Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections

A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children?s Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2 % to 17 %, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1 % to 14.5 %, and among cephalosporins is 0 % to 11.7 %.

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Quinolone Allergy

Pharmacy ◽

10.3390/pharmacy7030097 ◽

2019 ◽

Vol 7 (3) ◽

pp. 97 ◽

Cited By ~ 9

Author(s):

Edoabasi U. McGee ◽

Essie Samuel ◽

Bernadett Boronea ◽

Nakoasha Dillard ◽

Madison N. Milby ◽

...

Keyword(s):

Clinical Manifestations ◽

Provocation Test ◽

Cross Reactivity ◽

Skin Tests ◽

Diagnostic Tools ◽

In Vitro Tests ◽

Allergic Reactions ◽

Drug Induced ◽

Delayed Reaction

Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.

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Allergic reactions to cyclophosphamide: Delayed clinical expression associated with positive immediate skin tests to drug metabolites in five patients

Journal of Allergy and Clinical Immunology ◽

10.1016/s0091-6749(96)70279-8 ◽

1996 ◽

Vol 97 (1) ◽

pp. 26-33 ◽

Cited By ~ 27

Author(s):

N.Andrei Popescu ◽

Michael G. Sheehan ◽

Peter A. Kouides ◽

John E. Loughner ◽

John J. Condemi ◽

...

Keyword(s):

Skin Tests ◽

Allergic Reactions ◽

Clinical Expression ◽

Drug Metabolites

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COMPARATIVE SKIN TESTS WITH ANIMAL AND SYNTHETIC CORTICOTROPHIN IN PATIENTS HYPERSENSITIVE TO ANIMAL CORTICOTROPHIN

Acta Endocrinologica ◽

10.1530/acta.0.0470613 ◽

1964 ◽

Vol 47 (4) ◽

pp. 613-618 ◽

Cited By ~ 5

Author(s):

H. J. Buytendijk ◽

Fr. Maesen

Keyword(s):

Skin Reaction ◽

Anaphylactic Shock ◽

Therapeutic Use ◽

Skin Tests ◽

Allergic Reactions ◽

Skin Reactions ◽

Positive Skin ◽

Valuable Addition

ABSTRACT A study of the literature shows that 5 % of patients are hypersensitive to animal ACTH. Anaphylactic shock, even with a fatal issue, may occur (van Ufford 1952; Hill & Swinburn 1954; Eisalo et al. 1956). The same rather high percentage was also found for our own patients. In seven patients who had previously shown violent clinical reactions following the use of animal ACTH (Cortrophin), comparative skin tests were carried out with Cortrophin and the synthetic ACTH preparation, tetracosapeptide (CIBA 30.920-Ba). All patients showed a markedly positive skin reaction to the highly purified animal ACTH (Cortrophin); in two of these patients, the reaction occurred late. Skin reactions to the synthetic ACTH were negative. The synthetic ACTH, must be regarded as a valuable addition in the therapeutic use of ACTH, particularly in patients predisposed to allergic reactions (asthmatics).

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Immediate allergic reactions to β-lactams: Diagnostic accuracy of skin tests

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2011.05.007 ◽

2011 ◽

Vol 107 (1) ◽

pp. 89-90 ◽

Cited By ~ 2

Author(s):

Esther Moreno ◽

Ignacio Dávila ◽

Elena Laffond ◽

Teresa Gracia ◽

Francisco Múñoz ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Skin Tests ◽

Allergic Reactions

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153. Development of a Pathway for Removal of Inappropriate Penicillin Allergy Labels in Hospitalized Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.198 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S86-S87

Author(s):

Fnu Shweta ◽

Pooja Gurram ◽

Natalia E Castillo Almeida ◽

Douglas Challener ◽

Edison J Cano ◽

...

Keyword(s):

Pilot Project ◽

Study Data ◽

Hospitalized Patients ◽

Penicillin Allergy ◽

Skin Tests ◽

Control Group ◽

Allergic Reactions ◽

Beta Lactam ◽

Beta Lactam Antibiotics ◽

Pdsa Cycle

Abstract Background More than 90% of reported penicillin allergies are found inaccurate when formally assessed. These allergy labels lead to decreased utilization of first-line beta-lactam antibiotics, and adverse clinical outcomes. The objective of this study was to develop a multi-disciplinary approach to decrease inaccurate labeling among hospitalized patients with documented penicillin allergy. Methods A team of clinicians, pharmacists, and nurses utilized the DMAIC quality strategy to improve accuracy of penicillin allergy labeling. Allergic reactions were stratified to develop a penicillin allergy de-labeling algorithm (Figure 1). Admission to the intensive care unit (ICU) for anaphylaxis was defined as a balancing measure. We reviewed baseline data from patients with a documented penicillin allergy admitted to a single inpatient floor at Mayo Clinic, Rochester between June and October 2019. A cause and effect diagram was used to conduct a root cause analysis. The intervention was then applied to patients who reported penicillin allergy admitted to the same floor from November 2019 to January 2020. Study data were collected and basic descriptive statistics generated. Figure 1: Penicillin allergy delabeling algorithm Results 96 patients were included in the control group with mean age of 71 years (range 65–84 years) and 55% females. Breakdown of documented allergic reactions are represented in Figure 2. 58 (60%) received an antibiotic for a median duration of 1.5 days (IQR: 0 – 6). Of these, 7(12%) received penicillin-class antibiotics, and 41 (70.6%) received non-beta-lactam antibiotics. 2 (2%) of these patients were de-labeled without any penicillin skin tests. Detailed metrics of each PDSA cycle are shown in Table 1. During PDSA cycle 2, inaccurate penicillin documentation was removed in 9/19 (47.4%) of hospitalized patients. There were no ICU admissions for anaphylaxis. Figure 2: Graphic representation of proportion of type of documented allergic reactions to penicillin Table 1: Metrics and outcomes at baseline and during successive PDSA cycles Conclusion Various factors contribute to penicillin allergy mislabeling. Our comprehensive algorithm addresses nuances of penicillin allergic reactions and increased accurate penicillin allergy labeling in 47.4% of the cases. Beta-lactam use also increased to 37% through our pilot project while maintaining patient safety. A multi-disciplinary and patient-centered approach aligned with institutional workflows is necessary to improve patient outcomes. Disclosures All Authors: No reported disclosures

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Diagnosis of Peanut Allergy in Preschool Children: The Impact of Skin Testing With a Novel Composition of Peanuts

Frontiers in Pediatrics ◽

10.3389/fped.2021.739224 ◽

2021 ◽

Vol 9 ◽

Author(s):

Mona I. Kidon ◽

Soad Haj Yahia ◽

Diti Machnes-Maayan ◽

Yael Levy ◽

Shirli Frizinsky ◽

...

Keyword(s):

Preschool Children ◽

Peanut Allergy ◽

Skin Tests ◽

Diagnostic Tools ◽

High Threshold ◽

Allergic Reactions ◽

Predictive Values ◽

History Of ◽

Peanut Proteins ◽

The Impact

Peanut allergy is an increasing concern in younger children. Available bedside diagnostic tools, i.e., prick tests with commercial extracts or peanut-containing foods have only limited predictive values. In a cohort of preschoolers with both a history of allergic reactions and sensitization to peanut proteins, we aimed to characterize the impact of skin tests with a novel composition of peanuts LPP-MH. Almost one quarter (27/110) of preschool children, with a history of allergic reactions to peanuts and positive standard IgE-mediated tests for peanut allergy, can tolerate the reintroduction of peanut proteins into their diet after resolving their allergy and, thus, can avoid adverse health outcomes associated with the false diagnosis. In the younger age group, a quarter of peanut allergic children, display a relatively high threshold, potentially enabling an easier and safer oral immunotherapy protocol in this window of opportunity in childhood. The use of the novel diagnostic skin test, LPP-MH, significantly improves the predictive value of outpatient evaluation for the outcomes of peanut challenge as well as the expected threshold at which the PA child will react, thus, making for a better informed decision of how, when, and where to challenge.

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Comparative analysis of the allergenic characteristics and serodiagnostic potential of recombinant chitinase-like protein-5 and -12 from Sarcoptes scabiei

Parasites & Vectors ◽

10.1186/s13071-021-04654-0 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Nengxing Shen ◽

Yuhang Chen ◽

Wenrui Wei ◽

Lang Xiong ◽

Yuanyuan Tao ◽

...

Keyword(s):

Comparative Analysis ◽

High Sensitivity ◽

Specific Ige ◽

Sarcoptes Scabiei ◽

Positive Control ◽

Skin Tests ◽

Enzyme Linked Immunosorbent Assay ◽

Allergic Reactions ◽

Diagnostic Potential ◽

Recombinant Chitinase

Abstract Background Scabies is caused by burrowing of the mite Sarcoptes scabiei into the stratum corneum. Currently, diagnosis via routine skin scraping is very difficult, and information on the allergenic identification of S. scabiei remains limited. Methods We performed comparative analysis of the serological diagnostic potential of recombinant S. scabiei chitinase-like protein-5 (rSsCLP5) and recombinant S. scabiei chitinase-like protein-12 (rSsCLP12) by measuring the levels of serum-specific IgG and IgE antibodies (Abs) as diagnostic markers. In addition, the allergenic characteristics of rSsCLP5 and rSsCLP12 were evaluated using IgE-binding experiments and skin tests. Results The IgE Abs-based indirect enzyme-linked immunosorbent assay (ELISA) methods showed high sensitivity and specificity: the rSsCLP5-based assay had 93.5% sensitivity and 94.4% specificity; the rSsCLP12-based assay had 100% sensitivity and 98.1% specificity. The specific IgE Abs in infested mouse sera could bind rSsCLP5 and rSsCLP12. In skin tests, rabbits in the rSsCLP5 and rSsCLP12 groups and positive control (histamine) groups exhibited allergic reactions. Most test sites in the rSsCLP12 group had edema, bleeding spots, and even ulcers or scabs, but such allergy symptoms were rare in the rSsCLP5 group. Moreover, the allergic history rabbit group had more severe allergic reactions and lower levels of IgE Abs compared to the healthy rabbit group in the same protein group. Conclusions These findings validate the use of IgE Abs to rSsCLP5 and rSsCLP12 as potentially useful markers for diagnosing scabies. Moreover, both rSsCLP5 and rSsCLP12 have allergenic properties, and the potential allergen rSsCLP12 is a stronger allergen than rSsCLP5.

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Serious allergic reactions following tuberculin skin tests

Canadian Medical Association Journal ◽

10.1503/cmaj.050710 ◽

2005 ◽

Vol 173 (1) ◽

pp. 34-34 ◽

Cited By ~ 1

Author(s):

E. Youssef

Keyword(s):

Skin Tests ◽

Allergic Reactions

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Diagnostic Value of Histamine and Tryptase Concentrations in Severe Anaphylaxis with Shock or Cardiac Arrest during Anesthesia

Anesthesiology ◽

10.1097/aln.0000000000000276 ◽

2014 ◽

Vol 121 (2) ◽

pp. 272-279 ◽

Cited By ~ 59

Author(s):

Dominique Laroche ◽

Philippe Gomis ◽

Emmanuel Gallimidi ◽

Jean-Marc Malinovsky ◽

Paul Michel Mertes

Keyword(s):

Cardiac Arrest ◽

Clinical Signs ◽

Diagnostic Value ◽

Skin Tests ◽

Allergic Reactions ◽

Operating Characteristics ◽

Severe Anaphylaxis ◽

Group Control ◽

Control Shock ◽

Life Threatening

Abstract Background: The diagnosis of acute life-threatening allergic reactions during anesthesia relies on clinical signs, histamine and/or tryptase measurements, and allergic testing. In patients who die after the reaction, skin tests cannot be performed, and the effect of resuscitation manoeuvres on mediator concentrations is unknown. The authors compared plasma histamine and tryptase concentrations in patients with severe allergic reactions during anesthesia with those measured in patients with shock due to other causes. Methods: Patients with life-threatening allergic reactions were retrieved from a previous database (Group ALLERGY). All had positive allergy tests to administered agents. Patients with severe septic/cardiogenic shock or cardiac arrest (Group CONTROL) had histamine and tryptase measurements during resuscitation manoeuvres. Receiver operating characteristics curves were built to calculate the optimal mediator thresholds differentiating allergic reactions from others. Results: One hundred patients were included, 75 in Group ALLERGY (cardiovascular collapse, 67; cardiac arrest, 8) and 25 in Group CONTROL (shock, 11; cardiac arrest, 14). Mean histamine and tryptase concentrations remained unchanged throughout resuscitation in Group CONTROL and were significantly higher in Group ALLERGY. The optimal thresholds indicating an allergic mechanism were determined as 6.35 nmol/l for histamine (sensitivity: 90.7% [95% CI, 81.7 to 96.1]; specificity: 91.7% [73.0 to 98.9]) and 7.35 μg/l for tryptase (sensitivity: 92% [83.4 to 97.0]; specificity: 92% [73.9 to 99.0]). Conclusions: Resuscitation manoeuvres by themselves did not modify mediator concentrations. Virtually all life-threatening reactions during anesthesia associated with mediator concentrations exceeding the thresholds were allergic events. These findings have potential forensic interest when a patient dies during anesthesia.

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