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PubMed1984

Allergy to semisynthetic penicillins in cystic fibrosis.

Allergic reactions to anti-Pseudomonal penicillin derivatives are an increasing problem in therapy of cystic fibrosis lung disease. We evaluated 15 patients, ages 12 to 37 years, with documented allergic reactions to carbenicillin, ticarcillin, or piperacillin. Intradermal skin test reactions were positive for benzylpenicillin in seven patients, penicilloyl-polylysine in one, and ticarcillin or piperacillin in eight, for a total of 11 of 11 tested. Results of radioallergosorbent testing to penicilloyl conjugates were positive in eight of 14 patients and equivocal in four others. Overall, skin tests or RAST results were positive in 13 of 15 patients. All patients were desensitized with a semisynthetic penicillin by continuous serial intravenous infusion of 10-fold dose increments, beginning with 10(-6) of the therapeutic dose. Desensitization was successful in 25 of 26 instances. After intravenously administered therapy, maintenance of desensitization with dicloxacillin orally was unsuccessful in four of six patients. We conclude that (1) allergy to semisynthetic penicillins in cystic fibrosis usually is IgE mediated; (2) such allergy can be evaluated by skin testing; (3) it can be safely and in most cases successfully treated by intravenous desensitization; and (4) allergic patients should be desensitized on each subsequent admission for intravenously administered therapy.

Adolescent↗
PubMed2000

Autoimmune progesterone urticaria.

Autoimmune progesterone dermatitis is a rare cutaneous disorder characterized by recurrent and cyclic skin eruption with variable morphology, occurring during the luteal phase. A case of autoimmune progesterone urticaria in a 47-year-old woman is reported. An intradermal progestin test revealed a strong reactivity against this hormone. Treatment with tamoxifen and leuprolide acetate induced only a partial remission of urticaria. Bilateral oophorectomy was performed with absolute clearing of cutaneous lesions.

Autoimmune Diseases↗
PubMed1990

A new manifestation of seminal fluid hypersensitivity.

An immediate hypersensitivity reaction to seminal fluid is an uncommon but well recognized condition. We describe a young woman who developed haemorrhagic proctitis, arthralgia and urticaria on honeymoon. Investigations suggested an immune complex (type III) hypersensitivity. It subsequently became clear that her symptoms were temporally related to sexual intercourse. After 8 hours she developed nasal congestion and urticaria followed by migratory arthralgia and periorbital oedema. Over the ensuing 24 hours she had diarrhoea, occasionally with blood. She became breathless and had evidence of a restrictive ventilatory defect. These symptoms improved over 4-5 days. Further in vitro investigations were inconclusive but intradermal skin testing with seminal plasma led to recurrence of all her symptoms. Symptoms ceased with condom usage, and the condition abated over 2 years. This patient is unique in that seminal fluid hypersensitivity appears to have produced a type III immune response.

Adult↗
PubMed2005

Poor association between allergen-specific serum immunoglobulin E levels, skin sensitivity and basophil degranulation: a study with recombinant birch pollen allergen Bet v 1 and an immunoglobulin E detection system measuring immunoglobulin E capable of binding to Fc epsilon RI.

BACKGROUND: Results from several studies indicate that the magnitude of immediate symptoms of type I allergy caused by allergen-induced cross-linking of high-affinity Fc epsilon receptors on effector cells (mast cells and basophils) is not always associated with allergen-specific IgE levels. OBJECTIVE: To investigate the association of results from intradermal skin testing, basophil histamine release and allergen-specific IgE, IgG1-4, IgA and IgM antibody levels in a clinical study performed in birch pollen-allergic patients (n = 18). METHODS: rBet v 1-specific IgEs were measured by quantitative CAP measurements and by using purified Fc epsilon RI-derived alpha-chain to quantify IgE capable of binding to effector cells. Bet v 1-specific IgG subclasses, IgA and IgM levels were measured by ELISA, and basophil histamine release was determined in whole blood samples. Intradermal skin testing was performed with the end-point titration method. RESULTS: Our study demonstrates on the molecular level that the concentrations of allergen-specific IgE antibodies capable of binding to Fc epsilon RI and biological sensitivities are not necessarily associated. A moderate association was found between cutaneous and basophil sensitivity. CONCLUSION: Our results highlight the quantitative discrepancies and limitations of the present diagnostic tools in allergy, even when using a single allergenic molecule. The quantity of allergen-specific serum IgE is only one component of far more complex cellular systems (i.e. basophil-based tests, skin tests) used as indirect diagnostic tests for IgE-mediated allergic sensitivity.

Adult↗
PubMed2004

[Recurrent or chronic urticaria in thoroughbred race-horses: clinical observations].

Recurrent or chronic urticaria seems to be a food allergy in thoroughbred race-horses during the training season. In resistant cases, allergologic techniques will be required to determine aetiology. Intradermal skin tests with fresh allergenic food may cause syndromic reaction as urticaria and akin to enteritis in some horses. In most cases, an elimination of the allergen responsible brings a rapid and long-lasting result. Study about 22 cases.

Allergens↗
PubMed1991

Acquisition of resistance to the bont tick Amblyomma hebraeum (Acarina: Ixodidae) by goats.

Goats acquired resistance to larvae of Amblyomma hebraeum following three repeated infestations. Resistance was associated with immediate Type I hypersensitivity reactions following intradermal skin tests using crude egg extracts. In a separate experiment, the inoculation of tick-naive goats with extracts of the larvae of A. hebraeum failed to induce observable effects on feeding larvae despite the development of anti-larval antibodies.

Analysis of Variance↗
PubMed1998

Intravenous immunoglobulin in autoimmune chronic urticaria.

Histamine releasing autoantibodies play a central role in the pathogenesis of chronic urticaria (CU) in approximately 30% of affected patients. We investigated the therapeutic effect of high-dose intravenous immunoglobulin (IVIG) on disease activity in patients with severe CU of autoimmune aetiology. Autoimmune urticaria was diagnosed by the development of a weal-and-flare reaction to the intradermal injection of autologous serum and by serum-induced histamine release from the basophil leucocytes of healthy donors in vitro. Ten patients with severe, autoimmune CU, poorly responsive to conventional treatment, were treated with IVIG 0.4 g/kg per day for 5 days. The outcome on cutaneous wealing and itch was monitored using urticaria activity scores, visual analogue scales and autologous intradermal serum tests. Clinical benefit was noted in nine of 10 patients: three patients continue in prolonged complete remissions (3 years follow-up), two had temporary complete remissions, and symptoms in four patients improved subsequent to treatment. There was significant improvement in the urticaria activity scores and visual analogue scores at 2 (P < 0.01) and 6 weeks (P < 0.01) post-IVIG compared with the baseline values (Wilcoxon matched pairs). The diminution in urticarial activity in the majority of patients corresponded with a reduced weal-and-flare response to the intradermal injection of autologous post-treatment serum compared with the pretreatment serum. Minor side-effects were common, but there were no serious or long-term adverse effects. IVIG represents a novel therapeutic option in selected patients with recalcitrant CU associated with histamine releasing autoantibodies.

Adult↗
PubMed1982

Skin tests for coeliac disease employing fractions of a gliadin digest.

Gliadin sub-fractions have been tested by intradermal injection in 19 adult patients with coeliac disease in remission and in 19 healthy adult controls. Fraction 3, obtained by SP Sephadex chromatography of a peptic-tryptic digest of gliadin, produced strong reactions (areas of erythema greater than 1 cm2) in 13 of the patients. Weak or negative reactions to fraction 3 were produced in the remaining patients, including 2 patients who were currently on prednisolone therapy in addition to a gluten-free diet. There was no correlation between time on a gluten free diet and severity of reaction in the patients not on prednisolone therapy. A strong reaction was observed with only one control and in the remaining controls all reactions were negative. Other fractions produced strong reactions in comparatively few patients. Skin tests using Fraction 3 could thus form part of the diagnosis for coeliac disease and could lead to a knowledge of the composition of the peptides which are important in the aetiology of this disease.

Adolescent↗
PubMed1992

Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons.

PURPOSE: To determine the incidence of adverse reactions to hepatitis B plasma-derived vaccine. PATIENTS: Alaska natives (43,618) who received 101,360 doses of hepatitis B vaccine. METHODS: All adverse reactions, excluding transient fever, myalgia, or soreness lasting less than 3 days, were reported. An intradermal skin test was developed to test purported adverse reactions. Records of the entire population were reviewed for Guillain-Barré syndrome (GBS). SETTING: A statewide hepatitis B control program for Alaska natives. RESULTS: Possible adverse reactions occurred in 39 persons. The most frequent adverse reactions were myalgia/arthralgia lasting longer than 3 days (14), followed by skin rashes (eight) and dizziness (seven). Skin tests were performed on 13 persons and were positive in five. Six of the persons with negative skin tests and eight persons who did not undergo skin testing received additional doses of vaccine without any adverse reactions. No increased incidence of GBS was found in the vaccinees. CONCLUSION: Hepatitis B vaccine is safe and most adverse reactions are coincidental.

Adult↗
PubMedDate not supplied

Effect of H1- and H2-receptor blockade on the inhibition of immediate cutaneous reactions.

The effects of cyproheptadine, cimetidine, and their combination on the wheal-and-flare skin-test response was evaluated using an intradermal skin-test technique in a double-blind, placebo-controlled study. Sixteen volunteers with known positive skin-test reactions to at least two antigens were divided into four treatment groups in a four-way crossover design. The patients received baseline intradermal skin tests on the back consisting of dilutions of mixed grasses and weeds, histamine diphosphate and codeine phosphate, and buffered-saline control. Following the baseline testing, the patients received cyproheptadine (4 mg q.i.d.), cimetidine (300 mg q.i.d.), the combination, and placebo in a double-blind trial. Of the 16 patients, 12 completed all treatment courses. Following pretreatment with cyproheptadine, cimetidine, and the combination, areas of wheal-and-flare response for each test substance were significantly suppressed. Although it appeared that the combination augmented wheal-and-flare suppression, the observed difference, compared with the cyproheptadine pretreatment sequence, was not statistically significant. The administration of H1 and H2 antagonists should be discontinued before the diagnostic use of immediate skin tests.

Adult↗
PubMed1999

Allergic-type reactions to corticosteroids.

OBJECTIVE: To review reported cases of suspected allergic reactions to various corticosteroids. DATA SOURCES: A MEDLINE search (January 1966-December 1997) was performed to obtain case reports and review articles on allergic-type reactions to corticosteroids. Further references were obtained from these publications. STUDY SELECTION: Reports involving allergic or allergic-type reactions to systemic administration of corticosteroids were chosen for this review. An allergic-type reaction was defined as any reaction after administration of the drug that involved the appearance of adverse symptoms that are characteristic of unwanted immune responses. These symptoms include rash, sneezing, dyspnea, edema, bronchospasm, or death. Articles were excluded from the evaluation if they described reactions to topical, intraarticular, or ophthalmic corticosteroid administration. DATA SYNTHESIS: Corticosteroids are medications that are often used to treat allergic reactions. However, it appears that patients can also have allergic-type reactions to these agents. The severity of the reaction can vary from a rash to anaphylaxis or death. Both immediate and delayed reactions can occur. Allergic-type reactions are reported to occur more frequently in asthmatic and renal transplant patients than other patient populations. However, it is questionable whether all of these are true allergic responses, as there is conflicting evidence regarding the mechanism of the reaction. The most commonly implicated corticosteroids are methylprednisolone and hydrocortisone, but reactions have also occurred with others. Intradermal skin testing can help determine cross-sensitivity, although its value has not been conclusively demonstrated. CONCLUSIONS: Clinicians should be aware that allergic reactions to corticosteroids are possible. Worsening of symptoms may not always mean treatment failure, but may indicate an allergic reaction. High doses of corticosteroids (> or = 500 mg) should be given over 30-60 minutes, and patients should be observed after administration for at least the same time period. Asthmatics, renal transplant patients, and hemodynamically unstable patients may be at higher risk for adverse events. If a patient is found to be allergic to one corticosteroid, intradermal skin testing may help identify another corticosteroid that can be tolerated.

Adrenal Cortex Hormones↗
PubMed1991

[Correlation between nasal polyposis and perennial allergy exemplified by house dust mite and house dust allergy].

A total of 139 patients with nasal polyps were investigated by a standardized history, intradermal skin test and nasal challenge to house dust mite allergy. The aim of the study was to assess the disputed role of perennial allergy in patients with nasal polyps using allergens to the house dust mite as an example. Using our diagnostic criteria we found allergy to house dust mite in 28% of all cases. We found this diagnosis in 44.8% of patients aged 10-39. We recommend, especially in this age group, an allergy test, if necessary with the appropriate therapy. Test correlations are illustrated in 174 patients who have been examined by the above methods. Good reproducibility was found by the nasal challenge, which led to the right diagnosis in 92%, compared with 81% by a standardized history. Therefore, it can be considered to be the key to the diagnosis of allergy.

Adolescent↗
PubMed1978

The local anaesthetic activity of a benzotriazinium salt.

1 The local anaesthetic properties of 2-n-propyl-4-p-tolylamino-1,2,3-benzotriazinium iodide (TnPBI) were compared with those of lignocaine hydrochloride on intact and desheathed sciatic nerves of the frog, on the phrenic nerve-hemidiaphragm preparation of the rat, and by the intradermal wheal test in the guinea-pig. 2 Both TnPBI and lignocaine were more potent on desheathed than on intact sciatic nerves. The potency of TnPBI was affected more than that of lignocaine by the presence of the sheath in intact nerves. 3 Both drugs inhibited conduction in the rat phrenic nerve, as shown by the reduction in twitch tension of the diaphragm elicited by nerve stimulation. TnPBI also caused an initial augmentation of the twitch tension of the diaphragm when applied directly to the muscle. 4 TnPBI was shown to be approximately twice as potent as lignocaine by the guinea-pig intradermal wheal test. 5 These results are discussed in view of the known effects of TnPBI on intracellular calcium storage.

Anesthetics, Local↗
PubMed1984

Induction of intradermal skin reactions in the bovine by fractionated proteins of Hypoderma lineatum.

Protein species found in crude extracts of Hypoderma lineatum (Villers) 1st-instar gullet-stage larval homogenates were fractionated by chromatography and further identified by conventional polyacrylamide gel electrophoresis (PAGE) and SDS/PAGE techniques. Seven major fractions were resolved by ion exchange chromatography. Conventional PAGE of the crude antigen preparation revealed a minimum of 14 protein species, while SDS/PAGE revealed 3 major protein species. The ability to elicit cutaneous reactivity by isolated proteins was determined by the intradermal skin test. An immediate-type hypersensitivity reaction was elicited in the skin of vaccinated and previously infested animals by the components of the 4 protein fractions tested. Only one protein fraction, fraction 4, elicited an apparent delayed reaction at 48 h in vaccinated and previously infested animals. A non-specific background reaction was elicited in control animals by the fractionated proteins and was most notable between 1- and 4-h post-injection.

Animals↗
PubMedDate not supplied

[Correlation between intradermal reaction and immunoelectrophoresis in human hydatidosis].

The results obtained by the immunoelectrophoresis (IEP) aand Casoni intradermal (IDR) tests in a group of 50 hydatidosis patients in which the presence of cysts was later confirmed at surgery, are analyzed. The sensitivity of the IEP test was 74%; the IDR test was positive in 54% of these patients and there was no correlation between the results of the two tests in 24% of the cases. The low sensitivity observed for the IDR test, its known nonspecificity and its poor correlation with IEP test results do not enable us to recommend its use for the diagnosis of hydatid disease or for the selection of cases in which an immunodiagnostic confirmation is feasible. This recommendation would be possible if appropriate antigens regarding specificity and reactivity were available, and could be employed with standardized methods to read and evaluate cutaneous reactivity.

Echinococcosis↗
PubMed1981

Cell-mediated immune response in anaplasmosis in cattle.

The cell-mediated immune response (CMIR) was demonstrated during experimental Anaplasma marginale infection in cattle, in vivo by the intradermic skin test and in vitro by the leucocyte migration inhibition test (LMIT). The skin test showed a delayed hypersensitivity reaction which reached its maximum after 48-72 hours. Histopathological examination of the skin biopsies revealed excessive infiltration by mononuclear cells and accumulation of oedematous fluid in the deeper dermal layers. For LMIT, the particulate antigen was used and the inhibition of leucocyte migration was significant in vaccinated and carrier animals as compared to controls.

Anaplasmosis↗
PubMed1975

Tuberculin sensitivity in a high-risk canine population.

An epidemiologic study of tuberculosis in dogs exposed to humans with recently reported tuberculosis was undertaken in Philadelphia between July 1966 and June 1968. A total of 29 dogs meeting the criteria for inclusion in the high-risk population were studied by history, physical examination, intradermal tuberculin tests, and radiographic and bacteriologic examination. Ten of the 29 dogs showed positive responses to US Department of Agriculture (USDA) standard mammalian tuberculin. Positive tuberculin tests to second strength PPD were demonstrated in five of the 10 responders to USDA mammalian tuberculin. No physical, radiographic or bacteriologic evidence of tuberculosis was found in any of the high-risk animals examined. In a comparison group of 70 dogs without knwon exposure to tuberculosis, two positive responses to USDA tuberculin were demonstrated and none to PPD.

Animals↗
PubMed1992

Immunogenicity of diaspirin cross-linked human hemoglobin solutions.

To assess the potential immunogenicity of human diaspirin cross-linked hemoglobin (DCLHb) solution, repetitive doses of this material were given intravenously to rhesus monkeys at monthly intervals and the immune response to this challenge was assessed. Serum samples collected at multiple intervals throughout the study showed no evidence of DCLHb specific IgG or IgM production. Intradermal skin tests performed one month after the final DCLHb infusion were also negative. These data demonstrate that DCLHb is not antigenic when administered intravenously to rhesus monkeys. In addition, screening of a panel of normal human sera for pre-existing anti-DCLHb IgG antibodies was negative, suggesting that this modified hemoglobin is unlikely to be antigenic in humans.

Animals↗