High Rate of Negative Results of Tuberculin and QuantiFERON Tests Among Individuals With a History of Positive Skin Test Results

2006 ◽  
Vol 27 (5) ◽  
pp. 436-441 ◽  
Author(s):  
Lloyd N. Friedman ◽  
Esther R. Nash ◽  
June Bryant ◽  
Susan Henry ◽  
Julia Shi ◽  
...  
Keyword(s):  
Skin Test ◽  
Significant Proportion ◽  
High Rate ◽  
Negative Group ◽  
Tuberculosis Screening ◽  
Positive Skin ◽  
Screening Programs ◽  
History Of ◽  
Positive Results

Objectives.To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-γ.Methods.This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, <10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of <10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative.Results.A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (P<.001). Of 31 subjects who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (P<.005).Conclusions.A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.

Sequential degranulation of eosinophils induced by antigen or autocoids in allergic humans

1986 ◽  
Vol 44 ◽  
pp. 354-355
Author(s):  
Kate W. Sjoerdsma ◽  
W. James Metzger
Keyword(s):  
Allergic Rhinitis ◽  
Bronchoalveolar Lavage ◽  
Allergic Asthma ◽  
Skin Test ◽  
Positive Skin Test ◽  
Positive Skin ◽  
Human Eosinophil ◽  
Asthmatic Patients ◽  
Allergic Asthmatic ◽  
History Of

Eosinophils are important to the pathogenesis of allergic asthma, and are increased in bronchoalveolar lavage within four hours after bronchoprovocation of allergic asthmatic patients, and remain significantly increased up to 24 hours later. While the components of human eosinophil granules have been recently isolated and purified, the mechanisms of degranulation have yet to be elucidated.We obtained blood from two volunteers who had a history of allergic rhinitis and asthma and a positive skin test (5x5mm wheal) to Alternaria and Ragweed. Eosinophils were obtained using a modification of the method described by Roberts and Gallin.

Penicillin Hypersensitivity

1979 ◽  
Vol 1 (5) ◽  
pp. 132-158
Keyword(s):  
Skin Test ◽  
Multicenter Study ◽  
Positive Skin Test ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Penicillin G ◽  
Positive Skin ◽  
Positive History ◽  
History Of

A (massive) multicenter study of 3,000 patients has demonstrated that skin tests to penicillin G and penicilloyl-polylysine (PPL-now commercially available) predict and confirm penicillin allergy. Of patients with a history of penicillin reaction, 19% were positive to either, compared to 7% of controls. A history of anaphylaxis led to 46% positive. Of those with a history of urticaria 17% were positive, and those with maculopapular eruptions did not differ from controls (7% positive). Challenge with penicillin led to a reaction in 6% with a positive history (compared to 2% with a negative) and 67% with a combined positive history and positive skin test (to either).

Cost of Annual Tuberculosis Screening of Healthcare Workers with Negative Tuberculin Skin Test Results

2013 ◽  
Vol 34 (6) ◽  
pp. 642-643
Author(s):  
J. Brooks Jackson ◽  
Xuguang Tao ◽  
Laurie Sneed ◽  
Frances Humphrey-Carothers ◽  
Edward Bernacki
Keyword(s):  
Medical School ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Screening Program ◽  
Healthcare Providers ◽  
Johns Hopkins Hospital ◽  
Tuberculosis Screening ◽  
Screening Programs ◽  
Screening Cost ◽  
The Cost

The Centers for Disease Control and Prevention (CDC) recommends annual screening for Mycobacterium tuberculosis infection using the tuberculin skin test (TST) for individuals working in hospitals with 200 or more inpatient beds that have at least 6 documented cases of active tuberculosis (TB) per year. The cost of annual TB screening programs is significant, but the cost per individual with TST conversion is unknown. Therefore, we evaluated the annual TB screening program at the Johns Hopkins Hospital and Medical School to determine (1) the proportion of individuals with TST conversion among individuals in the annual TB screening program with patient care exposure at the Johns Hopkins Hospital and Medical School, (2) which employment and demographic factors are associated with TST conversion, (3) the prevalence of active TB disease among those with TST conversion, and (4) the annual cost of subsequent screening of individuals with initial negative TST results and the screening cost per individual with TST conversion.TST results were reviewed for individuals participating in the annual TB screening program during the previous 4 years (2007–2010) at the Johns Hopkins Hospital and Medical School, which has experienced an average of 12 documented cases of active TB per year. TST was performed before employment and then annually for healthcare providers according to CDC guidelines and the manufacturer's directions. Individuals in the testing program included anyone who had patient contact, such as physicians, nurses, technologists, students, phlebotomists, nutritionists, pharmacists, and clerks. All initial testing was 2-step testing if the individual was initially reactive.

scholarly journals The Frequency of Food Allergy Among Children With Migraine Headache; A Descriptive Cross-Sectional Study

2020 ◽  
Vol 14 (1) ◽  
pp. 46-52
Author(s):  
Akefeh Ahmadiafshar ◽  
Mohammad Vafaee-Shahi ◽  
Saeide Ghasemi ◽  
Fariba Khosroshahi ◽  
Aina Riahi
Keyword(s):  
Food Allergy ◽  
Skin Test ◽  
Migraine Headache ◽  
Critical Role ◽  
Food Allergies ◽  
Cross Sectional ◽  
Positive Skin ◽  
Migraine Headaches ◽  
Allergy Test ◽  
History Of

Background: Headache and particularly migraine headaches are considered as a debilitating disease worldwide that can adversely affect the quality of life of children and adults. Various factors can play a critical role in the development of migraine headache attacks. The food allergens are considered as important factors. This study aimed to determine the frequency of food allergy in children with migraine headaches. Methods: Forty patients aged <16 years with a migraine headache were entered into the study. A questionnaire was provided in which data on demographic information and skin test results for various allergens were recorded. Dietary allergies were defined based on a positive skin test plus a patient's history of food allergies. The severity of migraine was evaluated using the Migraine disability assessment score (MIDAS) questionnaire. Results: The present study showed 32.5% of our participants had a food allergy. No significant association was detected between sex (p=58) and age (p=0.14) with food allergy. However, the frequency of food allergy was significantly higher in patients aged ≥12 years old (44.4%) than those aged <12 (22.7%). A significant relationship was found between the number of attacks after prophylaxis and the frequency of food allergies (p=0.032). Individuals with lower attacks had a lower food allergy. Conclusion: Our findings revealed that about one-third of children with a migraine headache had a food allergy. This frequency was significantly higher in children with migraines than that of the general population based on the results of previous studies. It is recommended that these patients receive a skin allergy test while preparing a strong history of food allergies or when the frequency of migraine attacks does not decrease significantly despite proper prophylaxis.

scholarly journals Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke

2017 ◽  
Vol 2017 ◽  
pp. 1-11
Author(s):  
Cheuk-Lik Wong ◽  
Ho-Kee Vicki Tam ◽  
Chun-Kit Vincent Fok ◽  
Pong-Kai Ellen Lam ◽  
Lai-Ming Fung
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Significant Proportion ◽  
Persistent Atrial Fibrillation ◽  
High Rate ◽  
Factors Associated ◽  
History Of ◽  
Reduce Risk ◽  
Free Thyroxine Level

Background. Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke. Methods. We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke. Results. Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p=0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p=0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p=0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p=0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p=0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p=0.008) were associated with persistence of AF on multivariate analysis. Conclusion. Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.

scholarly journals The Role of Benzylpenicilloyl Epimers in Specific IgE Recognition

2021 ◽  
Vol 12 ◽  
Author(s):  
Cristobalina Mayorga ◽  
Maria I. Montañez ◽  
Francisco Najera ◽  
Gador Bogas ◽  
Tahía D. Fernandez ◽  
...  
Keyword(s):  
Skin Test ◽  
Chemical Stability ◽  
Provocation Test ◽  
Diagnostic Methods ◽  
Amide Bond ◽  
Skin Tests ◽  
Positive Skin

The high prevalence of allergy to β-lactam antibiotics is a worldwide issue. Accuracy of diagnostic methods is important to prove tolerance or allergy, with skin test considered the best validated in vivo method for diagnosing immediate reactions to β-lactams. Although drug provocation test is the reference standard, it cannot be performed in highly risk reactions or in those with positive skin tests. For skin tests, the inclusion of major and minor determinants of benzylpenicillin (BP) is recommended. Commercial skin test reagents have changed along time, including as minor determinants benzylpenicillin, benzylpenicilloate (BPO), and benzylpenilloate (PO). Major determinants consists of multivalent conjugates of benzylpenicilloyl coupled through amide bond to a carrier polymer, such as penicilloyl-polylysine (PPL) or benzylpenicilloyl-octalysine (BP-OL). The chemical stability of such reagents has influenced the evolution of the composition of the commercial kits, as this requirement is necessary for improving the quality and standardization of the product. In this work, we provide a detailed study of the chemical stability of BP determinants. We observed that those structures suffer from an epimerization process in C-5 at different rates. Butylamine-Benzylpenicilloyl conjugates (5R,6R)-Bu-BPO and (5S,6R)-Bu-BPO were selected as a simple model for mayor determinant to evaluate the role of the different epimers in the immunoreactivity with sera from penicillin-allergic patients. In vitro immunoassays indicate that any change in the chemical structure of the antigenic determinant of BP significantly affects IgE recognition. The inclusion of stereochemically pure compounds or mixtures may have important implications for both the reproducibility and sensitivity of in vivo and in vitro diagnostic tests.

The Importance of Glycerin-Containing Negative Control Tests in Allergy Research Studies that Use Intradermal Skin Tests

2002 ◽  
Vol 127 (3) ◽  
pp. 177-181 ◽  
Author(s):  
David S. Hurst ◽  
Bruce R. Gordon ◽  
John H. Krouse
Keyword(s):  
Skin Test ◽  
False Positive ◽  
Negative Control ◽  
Intradermal Injection ◽  
Skin Tests ◽  
Positive Skin ◽  
Test Response ◽  
Timothy Grass ◽  
Skin Response

OBJECTIVE: We sought to assess skin whealing with glycerin-containing control injections for intradermal skin tests. DESIGN: Observational. METHODS: Wheal sizes were measured at 0, 10, and 15 minutes after intradermal injection of 0.01 and 0.02 mL of phenolated normal saline and 0.5% and 5% concentrations of glycerin in the same quantity of phenolated saline. RESULTS: Intradermal injection of 0.01 mL of phenolated saline produced an average 4.9-mm wheal, which expanded to 5.2 mm at 10 minutes and to 6.0 mm at 15 minutes. Intradermal injection of 0.02 mL of phenolated saline produced a 6.4-mm wheal, which expanded to 7.0 mm at 10 minutes and 8.0 mm at 15 minutes. The addition of glycerin produced proportionally larger wheals. CONCLUSIONS: Because glycerin increases whealing beyond that with phenolated saline, skin tests containing glycerin must be compared with glycerin-containing negative controls. Intradermal skin tests that fail to compare findings in this manner contain an inherent methodologic flaw and are uninterpretable. A major issue in allergy testing is deciding whether the observed skin response is truly indicative of the patient having a clinically relevant, IgE-mediated reaction. 1 Skin test results are influenced by many variables, including patient skin response, specific technique, and tester consistency. Wheal measurement, comparisons with positive and negative control solutions, and interpretation are of equal importance. The development of in vitro methods for allergy diagnosis has helped to independently verify the accuracy of skin tests. In some cases, poor standardization of antigen sources and testing techniques has been shown to lead to discrepancies between skin tests and in vitro IgE antibody results of more than 100-fold. 2 It is also possible for skin tests to be falsely negative, as has been shown by comparing IgE blood tests with both skin tests and challenge tests. 3 Conversely, skin tests may be falsely positive because of nonspecific irritants, such as glycerin, present in allergen solutions. 4,5 Recommendations for immunotherapy must be based on clinical appropriateness as related to valid testing of proposed therapeutic agents. Recent reports by Nelson et al 6 and Wood et al 7 have suggested that skin prick tests (SPTs), even when negative, are sufficiently sensitive to diagnose clinical atopy without the need for further intradermal skin tests (IDTs). Both authors describe performance of a single IDT with injection of 0.02 mL of antigen solution. The basic tenant of their methodology is that all wheals resulting from an IDT measuring 6 mm or greater, accompanied by erythema, are to be recorded as positive. Nelson et al took measurements at 15 minutes, and Wood et al took measurements at an unspecified time. We were concerned that their methodology for IDTs created many false-positive results. This led to the condemnation of IDTs by these authors, stating that “a positive intradermal skin test response to Timothy grass in the presence of a negative skin prick test response to Timothy grass did not indicate the presence of clinically significant sensitivity to Timothy grass.” 6 We found the conclusion based on their particular IDT method to be suspect for 2 reasons: (1) it categorically assumes that an injection of 0.02 would produce a wheal of less than 6 mm and (2) it ignores the effects of small concentrations of the preservative glycerin, used in most all allergy test solutions, on whealing. Either assumption would lead to frequent false-positive skin test interpretations and discredit 60 years of intradermal testing. We therefore sought to evaluate control tests appropriate for use with the methodologies published in the general allergy literature to determine whether a 6-mm wheal with erythema should appropriately be interpreted as a positive or as a negative test.

scholarly journals Socioeconomic Status and Childhood Atopy

1996 ◽  
Vol 3 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Kitaw Demissie ◽  
Pierre Ernst ◽  
Margaret R Becklake
Keyword(s):  
Socioeconomic Status ◽  
Social Class ◽  
Skin Test ◽  
Point Of View ◽  
Skin Tests ◽  
Parental Occupation ◽  
Positive Skin ◽  
Before And After ◽  
History Of ◽  
Relationship Of

BACKGROUND:Variation in the prevalence of allergic disorders among socioeconomic groups could be due either to differences in the type of allergens encountered or to actual differences in susceptibility to sensitization to any particular antigen.OBJECTIVE:To examine the relationship of skin test positivity to inhaled aeroallergens and socioeconomic status (SES).METHODS:A total of 989 Montreal elementary school children were studied. A short questionnaire was completed by parents, and the children performed spirometry before and after a free-running exercise challenge. A subsample of 309 children underwent allergy skin prick tests to common inhaled aeroallergens. SES was established using parental occupation.RESULTS:Higher social class was associated with an increased likelihood of having positive skin tests to cat and trees, while there was a trend towards an inverse relationship between SES and skin test sensitivity to cockroach and moulds. Reported history of asthma, hay fever or eczema were unrelated to SES.CONCLUSIONS:The results of this study suggest differences in levels of exposure to different allergens by social class. From the public health point of view, community-based allergen avoidance measures need to be adapted to social class.

Sex differences in the significance of isolated reactive treponemal chemiluminescence immunoassay results

2017 ◽  
Vol 94 (3) ◽  
pp. 187-191
Author(s):  
Rohan I Bopage ◽  
Ute Vollmer-Conna ◽  
Antonia W Shand ◽  
Jeffrey John Post
Keyword(s):  
Pregnant Women ◽  
Descriptive Analysis ◽  
Significant Proportion ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Chemiluminescence Immunoassay ◽  
Immunoblot Assay ◽  
History Of ◽  
Record Review ◽  
Positive Results

ObjectivesThe significance of sera with isolated reactive treponemal chemiluminescence immunoassay (IRTCIA) results is unclear. Women have this phenotype more commonly than men. Most cohorts examining this phenotype have included predominantly men and have demonstrated evidence of past or subsequently confirmed syphilis infection in a significant proportion of cases. We hypothesised that a proportion of sera with IRTCIA results would be positive on immunoblot testing and that sera from women with IRTCIA would have different results in immunoblot testing than men.MethodsIRTCIA sera from a tertiary referral serology laboratory serving multiple clinical sites were analysed with a syphilis line immunoblot assay (LIA) and analysed by sex. Logistic regression was undertaken to assess factors associated with LIA status. Medical record review and descriptive analysis of a separate cohort of women with the IRTCIA phenotype from a single campus was also undertaken.ResultsOverall, 19/63 (30.1%) subjects with the IRTCIA phenotype were positive in the LIA, including 13 men and 6 women. Women were significantly less likely to have definitive results (positive or negative) than men (p=0.015). Pregnant women were less likely than non-pregnant women to have a negative LIA result (OR 0.57; p=0.03). Record review of 22 different women with IRTCIA reactivity showed that 2/22 (9.1%) had HIV and previous syphilis infection, 15/22 (68.2%) were pregnant and 3 (13.6%) had autoimmune disease.ConclusionsA significant proportion of sera with IRTCIA results on serological tests are reactive on LIA testing and some may not be false positive results. The interpretation of IRTCIA results should be undertaken in conjunction with an assessment of factors such as sex, pregnancy, a history of syphilis and other STIs and syphilis risk.

scholarly journals Comparison of Subject-Reported Allergy versus Skin Test Results in a Common Cold Trial

2003 ◽  
Vol 17 (3) ◽  
pp. 159-162
Author(s):  
Jason S. Krahnke ◽  
Deborah A. Gentile ◽  
Kelly M. Cordoro ◽  
Betty L. Angelini ◽  
Sheldon A. Cohen ◽  
...  
Keyword(s):  
Skin Test ◽  
Common Cold ◽  
Skin Testing ◽  
Positive Skin Test ◽  
Poor Correlation ◽  
Test Results ◽  
Positive Skin ◽  
Test Response ◽  
History Of ◽  
Allergy Skin Testing

Background Few studies have examined the relationship between subject-reported allergy and results of allergy skin testing in large unselected or unbiased cohorts. The objective of this study was to compare the results of self-reported allergy via verbal questioning with the results of allergy skin testing by the puncture method in 237 healthy adult subjects enrolled in a common cold study. Methods On enrollment, all subjects were verbally asked if they had a history of allergy and then underwent puncture skin testing to 19 relevant aeroallergens, as well as appropriate positive and negative controls. A skin test was considered positive if its wheal diameter was at least 3 mm larger than that obtained with the negative control. Results Forty-eight (20%) subjects reported a history of allergy and 124 (52%) subjects had at least one positive skin test response. A history of allergy was reported in 40 (32%) of the skin test-positive subjects and 8 (7%) of the skin test-negative subjects. At least one positive skin test response was found in 40 (83%) of those subjects reporting a history of allergy and 84 (44%) of those subjects denying a history of allergy. Conclusion These data indicate that there is a relatively poor correlation between self-reported history of allergy and skin test results in subjects enrolled in a common cold study. These results have implications in both clinical practice and research settings.

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