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PubMed1981

Atopic skin test re-evaluated. X. Comparison of a perfected technique of intracutaneous skin testing and the prick test performed with a modified Morrow Brown Needle.

With a modified Morrow Brown needle it proved possible to obtain duplicate skin-test values with almost the same reliability as those obtained with the intracutaneous method described in one of the preceding papers of this series. The results of the present study also showed that 50% glycerin has a distinct inhibitory effect when added to the extracts, whereas 0.0005% Tween 80 produces a distinct enhancement of the skin reaction.

Adolescent↗
PubMed1985

A liquid chromatographic study of stability of the minor determinants of penicillin allergy: a stable minor determinant mixture skin test preparation.

Various skin test reagents supplying minor determinants for detecting penicillin hypersensitivity have been examined by high-performance liquid chromatography (HPLC) for composition and stability. HPLC systems capable of separating and determining the four diastereoisomers of benzyl-D-penicilloic acid and the two benzyl-D-penicilloic acids were developed for this purpose. The "simple skin test reagent," consisting of an aged partial alkaline hydrolysate of penicillin, is possibly an adequate source of (5R,6R)-benzyl-D-penicilloate whereas the "simple skin test reagent," consisting of aged aqueous solution of penicillin, is a questionable source of this compound. A modified Levine, Voss, Redmond, and Zolov minor determinant mixture (MDM) reagent and the components (5R,6R)-benzyl-D-penicilloate and (5R)-benzyl-D-penilloate have been found to be highly labile in aqueous solution, giving rise to a mixture of diastereoisomers. The tendency to epimerize at C-5 was a prominent feature of (5R,6S)- and (5S,6R)- as well as (5R,6R)-benzyl-D-penicilloic acids. The MDM reagent has been prepared in single-dose ampules as a dried, lyophilized powder that can be stored without change and used as needed. Lyophilized MDM has served as a satisfactory substitute for freshly prepared MDM in several individuals with MDM-positive history and, in a recent clinical study, evaluating the question of penicillin skin test sensitization. This convenient, stable, single-dose form of the MDM reagent should facilitate skin testing for penicillin sensitivity.

Chromatography, Liquid↗
PubMed1979

Atopic skin test re-evaluated. VI. Skin reactions to compound 48/80 and histamine in patients with atopic and non-atopic chronic respiratory complains and in normal volunteers.

Using a perfected technique for skin testing, no difference was found between skin reactions to either histamine or compound 48/80 in atopic and non-atopic patients or in healthy volunteers. The correlation of the size of the skin reactions to both compounds was only slightly lower than the correlation of the duplicates, which indicates that compound 48/80 can be used as a control extract in skin testing. The skin reactions to this compound are read after 15 minutes, just as those to inhalant allergens.

Adolescent↗
PubMed2006

A university hospital's 10-year experience with tuberculin testing: value of the 2-step tuberculin skin test.

BACKGROUND: The usefulness of the 2-step tuberculin skin test as a tool for monitoring tuberculosis exposure among health care workers is controversial. OBJECTIVES: We aimed to determine the cost-effectiveness and influence of initiation of a preemployment, 2-step tuberculin skin-testing program on the annual tuberculin skin conversion rate among a university hospital's health care workers. METHODS: The tuberculin skin test conversion rates among the recipients of 31,729 tuberculin skin tests over 10 years were retrospectively analyzed. Data from the first 6 years of this study were generated when a single preemployment tuberculin skin test was utilized. Data from the last 4 years were gathered after the advent of a preemployment 2-step program. A cost analysis of the 2-step tuberculin skin test process was performed to determine the annual cost of this program. RESULTS: Relative risk of a conversion was 8.43 times less during the 2-step period when compared with the years when a single tuberculin skin test was given at the start of employment (P < .001). A cost analysis showed that the annual added cost of the 2-step program was approximately 9,565 US dollars. CONCLUSION: A greater than 8-fold reduction in the number of annual tuberculin skin test conversion coincided with, but could not be attributed solely to, the initiation of a 2-step program in our hospital. The Infection Control Committee concluded that the 2-step testing program is essential to achieve the hospital's goal of a 0% annual tuberculin skin test conversion rate and that the annual cost is justified.

Chi-Square Distribution↗
PubMedDate not supplied

The use of purified protein derivative mycobacterial skin test antigens in children and adolescents: purified protein derivative skin test results correlated with mycobacterial isolates.

During 13 years 1288 patients were tested with commercial tuberculin (PPD-T) and nontuberculous mycobacterial (NTM) purified protein derivative (PPD) antigens. Five hundred eighty-three (45%) had findings to suggest tuberculous infection or were asymptomatic tuberculin (PPD and/or old tuberculin) test reactors; the remaining 705 (55%) were PPD nonreactors. On the initial battery of PPD tests 553 patients had positive reactions; 513 (94%) could be classified as a human tuberculous reactor or a nontuberculous reactor. Of the 553 patients 363 were asymptomatic and 190 had clinical disease. Fifty-nine patients had Mycobacterium tuberculosis (TB) disease; 131 had NTM disease. Mycobacterial isolates recovered in 71 (47%) of 150 patients cultured were compared to the initial and repeat PPD-T and NTM-PPD test results. All 22 patients with TB isolates were positive to both PPD-T and at least one NTM-PPD antigen, while 36 of 42 patients (86%) had a positive homologous NTM-PPD reaction compared to that of the NTM species isolated. A PPD-T reaction of 5 to less than 15 mm suggested either a TB or NTM infection, while a PPD-T greater than or equal to 15 mm was strongly associated with TB infection. Dual (PPD-T and PPD-Battey) Mantoux testing in tuberculin-positive children and adolescents can discriminate (88% of 26 Mycobacterium avium-intracellulare culture-positive subjects) between TB or NTM infections and should be a valuable guide in their management.

Adolescent↗
PubMed1980

Studies on stimulation of cell-mediated cytotoxicity by skin test antigens. I. Candida antigen stimulation of cell-mediated cytotoxicity in vitro correlated with the skin test response to candida antigen in vivo.

The magnitude of the skin test response in a group of normal volunteers to intradermal Candida antigen correlated closely with the level of cytolytic activity stimulated by Candida antigen in vitro in the peripheral blood lymphocytes from those same individuals. The cytolytic activity stimulated by Candida antigen was cell mediated, and cold target inhibition studies demonstrated that Candida antigen-stimulated effector cells were capable of cross-species (i.e., nonspecific) killing. Analysis of the Candida antigen-induced effector cell population for various cell markers did not enable absolute identification of the cell responsible for the killing. The findings in this study indicate that the stimulation of cell-mediated cytolysis by Candida antigen may be related to the delayed-type hypersensitivity response produced by the same antigen.

Animals↗
PubMed1975

Allergy skin testing of children.

Skin tests are important aids in the management of patients with inhalant allergy. Their usefulness will be increased if these basic principles are kept in mind: (1) Scratch test should be sufficiently deep, (2) Antigen extracts used for intradermal tests should be fresh enough to insure their activity, (3) Two control tests should be used each time tests are done, (4) Hydroxyzine and promethazine may diminish skin reactivity; therefore, negative skin tests should not be relied upon until repeated in the absence of such medication, and (5) Skin tests for food allergy are quite unreliable, whether positive or negative. Food allergy is best studied by means of elimination trial diets.

Age Factors↗
PubMed1985

Viral contamination of intradermal skin test syringes.

Intradermal skin tests are often performed using a common syringe with multiple needles. Bacterial contamination of intradermal skin test syringes can occur as a result of apparent siphoning caused by needle changing. The bacterial contamination of the syringe can be prevented by flushing the contaminated needle prior to changing. In this study, two different needle changing techniques were examined using a polio virus contaminant. Viral contamination of the syringe was not prevented by flushing the infected needle prior to removal. All syringes were contaminated with virus regardless of needle changing technique. We, therefore, cannot recommend the continued use of a common syringe for intradermal skin tests between patients regardless of needle changing technique.

Equipment Contamination↗
PubMed2002

[Problems about tuberculin skin test raised from consultations and countermeasures--influence to the interpretation of tuberculin skin test in case of the stoppage of BCG revaccination abolition and the introduction of induration measurement].

Since people have very limited access to informations on TB, Chiba Anti-TB Association started "Chiba Kekkaku Dial 110", free TB consultation service through telephone, fax and e-mail, since October 1997. We received 1453 consultations during three years by September 2000. The most frequent consultations was about tuberculin skin test (TST) that amounted to 383, 26.4% of the all consultations. We reviewed the consultations on TST to know why consultations on TST are so frequent and what are problems clients want to know. We categorized the consultations according to the professions of clients and three periods of TST, that is, before testing, during testing and reading, and post reading. There were 178 (46.5%) consultations from health professionals, 134 (35.0%) from general citizens and the rest of them were from those unknown job. The health professionals were 94 physicians, 34 public health nurses, 23 school nurses, 19 nurses, 2 medical technicians, 2 radiographers and 4 others. Consultation after tuberculin reading was the most frequent: 93 out of 178 consultations from health professionals and 97 out of 134 from general citizens. Especially, difficulty in the interpretation of the reading result was common reason of the consultations in both health professionals (69/93) and general citizens (89/97). They feel difficulties in TST result because of widely practiced BCG revaccination and booster phenomenon due to the repetition of TST. Furthermore, TST reading results vary very much between readers especially in double redness (erythema), and it sometimes affects the diagnosis of tuberculosis infection. Therefore, if repeated TST and BCG revaccination practices in children are abolished, most of those consultations might be solved. When induration measurement is used in TST according to the international standard, the complexity of the classifications of the result seems to be dissolved. Considering the current practices in Japan, we recommend that the size of TST induration should be measured and recorded as we measure and record erythema. And induration should be referred in interpretation when they diagnose TB infection with TST.

BCG Vaccine↗
PubMed1989

A differentiated approach to testing skin sensitization. Proposal for a new test guideline skin sensitization.

The present EEC and OECD Guidelines for testing skin sensitization have been reviewed in light of scientific evidence demonstrating that those methods which use Freund's Complete Adjuvant (FCA) are likely to be more accurate in predicting a probable skin-sensitizing effect of a new substance in humans than those methods not employing Freund's Complete Adjuvant. In this new test guideline, therefore, the primary testing of a substance should be carried out using one of the recommended Adjuvant methods. In special cases a non-adjuvant method may be performed in addition. Not all of the seven methods in the EEC Guideline or eight methods in the OECD Guideline have been included, but in a proposal for an updated test protocol two Adjuvant tests (Maximization test by Magnusson and Kligman and Optimization test by Maurer), and two non-Adjuvant tests (Open Epicutaneous test by Klecak and Buehler test) are suggested. The criteria for selecting these methods are based on the fact that they are well validated and widely used on a broad basis by the scientific community. Furthermore, it is considered appropriate to permit the use of a lower number of animals than presently recommended for the testing of skin sensitization. This is also in agreement with aspects of animal welfare.

Animals↗