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PubMed1986

Immunologic responses following serial skin testing.

Twenty volunteers underwent intradermal skin testing with tetanus toxoid (TT) and varicella-zoster (VZ) antigens weekly for 7 weeks. In addition to measurements of delayed hypersensitivity skin test responses, in vitro antigen specific lymphocyte stimulation and antibody levels were monitored. Data for TT exhibited more variability than VZ, demonstrating a marked boost in antibody titers after the first skin test and a shift in the kinetics of the skin test reaction to later maximum responses after the first 3 weeks. In contrast, serial skin testing with VZ was not associated with changes in cellular immune assays. Following the initial VZ skin test there was a slight rise in antibody levels for one-third of studied individuals. These observations suggest that VZ skin test antigen is ideal for monitoring immune function and that repeated testing should not significantly influence in vitro assays.

Adolescent↗
PubMed1980

Allergy skin testing under general anesthesia with treatment response in ninety-two patients with chronic serous otitis media.

This is a study of Ninety-two patients with chronic serous otitis media, all of whom have been previously treated with myringotomy and middle-ear ventilation tubes. Intradermal skin testing was done by the Rinkel technique under general anesthesia in conjunction with myringotomy and associated surgical procedures. Twenty of these patients were tested in the office one week later with little or no change in their intradermal test results. Eighty-four patients were managed with a hyposensitization program. Of these, fifty-seven have their tubes out with no fluid recurrence, twelve continue to have episodic fluid recurrence and middle-ear infections. Five patients had one or more tubes replaced, and ten were lost to follow-up.

Anesthesia, General↗
PubMed1976

Lack of interference in skin tests by histamine in food extracts.

Because histamine occurs naturally in some food products, quantitative analysis of the histamine content of extracts of food used for skin testing seemed desirable to determine its effect in the production of positive reactions. Up to 200 nanograms of histamine per milliliter were found in some food extracts. When the extracts are diluted to 1:100 and 1:1000 W/V for skin testing the amount of histamine which would be injected in a intradermal skin test is one-thousandth of the amount required to produce a significant wheal. Therefore the histamine content of the foods analyzed is too small to be of practical concern and not enough to give nonspecific wheal reactions in intradermal tests using extracts of 1/1000 or 1/100 W/V concentrations. Nonspecific reactions in skin tests are probably most often due to use of food extracts of unnecessarily high concentration.

False Positive Reactions↗
PubMedDate not supplied

Diagnostic value of total IgE and antigen specific IgE using RAST in pollenosis.

41 patients with clinically demonstrated pollinosis are studied. The following test were performed on all of them: a) Intradermal skin tests using grass pollen extracts (Pangramin III) and with extracts of Dactylis glomerate, Lollium perenne and Poa pratensis. b) Totol serum IgE determination. c) Antigen specific IgE (RAST) determination against the pollens mentioned in b). d) Passive hemagglutination against the pollen Dactylis glomerate. Basing on the results obtained, we have arrived to the following conclusions: 1) IgE determination with intensely positive intradermal skin tests in all cases, gave the following data: 27.5% normal values, 35% slightly elevated and 37.5% highly increased values. We believe that IgE determination can only be used to estimate the "allergization" degree of the patient. 2) No relation between the antigen concentration used in the intradermal skin test, and serum IgE concentration was found. 3) Taking in consideration that the antigen extracts used for RAST and intradermal skin tests were obtained from different sources (Sweden and Spain, respectively), the relation between both determinations ranged between 52.5% and 60%, in a total of 123 tests performed. 4) Considering that in the allergic response antibodies other than reagins (IgG) take part, and taking into account the results obtained with the passive hemagglutination technique, we consider that this last method should be included as a diagnostic routine tool in the pollinic patient.

Adolescent↗
PubMed2004

In vitro testing to diagnose venom allergy and monitor immunotherapy: a placebo-controlled, crossover trial.

BACKGROUND: In people with a history of sting allergy, only prior reaction severity and older age are known to predict subsequent reaction risk. Furthermore, no diagnostic test other than a deliberate sting challenge has been found to identify people in whom venom immunotherapy (VIT) has been unsuccessful. OBJECTIVE: We aimed to assess the utility of a number of in vitro tests to diagnose venom allergy and to monitor immunotherapy. METHODS: During a double-blind randomized placebo-controlled crossover trial of Myrmecia pilosula ant VIT the following venom-specific tests were performed at enrolment, and at completion of treatment prior to a diagnostic sting challenge; leucocyte stimulation index (SI), IL-4 production, IgE RAST, histamine release test (HRT), leukotriene release test (LRT) and basophil activation test (BAT). Intradermal venom skin testing (VST) was also performed at trial entry. RESULTS: Only VST and HRT identified those at risk of sting anaphylaxis in the placebo group. Although IgE RAST, leucocyte SI and IL-4 production, LRT and BAT all correlated well with intradermal VSTs, they did not predict sting challenge outcome. After successful VIT, venom-induced leucocyte IL-4 production tended to fall, whereas IgE RAST increased and a natural decline in HRT reactivity was reversed. A confounding seasonal affect on laboratory results was suspected. CONCLUSION: The HRT warrants further assessment for diagnosis of venom allergy. Uninformative performance of the commercially available LRT and BAT tests may be due to pre-incubation with IL-3. None of the tests evaluated appear to be reliable markers of successful VIT.

Animals↗
PubMed1999

Systemic reactions to allergy skin tests.

BACKGROUND: Skin testing is a common diagnostic tool in allergy. It is considered a safe procedure, although systemic reactions have been reported. OBJECTIVE: To identify the systemic reaction rates of allergy skin tests and to determine the clinical outcome of such reactions. METHOD: This retrospective study used a computerized database at the Mayo Clinic to identify patients who developed systemic reactions to skin tests. Altogether 497,656 skin tests were performed on 18,311 patients from January 1992 to June 1997. Skin puncture tests were performed on 16,505 patients. Skin puncture and intradermal skin tests were performed on 1,806 patients. Systemic reactions were evaluated and treated by physicians. RESULTS: There were 6 systemic reactions, an overall rate of 33 systemic reactions per 100,000 skin tests. All six patients had asthma. The systemic reaction rates for latex skin testing was 152 or 228 reactions per 100,000 latex skin tests, to penicillin and antibiotics 72 reactions per 100,000 penicillin and antibiotics skin tests, and to aeroallergens 15 or 23 reactions per 100,000 aeroallergen skin tests. The systemic reaction rate for skin puncture test was 30 reactions per 100,000 skin puncture tests, for skin puncture and intradermal skin tests, the rate was 55 reactions per 100,000 skin puncture and intradermal skin tests. All 6 patients were treated and dismissed within 1 hour after treatment. CONCLUSION: The systemic reaction rate to skin tests was very low. Systemic reactions were mild and all patients recovered fully within 1 hour.

Adult↗
PubMed2006

Comparison of the skin test and ImmunoCAP system in the evaluation of mold allergy.

BACKGROUND: Mold is ubiquitous in our environment and is a common allergen in allergic diseases. The skin test and the Pharmacia ImmunoCAP system (CAP) for assay-specific immunoglobulin E (IgE) antibodies are both widely used. The goal of this study was to compare the performance of the skin test and CAP in the evaluation of mold allergy. METHODS: Patients with allergic rhinitis were enrolled at our outpatient department. The diagnosis of allergic rhinitis was based on typical symptoms for more than 2 years. All patients were tested by both intradermal skin test and serum assay for specific IgE antibodies. The skin test included house dust, cotton, ragweed, and 5 fungal antigens (Candida, Alternaria, Aspergillus, Cladosporium, and Penicillium). The serum-specific IgE antibodies were quantified using the radioimmunoassay version of CAP. RESULTS: Seventy-five patients (44 males and 31 females) with allergic rhinitis were enrolled in this study. Their ages ranged from 12 to 76 years old, with a mean of 31.9 years. The positive rates of skin test and CAP were 56.0% versus 9.3% for Candida, 22.7% versus 1.3% for Alternaria, 16% versus 9.3% for Aspergillus, 14.7% versus 1.3% for Cladosporium, and 32% versus 8% for Penicillium. There were statistically significant differences between the positive rates for Candida, Alternaria, Cladosporium, and Penicillium when analyzed by the McNemar test. CONCLUSION: The positive rate of the skin test is higher than CAP when evaluating mold allergy. Clinicians should note that a discrepancy may exist between the results of in vitro and in vivo tests when evaluating mold allergy.

Adolescent↗
PubMed1976

Partial purification of antigens collected during in vitro cultivation of the larval stages of Taenia pisiformis.

Larvae of Taenia pisiformis were cultured in vitro in medium containing 2-5, 5 or 20% (v/v) of normal rabbit serum (NRS). Greatest development occurred in 20% NRS, and the potency of antigens collected in medium from each culture tested by intradermal (2/d) skin tests in infected rabbits paralleled the in vitro growth rate of larvae. 'Culture' antigens from 5% NRS stimulated good immunity in rabbits to a challenge infection with T. pisiformis eggs, although they were poorly reactive in skin tests. T. pisiformis larvae were also cultured in 10% (v/v) of filtrates of serum reduced to one-half of its volume by passage through 300 000 MW cut off (XM300F) or 100 000 MW cut off (XM100F) ultrafiltration membranes. Larvae cultured using XM300F had growth rates comparable with those cultured in 20% NRS, and the antigens release into the culture medium had equal potency in i/d tests and in stimulating protective immunity in rabbits. Larvae did not develop in XM100F or produce skin-reactive or protective antigens. Crude 'culture' antigen from cultures in 20% NRS was separated into 4 fractions by filtration on Sephadex G200. All of these fractions gave i/d skin reactions in infected rabbits. Fraction 3 (F3) was the most active, but was shown by acrylamide gel electrophoresis and immunoelectrophoresis to be highly contaminated with rabbit serum proteins. F3 was separated into fractions on DEAE-Sephadex A50, and the third fraction from this was as active as the original culture medium in i/d skin tests, but had only 5% of the original protein concentration. Electrophoresis demonstrated few serum contaminants, and 2 indistinct protein bands that were not present in a similar fraction of NRS. Neither Sephadex G200 F3 nor DEAE-Sephadex F3 stimulated protective immunity in rabbits, suggesting that antigens stimulating immunity against the establishment of T. pisiformis in rabbits and those provoking cell-mediated immune reactions may be different.

Animals↗
PubMed2001

In vitro T-cell responses to beta-lactam drugs in immediate and nonimmediate allergic reactions.

BACKGROUND: beta-Lactam drugs may induce both cellular and humoral allergic reactions, and there is evidence that T cells play an important role in the pathogenesis of these reactions. The aim of this work was to assess the sensitivity and specificity of the lymphocyte transformation test (LTT) as an in vitro diagnostic tool, in patients with either an immediate or a nonimmediate reaction to penicillin G and/or amoxicillin. METHODS: Fifty patients with a well-documented history of allergic reactions to beta-lactams (31 immediate and 19 nonimmediate) were studied by means of skin tests (prick and intradermal), radioallergosorbent test (RAST), and, when necessary, controlled administration of the drug. Twenty-eight healthy subjects with good tolerance to penicillins served as controls. LTT was performed in all subjects. RESULTS: Skin tests were positive in 77.4% of the patients with immediate reactions and in 36.8% of those with nonimmediate reactions. The overall sensitivity of LTT in the allergic patients was 62%, but, when analyzed separately, sensitivity was 64.5% for the immediate group and 57.9% for the nonimmediate group. The LTT specificity was 92.8%. CONCLUSION: The LTT should be considered a useful in vitro diagnostic tool to identify subjects allergic to penicillins, especially patients with nonimmediate reactions where the LTT has a better diagnostic value than skin tests. Interestingly, positive T-cell proliferative responses can be observed 10 or more years after the occurrence of the reaction without further exposure to the drug.

Adult↗
PubMed2003

Asthma caused by human seminal plasma allergy.

Human seminal plasma allergy (HSPA) in women is a rare phenomenon and can be life-threatening. Hypersensitivity reactions occur during or immediately after coitus and are usually caused by sensitization to proteins in the seminal fluid. This can be very distressing for the patients and their partners. Young, married female patients with episodic asthma dating to their marriage with a history of difficulty in conceiving were specifically asked for local and systemic symptoms chronologically related to coitus. This methodology was adopted keeping in view our social conditions and sensitive nature of the information sought. Two patients thus detected were evaluated further. Condom usage, on our advice, abolished both local and systemic postcoital symptoms. Both patients tested positive to intradermal skin test with the seminal plasma antigen (SPA) derived from their respective husbands and, in patient 1, was accompanied by intense burning, irritation, and itching of the skin. Specific IgE against SPA was demonstrated in the serum of both patients. Elevated levels of total IgE were also detected. A high index of suspicion is needed to diagnose HSPA, especially the local forms, which can easily be overlooked due to patient embarrassment and lack of physician awareness.

Adult↗
PubMed1981

Allergic reaction to an amide local anaesthetic.

A 67-yr-old female patient gave a history of allergy to lignocaine. When she was challenge-tested with the intradermal injection of 0.5% bupivacaine 0.2ml she had a systemic reaction. This reaction was accompanied by a decrease in the concentration of complement C4 in the plasma, which indicated that the reaction was immunologically-mediated. This is the first report of allergy to a local anaesthetic drug which has been documented by concurrent immunological changes.

Aged↗
PubMed2001

Recent advances in the diagnosis of drug allergy.

The diagnosis of immunologic drug reactions is based primarily on a detailed clinical history and historical data on relative immunogenicity of the culprit drugs. Except for a few standardized skin tests, most of the other methods for diagnosing drug allergy have unproven diagnostic or predictive clinical utility. Many tests for drug-specific immune responses are suggestive if positive, but have unknown negative predictive values. The present review addresses the most recent published literature regarding the diagnosis of drug allergy. Recent advances in the use of the lymphocyte transformation test, and delayed intradermal skin tests and patch tests for the diagnosis of delayed cutaneous reactions to penicillins suggest that these tests may have clinical utility, although confirmatory reports are still missing. For the diagnosis of acute vaccine reactions, gelatin-specific IgE as measured by radioallergosorbent test has now been shown to be reliably associated with allergic reactions to gelatin-containing vaccines.

Drug Hypersensitivity↗
PubMedDate not supplied

Postoperative radiation therapy and adjuvant chemoimmunotherapy in breast cancer. Aspects of timing and immune competence.

The effects of radiation therapy and adjuvant chemoimmunotherapy on the immune competence of patients with breast cancer were investigated. The tests performed included intradermal tuberculin tests, T- and B-lymphocyte counts, and lymphocyte blast transformation tests; phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogen (PWM) were used as mitogens. Enhancement in lymphocyte proliferative response to mitogenic stimulation by PHA and PWM was seen in patients after 3 courses of chemotherapy + levamisole, whereas irradiation given after chemotherapy caused long-lasting depression in response to PHA (p = 0.039) and PWM (not significant). T-lymphocyte counts were also lower after irradiation than after chemoimmunotherapy (p = 0.007). Clinically, the 16 patients treated with radiation therapy after chemotherapy exhibited a higher recurrence rate than the 24 patients treated first by irradiation. Enhanced reactivity to tuberculin tests occurred generally in patients receiving a planned treatment including irradiation, chemotherapy (5-fluorouracil, doxorubicin, cyclophosphamide) and levamisole. Enhancement of reactivity was seen more often in patients who had not relapsed.

Adult↗