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PubMedDate not supplied

Allergy to heparin: a new in vitro diagnostic technique.

INTRODUCTION: Few descriptions of allergic reactions to heparin have been published, because these reactions are not well known, their prevalence is low and they are difficult to diagnose due to the lack of an in vitro test until now. We propose a new technique, the basophil activation test (BAT) for the diagnosis of these reactions. METHODS AND RESULTS: We performed in vivo and in vitro studies with heparin and its derivatives in two patients with heparin-induced acute urticaria. In both patients the results of prick tests with sodium and calcium heparin, enoxaparin and nadroparin with immediate reading were negative. Intradermal skin tests with immediate reading and reading at 48 and at 96 hours with calcium heparin, enoxaparin and nadroparin were positive in the immediate reading and after 48 hours in the first patient. The second patient showed positivity to nadroparin in the immediate reading. The same drugs were also tested using patch tests, with reading after 48 and 72 hours. The second patient showed positivity to nadroparin after 48 hours. The BAT was positive to enoxaparin in the first patient and revealed showed slight positivity to sodium heparin in the second patient. CONCLUSIONS: We consider the BAT to be a useful, safe and reliable test for the in vitro diagnosis of heparin allergy. This test avoids the use of provocation tests, which present a risk to the patient.

Adolescent↗
PubMed1976

The diagnostic value of the tine and Mantoux tests in a general hospital.

Tine and Mantoux tuberculin tests were compared in 193 hospitalised White patients with a variety of illnesses. With the Mantoux test 52 (27%) were tuberculin-positive and 19 (9.8%) were positive with the tine test. Had the tine technique alone been used, 33 of 52 tuberculin reactors would have been missed. Additional findings were (i) a 73% positivity for Monilia antigen; (ii) the optimal time for reading the Mantoux tests was on the third, rather than the second day; (iii) tuberculin reactivity was not suppressed by either pyrexia or elevation of the sedimentation rate; and (iv) the use of avian PPD demonstrated very few reactors in this population. It is recommended that the tine test be replaced by the intradermal Mantoux test with stabilised freeze-dried PPD tuberculin supplied in test kits with diluent. This matter should be given high priorty in South African general hospital practice and population surveys.

Adolescent↗
PubMed1989

The potential of schistosomal skin test as a diagnostic method in the detection of schistosomiasis.

One hundred and sixty seven volunteer medical students were exposed to intradermal skin tests for schistosomiasis. 35(21%) were positive. On further screening using routine stool and urine examinations, only 11(6.6%) were found to have eggs of Schistosoma mansoni. We conclude that although a useful procedure, schistosomal skin test should not be used alone for the diagnosis of schistosoma infections but should be complimented with the routine stool and urine examinations.

Evaluation Studies as Topic↗
PubMed1982

Diagnosis of granulomatous starch peritonitis by delayed hypersensitivity skin reactions.

Intradermal skin tests were performed on 6 patients with histologically proved granulomatous starch peritonitis and on 15 control subjects. All patients with starch peritonitis developed an erythematous reaction at least 5 mm wide between 3 and 8 days after inoculation. Such a skin reaction was not seen at that time in any of the control subjects. The microscopic changes seen in the positive reactions were dense mononuclear perivascular exudates with organized giant cell or epitheloid cell granulomas in 4 patients and loose histiocytic aggregations in a fifth patient. This evidence of cutaneous delayed hypersensitivity suggests that an immunological response underlies granulomatous starch peritonitis and that intradermal skin tests are of value in its diagnosis.

Adult↗
PubMed1993

Relationship between negative skin test with Johnin after vaccination and post mortem findings.

One hundred and seventy-six cattle, vaccinated against paratuberculosis in the first month of life with a whole-cell inactivated vaccine, containing Mycobacterium paratuberculosis suspended in a water/oil emulsion, were tested with intradermal Johnin between the ages of five and 14 months. Negative results in the skin test occurred more frequently in animals found positive in post mortem examinations (P = 0.008) using histological, microscopical and cultural techniques.

Animals↗
PubMed2003

Determination of the incidence of sensitization after penicillin skin testing.

BACKGROUND: Concerns for sensitization after penicillin skin testing are a factor in limiting the timing and population for whom this testing is offered. The sensitizing potential of the penicillin skin test has never been studied directly. METHODS: A total of 329 volunteers underwent prick and intradermal skin testing with penicillin G, benzylpenicilloyl-polylysine, and a minor determinant mixture. Those with negative skin testing had repeat testing 4 weeks later. Medical history and antibiotic use were determined by interview, questionnaire, and electronic pharmacy records. RESULTS: Seventy-two of the 329 subjects (22%) reported a history of previous beta-lactam reaction, of which 10 (14%) had a positive initial skin test. Overall, the initial skin test was positive in 23 of 329 (7%). Of the subjects with a negative initial skin test, 239 completed the second test 4 weeks later. Of these, 6 subjects (2.5%, 95% confidence interval 0.5% to 4.5%) converted to a positive skin test. None had taken a beta-lactam antibiotic between the two tests, and none had any previous history of beta-lactam reaction. One subject reported having never taken a beta-lactam antibiotic before. In comparison to the 233 subjects who did not convert their skin test, the statistically significant factors favoring sensitization were: female sex (odds ratio [OR] 6.53, P = 0.05), atopy (OR 5.31, P = 0.04), and history of food allergy (OR 6.35, P = 0.02). There was a trend toward more recent penicillin use in the newly sensitized subjects, but this was not statistically significant.. CONCLUSION: Penicillin skin testing may sensitize a small number of individuals to penicillin.

Adult↗
PubMedDate not supplied

Our experience with acetylsalicylic acid hypersensitivity.

Results of a study carried out in 21 patients with acetylsalicylic acid (Aspirin), hypersensitivity, 17 females and 4 males, aged 16 to 69 years (mean 45.7) are presented. Some patients suffered from several types of allergic symptoms - 11 from Asthma, 3 Rhinitis, 3 Quinke edema, 5 Urticaria and 2 Anaphylactic Shock. Concomitant drug allergies, route of administration and composition of the ingested drug, familiar complaints of drug allergy, nasopharyngeal examination and lung function by spirometry and Acetylcholine tests were evaluated. Blood, sputum and nasal mucous eosinophil count, as well as secretory IgA and its secretory piece identification in saliva and nasal mucous, serotonin and histaminopexic power of serum and immunoelectrophoresis of serum proteins were performed in all patients. Human basophil degranulation test to Aspirin were evaluated in 12 patients. Skin prick tests with one standard range of 21 common allergens were done in all patients and intradermal skin tests with 1 lysine acetyl-salicylate (1/100 and 1/1000) were performed in all patients as well as in a selected control group of 12 healthy subjects.

Adolescent↗
PubMed1978

Effect of indomethacin in vivo on humoral and cellular immunity in humans.

We studied the effect of indomethacin on intradermal skin testing and antibody responses in humans. Since we and others have shown that prostaglandins are suppressor cell mediators, it was probable that in vivo inhibition of prostaglandin synthesis might enhance the humoral and/or cellular immune response. Administration of indomethacin (Indocin) in a dosage of 100 mg/day to 15 normal men and women resulted in a significantly increased antibody titer to A-Victoria (P less than 0.025) as compared with age- and sex-matched controls. There was no difference in titer to A-New Jersey. Since 90% of the subjects had antibody titers to A-Victoria before inoculation, whereas none had detectable titers to A-New Jersey, we interpret this data as suggesting that indomethacin enhances the secondary but not the primary humoral immune response. Indomethacin administration did not alter the intradermal skin test responses.

Adult↗
PubMed1995

Estrogen dermatitis.

BACKGROUND: Autoimmune progesterone dermatitis includes pruritus, urticaria, papulovesicular eruptions, and bullous erythema multiforme. Sensitivity to estrogen has not been described, although it was probably first recognized almost 50 years ago. OBJECTIVE: Our purpose was to assess sensitization to selected hormones in women with a significant premenstrual flare of skin lesions. METHODS: Intradermal skin tests to 18 hormones and control substances were performed in seven patients and four control subjects and read for immediate urticarial and delayed type reactions. Six other control subjects had only estrone and progesterone skin tests. The effect of the antiestrogen tamoxifen on the course of the dermatosis was studied. RESULTS: Seven women exhibiting severe premenstrual exacerbations of papulovesicular eruptions, urticaria, eczema, or generalized pruritus proved to have an unrecognized sensitivity to estrogen. Five patients had a positive delayed tuberculin-type skin test to estrogen. Two patients with generalized chronic urticaria had only an urticarial reaction to intradermal estrogens. Antiestrogen therapy with tamoxifen proved effective in all five patients, whereas elimination of oral estrogen therapy cured the other two patients. CONCLUSION: Women can become sensitized to their own estrogens; the major clue is worsening of the skin problem premenstrually. Positive intradermal skin tests to estrogens are diagnostic. Tamoxifen is a specific therapy. We have named this disorder estrogen dermatitis.

Adult↗
PubMed1984

Correlation of a micro-ELISA assay with the skin test and the RAST assay in inhalant allergy.

Several modifications of a previously described micro-ELISA assay (IP Assay) for the diagnosis of IgE mediated disorders were developed to increase the assay sensitivity and specificity. The absorbance values in milliunits obtained in this assay were normalized with a computer algorithm. The results of this assay correlate well with those obtained with the RAST assay (normalized milliunits of absorbance versus bound radioactivity: r = 0.74 to 0.87). However, the IP assay detected allergen specific IgE antibodies in many sera for which the RAST assay gave negative results (from 13.3% to 28% for a variety of allergens). The converse was seen in fewer than one percent of tests. Further, in a series of 300 tests for a panel of ten allergens, the IP assay showed a higher degree of correlation with the intradermal skin test (82%) than the RAST assay (77.3%). The specificity of the IP and RAST assays were comparable. Data showing the stability of the polystyrene surface immunosorbent and the independence of the IP assay from high levels of total IgE antibodies are presented. The reasons for higher sensitivity of the IP assay than the RAST assay (and hence superior correlation with the skin test) are discussed.

Allergens↗
PubMed1979

The ribonucleic acid (RNA) skin test in systemic lupus erythematosus and other connective tissue diseases.

A series of 65 patients with different autoimmune diseases was examined using different RNA-solutions for intradermal skin tests. Clinically positive results were obtained most often in patients with mixed connective tissue disease but quite often also in patients with systemic lupus erythematosus and progressive systemic sclerosis or with some symptoms of an automimmune nature. The histological examination of the biopsies from the test sites revealed that there was no correlation between the clinically positive tests and the histological criteria usually used as a sign of a positive test.

Adult↗
PubMed1991

Diagnostic testing of dogs for food hypersensitivity.

Thirteen food-allergic dogs were studied to evaluate the efficacy of feeding a commercially available egg and rice diet, intradermal skin testing, and serologic testing by ELISA for diagnosing and/or characterizing food hypersensitivity. Feeding of a home-cooked whole lamb meat and rice diet for 3 weeks, followed by challenge with each dog's regular diet, served as the standard for diagnosing food hypersensitivity. Each dog underwent provocative testing with 6 individual ingredients to determine as many of its dietary allergens as possible. Prior to skin testing and serologic testing by ELISA, most dogs had been recently exposed to the offending diet and subsequently manifested clinical signs of allergy. All dogs that tolerated the aforementioned commercial diet were exposed to it for at least 7 weeks; 84.6% of food-hypersensitive dogs ate the commercial diet with impunity. Of the 2 reactors to the commercial diet, only 1 became pruritic in response to provocation testing with chicken eggs. Low sensitivity and high specificity were found for skin testing and the ELISA, indicating a lack of true- and false-positive reactions. Neither the positive nor negative predictive values adequately predicted positive and negative reactions, respectively, for either test. On the basis of these results, the commercial diet, skin testing, and anti-IgE ELISA cannot replace an owner-prepared food elimination diet for food hypersensitivity testing in dogs.

Animal Feed↗
PubMed2003

Effects of toxic exposure to molds and mycotoxins in building-related illnesses.

The authors studied 100 patients who had been exposed to toxic molds in their homes. The predominant molds identified were Alternaria, Cladosporium, Aspergillus, Penicillium, Stachybotrys, Curvularia, Basidiomycetes, Myxomycetes, smuts, Epicoccus, Fusarium, Bipolaris, and Rhizopus. A variety of tests were performed on all, or on subgroups of, these patients. Sensitivities and exposures were confirmed in all patients by intradermal skin testing for individual molds (44-98% positive), and by measurement of serum antibodies. Abnormalities in T and B cells, and subsets, were found in more than 80% of the patients. The findings of trichothecene toxin and breakdown products in the urine, serum antibodies to molds, and positive intradermal skin tests confirmed mycotoxin exposure. Respiratory signs (e.g., rhinorrhea, sinus tenderness, wheezing) were found in 64% of all patients, and physical signs and symptoms of neurological dysfunction (e.g., inability to stand on the toes or to walk a straight line with eyes closed, as well as short-term memory loss) were identified in 70% of all patients. Objective abnormal autonomic nervous system tests were positive in all 100 patients tested. Brain scans, conducted using triple-head single photon emission computed tomography, were abnormal in 26 (86%) of 30 (subgroup of the 100) patients tested. Objective neuropsychological evaluations of 46 of the patients who exhibited symptoms of neurological impairment showed typical abnormalities in short-term memory, executive function/judgment, concentration, and hand/eye coordination.

Adult↗
PubMed1985

Severity of asthma in skin test-negative and skin test-positive patients.

The standardized records of 144 asthmatic patients have been analyzed to determine whether the severity of their condition was correlated with the presence or absence of positive intradermal skin test reactions to a panel of seven allergen extracts (dust, feathers, Alternaria, Hormodendrum, mixed tree pollen, mixed grass pollen, and ragweed pollen). The skin tests were totally negative in 71 of the subjects, whereas in 73 subjects there was a strongly positive response to two or more allergens. The skin test-negative patients were older than the skin test-positive ones and had a shorter duration as well as a later onset of asthma. Also, they had lower serum-IgE levels and a lower frequency of a family history of atopic disease. Moreover, the skin test-negative group lost more time from their normal activities, required more visits to their doctor as a result of asthma, and were more frequently treated with oral corticosteroids. They additionally had greater air trapping on pulmonary function tests. However, when the groups were adjusted for the discordance in their age and duration of asthma, they tended to converge in the level of the variables that described the severity of their asthma. Thus the severity of asthma was found to be relatively similar in skin test-negative and skin test-positive patients.

Adult↗
PubMed1975

Specificity and sensitivity of skin test reactions to extracts of Toxocara canis and Ascaris suum. I. Skin tests done on infected guinea pigs.

The specificity and sensitivity of adult and larval somatic antigens, and perienteric fluid of Toxocara canis and Ascaris suum were investigated by using intradermal skin tests in guinea pigs. These animals were infected with low doses (0.01, 0.1 or 1.0 egg/g) of these helminths. Toxocara larval antigen (TL) induced larger reactions in Toxocara-infected animals than did the other antigens, suggesting a superior sensitivity for this antigen. In addition, Ascaris perienteric fluid (AP) provoked skin responses in these animals of a magnitude similar to those induced by TL. The reciprocal relationship, i.e., comparable reactivity of AP and TL in Ascaris-infected animals, was not apparent. In general, Ascaris larval antigen and AP elicited larger intradermal reactions than other antigens in Ascaris-infected animals. The results of this study indicated no superiority of adult antigens in differentiating Ascaris and Toxocara infections.

Animals↗
PubMed1982

Immunological studies on equine phycomycosis.

One in vivo and 2 in vitro tests were developed to study immunological aspects of phycomycosis in clinically infected, recovered and normal in-contact horses. Serum from all infected horses gave positive readings in an agar-gel double diffusion test; serum from normal and recovered horses did not react. A complement fixation test detected antibody against Hyphomyces destruens in 82% clinical cases at an average titre of 20. Serum from recovered and in-contact horses reacted sporadically at positive titre. An intradermal hypersensitivity test (Heaf test) was used to detect evidence of cellular immunity to H. destruens. Positive tests were observed in 64% of clinically infected horses, 100% of recovered animals and 31% of normal in-contact horses. Negative tests in the clinically infected group were thought to be due either anergy in chronic cases or no stimulation in very acute cases. It was concluded that many horses showed evidence of past contact with H. destruens and had acquired resistance to infection.

Animals↗