosis of allergy to muscle relaxant drugs in 40 patients (Group A) and a control group of 44 subjects with negative leukocyte histamine release (Group B). Non-IgE dependent histamine release, expressed as a percentage of the total blood histamine, was 3.94% +/- 0.49 in Group B. The upper limit of positivity was estimated to be 5% (mean + 2 SD). Leukocyte histamine release tests were positive in 65% of the patients from Group A. The concordance between LHR and QAS-RIA was 64%. The maximal histamine release was observed at dilutions of 10(-2)-10(-4) in 20 of the 26 positive cases. The maximal histamine release was 43.8% +/- 23.3. The spontaneous histamine release was as low as 1.7% +/- 1.1. Cross-reactivity among the 5 different muscle relaxant drugs has been investigated and compared by intradermal testing. The muscle relaxant drugs which gave the lower skin reaction (M2) and the drug responsible for shock (M1) were selected for the study of in vitro leukocyte histamine release. Of 20 M2. All of the 10 cases had negative ID tests with M2. Three of these patients subsequently underwent general anesthesia with the muscle relaxant chosen as harmless (M2) without any clinical reaction.

Adult↗
PubMed1985

Skin testing in the investigation of reactions to intravenous anaesthetic drugs. A prospective trial of atracurium and tubocurarine.

Intradermal skin testing is widely used to determine the causative drugs of presumed anaphylactic anaesthetic reactions. This paper sets out to evaluate the usefulness of skin tests, both intradermal and prick testing, in the prediction of anaesthetic reactions. The muscle relaxant drugs tubocurarine and atracurium were chosen for study since they are known to produce a high incidence of minor histaminoid reactions. A trial was conducted in 22 female patients about to undergo elective gynaecological surgery for non-malignant conditions. In intradermal tests, positive wheal and flare reactions to one or other relaxant (diluted 1 in 1,000) occurred in 17 patients and reactions to both drugs in 11 patients. Despite this high incidence of positive reactions, none of the patients had received either drug previously, a view confirmed by the negative results of prick testing. Likewise, when anaesthetized for surgery using atracurium or tubocurarine allocated randomly, the minor histaminoid manifestations observed showed no correlation whatsoever with the intradermal tests results. The results of the trial, combined with external reports to this centre, indicate that intradermal testing of anaesthetic drugs, particularly muscle relaxants, produces a high incidence of false positive results. This probably reflects their pharmacological activity rather than antigenicity. It is recommended, therefore, that skin testing should be reserved for situations in which there are strong indications from laboratory tests, backed by case history, of immune sensitization.

Adult↗
PubMed2006

Contemporaneous occurrence of allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, and aspergilloma.

BACKGROUND: The clinical categories of Aspergillus-related respiratory disorders usually remain mutually exclusive. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) with aspergilloma is uncommon, whereas concurrent ABPA and allergic Aspergillus sinusitis (AAS) is rare. The association of these 3 clinical entities has previously been documented only once in a patient who had earlier been operated on for an aspergilloma before the diagnoses of ABPA and AAS were established. OBJECTIVE: To describe an adult in whom ABPA, AAS, and aspergilloma were diagnosed simultaneously. METHODS: Spirometry, radiography, computed tomography, skin allergy testing with Aspergillus antigens, serum precipitins against Aspergillus, total and specific IgE, functional endoscopic sinus surgery, and fungal culture were performed. RESULTS: A 26-year-old man who had asthma and rhinitis since childhood presented with hemoptysis. Serial chest radiographs revealed transient pulmonary infiltrates and an aspergilloma. Computed tomography of the thorax confirmed the aspergilloma and showed bilateral central bronchiectasis along with patchy infiltrates. Strong bands of precipitins were detected against Aspergillus fumigatus, and intradermal testing with Aspergillus antigens elicited strong type I and III hypersensitivity reactions. Specific IgE and IgG antibodies against A fumigatus were positive, and total IgE levels were significantly elevated. Peripheral blood eosinophilia was also detected. Sinus involvement was confirmed on computed tomography, and pathologic material obtained by functional endoscopic sinus surgery demonstrated allergic mucin that contained fungal elements. In addition, A fumigatus was cultured. CONCLUSIONS: ABPA, AAS, and aspergilloma can occur simultaneously in the same patient.

Adult↗
PubMed2004

A patient with severe black fly (Simuliidae) hypersensitivity referred for evaluation of suspected immunodeficiency.

BACKGROUND: Biting flies of the Diptera order and specifically the black fly (Simuliidae family) can be rare causes of severe hypersensitivity reactions. OBJECTIVE: To describe a patient referred for evaluation of immunodeficiency whose clinical course is explained by severe Simuliidae hypersensitivity. METHODS: The patient's immune system was investigated using standard laboratory evaluations. Hypersensitivity to Simuliidae was pursued because of historical features of her presentation and was specifically examined by skin prick and intradermal testing with whole body extract. RESULTS: The patient's history was notable for recurrent and severe seasonal episodes of presumed cellulitis after black fly bites that responded poorly to intravenous antibiotics. One episode was followed by acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome) and another by minimal change nephrotic syndrome. The results of immunologic investigations were unremarkable, but cutaneous hypersensitivity to Simuliidae was demonstrated with a 6.5-mm wheel and 35-mm flare reaction to intradermal injection of only 0.0005 microg of whole body extract. CONCLUSION: Similar to Hymenoptera, Simuliidae can rarely result in extreme hypersensitivity and should be considered in appropriate cases. This patient illustrates how severe reactions toinsect bites can be misdiagnosed.

Animals↗
PubMed1984

Immunological observations before and after successful treatment of chronic mucocutaneous candidiasis with ketoconazole and transfer factor.

A girl, 13 months of age, presented with generalised granulomatous skin, hair and mucosal candidiasis. Her lymphocytes failed to respond in vitro to Candida antigen (CA); the intradermal test with CA was also negative. Serum immunoglobulins, complement components, granulocyte functions (phagocytic and fungicidal), T-cell subsets, mitogenic and allogenic lymphocyte stimulation, natural killer cell activity and immune interferon production were all found to be normal. No circulating immune complexes were detected. Ketoconazole, an antimycotic drug, 5 mg/kg twice daily for 1 month and 2.5 mg/kg twice daily for another month spectacularly cleared all lesions. Afterwards, 4-monthly injections with transfer factor (TF) were given. Intradermal reactivity to CA was observed after the second TF injection. The lymphocyte responsiveness to CA in vitro became strongly positive 3 months after the last TF injection. The level of CA precipitins in serum, which was very high (11 lines) before ketoconazole treatment, decreased to 4 lines. No serum inhibitor of lymphocyte proliferation to CA could be demonstrated in the patient's serum before or after treatment. This specific CA unresponsiveness was not due to an excess of OKT8 + (suppressor) cells; macrophage migration inhibiting factor (MIF) production was normal. The nonresponsiveness might be due to antigenic overload or to suppressor cell induction not demonstrable in the present studies. The child has remained free of lesions during 3 years of follow-up without any further treatment.

Antibody Formation↗
PubMed2004

Use of a synthetic peptide epitope of Asp f 1, a major allergen or antigen of Aspergillus fumigatus, for improved immunodiagnosis of allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically complex allergic disorder caused by the fungal pathogen Aspergillus fumigatus. Elevated levels of total immunoglobulin E (IgE), specific IgE, and IgG antibodies in sera are important immunodiagnostic criteria for ABPA. International reference standards or standardized immunodiagnostic assays are not available due to a lack of well-defined diagnostic antigens. The present study was carried out to identify and evaluate the immunodiagnostic relevance of synthetic epitopic peptides of Asp f 1, a major allergen, antigen, or cytotoxin of A. fumigatus. Five overlapping peptides were synthesized from the N terminus of Asp f 1, one of the potential immunodominant regions predicted by algorithmic programs. The 11-amino-acid synthetic peptide (P1) significantly inhibited both IgG binding (89.10% +/- 4.45%) and IgE binding (77.32% +/- 3.38%) of the standardized diagnostic antigen (SDA) (a well-defined pool of diagnostically relevant allergens and antigens of A. fumigatus). With a panel of sera of ABPA patients, allergic patients with skin test negativity to A. fumigatus, and healthy individuals, P1 showed a higher diagnostic efficiency than SDA (specific IgG, 100%; specific IgE, 98.3%). The diagnostic efficiency of P1 could be attributed to the presence of homologous epitopes in various immunodominant allergens or antigens of A. fumigatus. The ability of P1 to induce histamine release from sensitized mast cells and a Th2 type of cytokine profile in peripheral blood mononuclear cells of ABPA patients suggests its potential for use in intradermal testing. P1 could be further explored for development of a standardized, specific, and sensitive immunodiagnostic test for aspergillosis.

Allergens↗
PubMed2005

Allergy to mammal's meat in adult life: immunologic and follow-up study.

UNLABELLED: Allergy to bovine meat and Bovine serum albumin (BSA) is exceptional, especially in the adult life. BSA is considered a minor allergen in cow's milk allergy, but there is little information about this antigen in reactions produced by other beef products as meat. To our knowledge, evolutive studies of beef's allergic patients have not been reported. OBJECTIVE: To present one patient with several allergic reactions (urticaria-angioedema) after eating different mammals' meat. METHODS: The patient underwent allergy testing through skin prick test (SPT), specific IgE detection and SDS-PAGE Immunoblotting and Immunodot inhibition studies. Periodic determinations of specific IgE to meats and epithelia were performed. RESULTS: Routine studies for chronic urticaria were normal or negative. SPT showed positive responses to pork, cow, rabbit and lamb meat, and dog, pork, sheep and cow epithelia. It was negative to cat, horse, guinea pig, rabbit, lamb, mouse epithelia, mixture of feathers, cow milk, soybean, mustard, mites and chicken meat and Anisakis simplex. Intradermal testing to BSA was positive. Determinations of specific IgE were positive to beef meat, lamb meat, pork meat and rabbit meat, dog, cat, cow, sheep and pork dander, cow's milk, and negative to chicken meat. Immunoblot and immunodot studies showed IgE recognition bands to bovine and lamb meat which were totally inhibited by BSA. A progressive reduction of the total and specific IgE, the latter until its total negativization, has been observed in the following three-year period. CONCLUSION: We report a case of IgE-mediated urticaria-angioedema due to BSA hypersensitivity, possibly induced by a subclinical sensitivity to dog and cat epithelium. The exclusion diet in patients allergic to these foods may be a progressive loss of clinical allergy.

Angioedema↗
PubMed1999

Antihistamines in urticaria.

Urticaria is one of the most common and, in its chronic course, excruciating dermato-allergic diseases. Apart from the dermatological diagnosis, the identification and evaluation of causal triggering factors is of utmost importance. Here a 'three-step guideline' (according to Ring and Przybilla) has gained acceptance, ranging a general basic examination via an intensive investigation until oral provocation tests for food allergy and oral provocation tests for idiosyncrasy (OPTI) against food additives. Apart from true IgE-mediated allergies, pseudo-allergic reactions against food additives as well as food contents represent a major problem in chronic urticaria. Recently gastric mucosal colonization with Helicobacter pylori as the trigger of chronic urticaria has received attention. New pathophysiological concepts describe autoantibodies that are directed either against IgE or against the high-affinity IgE-receptor on the surface of mast cells and basophil leucocytes. In the intradermal test with autologous serum positive wheal and flare reactions can be observed (Greaves' test). In many patients with chronic urticaria considerable psychosomatic involvement is also observed. Histamine is one of the major mediators of most forms of urticaria although in some cases, especially physical urticaria, other mediators seem to play a role. Therefore antihistamines, and mainly H1 antihistamines, are the mainstay of antiurticaria therapy. Some studies have shown a benefit of combined H1- and H2-antagonist treatment in special forms of urticaria namely urticaria factitia. Similarly pretreatment with combined H1 and H2 antagonists has been proven to reduce effectively the frequency of pseudo-allergic reaction to some histamine-releasing drugs used in radiology or surgery. More than 50 years after the first introduction of an antihistamine into allergy therapy, antihistamines still represent modern and exciting agents contributing to the continuous improvement of antiallergic therapy. Antihistamine therapy can be performed with either the classical or second generation antihistamines. Classical antihistamines are connected with considerable side-effects especially sedation and anticholinergic effects. New non-sedating antihistamines have been developed that do not cross the blood-brain barrier. The efficacy of mizolastine, a new non-sedating H1 antagonist, has been evaluated in several placebo-controlled and comparative clinical trials. Overall, mizolastine 10 mg/day was found to be significantly more effective than placebo and as effective as other second generation antihistamine drugs in the management of patients with chronic urticaria, with a rapid and sustained action.

Benzimidazoles↗
PubMed1999

Identification of a 36-kDa olive-pollen allergen by in vitro and in vivo studies.

BACKGROUND: Ole e 1 has been considered the major allergen of olive (Olea europaea) pollen. Some other relevant allergens (Ole e 2, 3, 4, and 6) have been recently described. This work aimed to study the IgE-binding frequency of a 36-kDa protein from O. europaea pollen in a large population of olive-allergic patients, its allergenic reactivity in vivo, and its presence in olive pollens of different origin, as well as in other relevant allergenic pollens. METHODS: Identification of IgE-binding components from O. europaea pollen extracts was elucidated by inhibition of SDS-PAGE immunoblotting using recombinant profilin (Ole e 2) and Ole e 1 molecules. The IgE-binding frequency of the 36-kDa protein was estimated by Western blot in a sample of 120 sera from olive-allergic patients. The cutaneous test with the 36-kDa protein was performed by intradermoreaction in allergic patients and control subjects. RESULTS: Exactly 83% of the sera from O. europaea-allergic patients recognized a protein with an apparent molecular weight of 36 kDa, under reducing conditions. It was detected by sera from monosensitized and polysensitized patients, showing a higher IgE frequency than the major allergen Ole e 1 (59%) and the minor profilin (Ole e 2) allergen (27%). Similar reactivity rates (79%) was found by intradermal test. Extracts from olive pollens collected in California presented a much higher amount (around 16-fold on average) of the 36-kDa protein than those from pollens of Spanish origin. The presence of similar allergens was detected only in closely related species (Syringa, Fraxinus, Ligustrum), and not in other common allergenic pollens. CONCLUSIONS: The 36-kDa protein constitutes a major allergen for olive-sensitized patients, but it is not equally represented in O. europaea pollens of different origins.

Allergens↗
PubMed2006

Systemic reactions from skin testing: literature review.

The skin prick test (SPT) is the most appropriate diagnostic approach to identify IgE sensitization to aeroallergens, foods, hymenoptera venom and some pharmacological compounds. SPT is considered a safe diagnostic approach, but several fatal or near-fatal reactions have been described. Based on the literature, the occurrence of systemic reactions with inhalant allergens has diminished over the last thirty years, whereas fresh food, hymenoptera venom and antibiotic SPT still carry some risk. In general, the risk of systemic reactions is lower with SPT than with intradermal testing. Some patients (history of previous anaphylactic reactions, small children, pregnant women, uncontrolled asthma, high degree of reactivity) should be considered at higher risk of systemic/anaphylactic reactions. Based on the literature, the risk of fatality due to SPT is extremely remote, and severe/anaphylactic reactions are rare. Nevertheless, this risk cannot be completely excluded, especially in highly susceptible subjects. Physicians who perform SPT should be aware of this and apply simple precautional rules.

Allergens↗
PubMed1996

Cutaneous leishmaniasis in Tupí-Mondé Amerindians from the Brazilian Amazonia.

This paper reports the results of a cross-sectional survey aimed at characterizing the epidemiology of American cutaneous leihsmaniasis (ACL) in 3 Tupí-Mondé-speaking Amerindian groups from the Brazilian Amazon region. Data include results of Montenegro skin tests (n = 550), serology (n = 233), and physical examinations (n = 676). Rates of skin test positivity were higher for males and differed between the groups (Gavião 43.0%, Suruí 52.8%, Zoró 68.1%), with a trend toward increase with age. Strong associations were also detected for the presence of suggestive ACL scars, on the one hand, and age, sex, and tribal affiliation, on the other. Although 14.7% of the subjects showed typical scars of past ACL disease, only 3 cases of active primary leishmanial ulcers were observed. The results did not indicate any clear association between seropositivity and positivity to the Montenegro intradermal test or presence of scars. The authors discuss the epidemiology of ACL in the Tupí-Mondé in the light of their ecology and recent history.

Adolescent↗
PubMed1985

Histaminoid responses to atracurium, vecuronium and tubocurarine.

Sixty patients scheduled for elective surgery underwent intradermal testing with 0.1 ml of the following solutions diluted in 0.9% saline: vecuronium and tubocurarine (1 in 1,000), atracurium (1 in 1,000 and 1 in 10,000), thiopentone (1 in 100) and also a 0.9% saline control. Thirty minutes later, an area of erythema of greater than 1.5 cm, or a wheal exceeding 1.0 cm in diameter, was recorded as a positive reaction. The patients then randomly received equipotent doses of atracurium, vecuronium or tubocurarine during a standardized anaesthetic induction. Any cutaneous reaction and the percentage fall in systolic pressure three minutes after administration of the relaxant were recorded. In 51 patients plasma IgE levels were measured. The incidence of positive cutaneous reactions to intradermal and intravenous relaxants was significantly different with each agent (p less than 0.01). The percentage fall in systolic pressure after tubocurarine was significantly different relative to the other two agents (p less than 0.01). This was regarded as reflecting potency in releasing histamine and placed the relaxants in the same order: tubocurarine, atracurium and vecuronium. The response to intradermal administration was no guide to the subsequent response after intravenous administration of the three relaxants. IgE levels below 15 IU X ml-1 occurred significantly more often in females and were associated with a significantly higher incidence of cutaneous reactions after intradermal atracurium (1 in 1,000 and 1 in 10,000) (p less than 0.05 and 0.001 respectively) and tubocurarine (1 in 1,000). With these two agents, generalized flushing after intravenous administration was also more common in this group, relative to the normal/high IgE group.

Adult↗
PubMed1990

Individual patterns of immediate skin reactivity to mold extracts.

One hundred atopic patients were skin tested intradermally over a 2-year period with 30 different mold extracts. Subjects were monitored for immediate reactions. Data suggest that to evaluate mold sensitivity in atopic patients one must use multiple mold extracts.

Administration, Topical↗
PubMed1980

Immune condition in patients with Hodgkin's disease.

In 40 cases of Hodgkin's disease (24 untreated patients and 16 patients in remission) the immunological humoral and cell-mediated competence was studied using test of hypersensitivity of DNCB and PPD, blastic transformation and the ability of 3H-DNA synthesis in lymphocytes stimulated with PHA and PWM, and in some cases, with PPD. In all patients the concentration of serum immunoglobulins was determined as well. Impairment of immunological reactivity was found in about 40% of patients, on the average, in various stages of the disease and during remissions following treatment with cytostatic agents and radiotherapy. The most frequent abnormality found in 52.5% of cases was impairment of blastic transformation of lymphocytes stimulated with PHA in vitro. In 60% of cases negative results of intradermal test with PPD and in 75% of patients the DNCB test was negative. No correlation could be found between impairment of the immune competence in this disease and the clinical stage and/or type of histological changes in lymph nodes.

Cells, Cultured↗
PubMed1994

Delayed hypersensitivity to Propionibacterium acnes in patients with severe nodular acne and acne fulminans.

BACKGROUND: Increased hypersensitivity reactions to Propionibacterium acnes may be involved in the pathogenesis of severe acne. OBJECTIVE: To study delayed and immediate hypersensitivity reactions to P. acnes in patients with severe nodular acne (SNA) and acne fulminans (AF). METHODS: We performed lymphocyte stimulation and skin tests for P. acnes antigens on 11 patients with SNA and 7 patients with AF. RESULTS: The patients with SNA had similar mean lymphocyte stimulation indices (mean 13.96, SD 8.6) to P. acnes during active disease as had healthy controls (12.63, SD 6.46). After the treatment the mean stimulation index was significantly elevated (23.47, SD 13.84, p = 0.006). A similar increase occurred in the patients with AF (mean 17.04, SD 5.74, and 33.42, SD 27.17, respectively). Two of 7 patients with SNA and 3 of the 7 patients with AF but none of the 10 control subjects showed positive 48-hour intradermal tests to P. acnes. CONCLUSION: Specific cell-mediated immunity to P. acnes increases during the course of severe inflammatory acne.

Acne Vulgaris↗