The radioallergosorbent test (RAST) in the diagnosis of reaginic allergy. A comparison between provocation tests, skin tests and RAST employing allergo-sorbents which were arbitrarily prepared with commercial allergen extracts

Beta-lactam (BL) antibiotics are the most frequent cause of drug hypersensitivity in children, inducing both immediate and non-immediate reactions. Here we report a case of a 4-year-old child with a disseminated maculopapular exanthema 7 days after the first dose of amoxicillin–clavulanate, referred to our paediatric allergy department. Skin prick tests were negative. Intradermal tests were performed and, after 10 hours, indurated wheals larger than 10×10 mm with progressive erythema and disseminated maculopapular eruption were developed, related to amoxicillin and amoxicillin–clavulanate. Systemic reactions to BL skin tests are rarely reported and the majority are immediate reactions. This case illustrates a rare example of a non-immediate systemic reaction to intradermal tests, underlying the importance of skin testing before drug provocation tests in cases of moderate to severe non-immediate reactions.

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IMMUNOCHEMICAL EFFECTS OF INJECTION THERAPY WITH ALLERGENS BY CUSTOMARY AND INTENSIVE DOSAGE REGIMENS IN CHILDREN

PEDIATRICS ◽

10.1542/peds.49.4.536 ◽

1972 ◽

Vol 49 (4) ◽

pp. 536-546

Author(s):

C. D. May ◽

M. Lyman ◽

R. Alberto ◽

N. Aduna

Keyword(s):

Clinical Trials ◽

Injection Therapy ◽

Skin Tests ◽

Protein Nitrogen ◽

Blocking Antibody ◽

Dosage Regimens ◽

Neutralizing Capacity ◽

Allergen Extracts ◽

Frequent Measurement

Evaluation of dosage regimens for injection therapy with allergen extracts was undertaken by determination of immunochemical responses. Antigenic release of histamine was used as a means of measuring leukocyte sensitivity to allergens and antigen-neutralizing capacity of serum or "blocking" antibody. Customary dosage regimens providing 190,000 to 265,000 Protein Nitrogen Units of allergen in 2 years, and intensive dosage regimens providing these amounts or more in a few weeks were evaluated in 46 allergic children by frequent measurement of luekocyte sensitivity and antigen-neutralizing capacity of serum. Uninjected subjects were studied simultaneously. With 32 children receiving customary dosage regimens for injection of an allergen extract (Alternaria, ragweed, house dust), increases and decreases in leukocyte sensitivity in those children receiving injections did not differ significantly from others without injections. Modest increases in antigen-neutralizing capacity of serum occurred with injections. With 14 children receiving intensive dosage regimens for injection of the same allergens, much higher titers of antigen-neutralizing capacity in the serum could be achieved, but little net change in leukocyte sensitivity was observed, except for one case in which leukocytes became desensitized. In no case did intradermal skin tests with the allergens become negative, meaning the children were not desensitized. The dosage regimens used for injection of the allergens tested did not evoke immunochemical responses which encourage one to undertake extensive clinical trials.

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Effects of injections of allergen extracts on antigenic release of histamine from leucocytes, skin tests and bronchial challenge in allergic children

Clinical & Experimental Allergy ◽

10.1111/j.1365-2222.1972.tb01299.x ◽

1972 ◽

Vol 2 (4) ◽

pp. 345-360 ◽

Cited By ~ 14

Author(s):

MICHAEL J. SCHUMACHER ◽

CHARLES D. MAY

Keyword(s):

Skin Tests ◽

Bronchial Challenge ◽

Allergen Extracts

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THE PREVALENCE OF DUST ALLERGY IN BRONCHIAL ASTHMA AND THE IMPORTANCE OF CARRYING OUT PROVOCATION TESTS, EVEN WHEN SKIN TESTS REVEAL NEGATIVE RESULTS

Allergy ◽

10.1111/j.1398-9995.1960.tb02873.x ◽

1960 ◽

Vol 15 (5) ◽

pp. 449-458 ◽

Cited By ~ 4

Author(s):

ERIK FAGERBERG

Keyword(s):

Bronchial Asthma ◽

Skin Tests ◽

Negative Results ◽

Provocation Tests

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Delayed positive drug provocation tests to beta‐lactams with flare‐up reactions of skin tests sites

Clinical & Experimental Allergy ◽

10.1111/cea.13810 ◽

2020 ◽

Author(s):

Sabela Pérez‐Codesido ◽

Jean‐Luc Bourrain ◽

Pascal Demoly ◽

Anca‐Mirela Chiriac

Keyword(s):

Skin Tests ◽

Beta Lactams ◽

Provocation Tests ◽

Drug Provocation Tests

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Gum Arabic as a Cause of Occupational Allergy

Journal of Allergy ◽

10.1155/2011/841508 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Arja Viinanen ◽

Maija Salokannel ◽

Kaija Lammintausta

Keyword(s):

Food Industry ◽

Pulmonary Function Tests ◽

Gum Arabic ◽

Skin Tests ◽

Factory Workers ◽

Provocation Tests ◽

Airborne Exposure ◽

Skin Symptoms ◽

Oral Symptoms ◽

Occupational Contact

Background. Gum arabic is a potential sensitizer in food industry. Methods. We examined 11 candy factory workers referred to examinations due to respiratory and skin symptoms paying attention to exposure and sensitization to gum arabic. Skin tests, pulmonary function tests, and respiratory provocation tests were carried out as indicated by the symptoms and findings. Results. Occupational asthma, caused by gum arabic was diagnosed in 4/11 candy factory workers and two of them had also occupational contact urticaria and one had occupational rhinitis. One of them had oral symptoms associated with ingestion of products containing gum arabic. Conclusions. Airborne exposure to gum arabic may cause sensitization leading to allergic rhinitis, asthma, and urticaria.

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Review of Symptoms Assessment During Nasal Allergen Provocation in Patients with Allergic Rhinitis

The Open Allergy Journal ◽

10.2174/1874838401003010001 ◽

2010 ◽

Vol 3 (1) ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Akli Zetchi ◽

Marie-Claire Rousseau ◽

Annie LeBlanc ◽

Marie-Eve Boulay ◽

Louis-Philippe Boulet

Keyword(s):

Allergic Rhinitis ◽

Animal Models ◽

Therapy Monitoring ◽

Literature Searching ◽

Validation Process ◽

Provocation Tests ◽

Nasal Provocation ◽

Nasal Symptoms ◽

Allergen Provocation ◽

Allergen Extracts

Background: Allergic rhinitis is the most prevalent allergic disease. Nasal provocation tests (NPTs) may be useful for its clinical diagnostic and therapy monitoring although they are mostly used in clinical research. However, the lack of standardisation in the symptoms assessed and the variety of instruments used make effective comparison between studies difficult. Objective: To review the published literature searching for instruments assessing nasal symptoms during NPTs for allergic rhinitis. Methods: Pubmed and Embase electronic databases were reviewed, looking for all methods including an instrument assessing symptoms during or following NPTs. Studies on animal models, pediatric subjects, and patients without allergic rhinitis were excluded. Studies were also excluded if they did not assess nasal symptoms during or following the NPT. Only NPT studies performed with allergen extracts or histamine were included. Results: A total of 520 studies were retrieved, from which 81 different instruments from 81 studies were included in the present analysis. There was no instrument reporting a validation process for the assessment of symptoms during NPTs. From the remaining instruments, the most common symptoms assessed were rhinorrhea (67), sneezing (70), congestion (67), and nasal pruritus (50). The most frequently used type of scales among those instruments was the four-point Likert scale (39), although different methods were used. Conclusions: This review illustrates the large variety of symptoms and methods used to assess the aforementioned NPTs. The lack of validation studies suggests the need to develop and validate a standardized instrument assessing symptoms following NPTs.

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Diagnosis of Multiple Inhalant Allergies in Children by Radioimmunoassay

PEDIATRICS ◽

10.1542/peds.54.2.151 ◽

1974 ◽

Vol 54 (2) ◽

pp. 151-156

Author(s):

Donald R. Hoffman ◽

Zack H. Haddad

Keyword(s):

Atopic Dermatitis ◽

House Dust ◽

Skin Testing ◽

Skin Tests ◽

Severe Atopic Dermatitis ◽

Group I ◽

Wide Range ◽

Radioallergosorbent Test ◽

Inhalant Allergens ◽

Inhalant Allergy

A series of 302 patients reporting immediate hypersensitivity symptoms to inhalant allergens was evaluated by both puncture skin testing and the radioallergosorbent test (RAST) using 13 common inhalant allergens. Agreement between the two tests varied from 71% to 93% for the various allergens and averaged 82%. The best correlation, 93%, was obtained with mixed grass pollen allergens. If a purified allergen, rye group I, was used the correlation rose to 97.5%. The correlation was 88% for the mold Alternaria, and the negative-sera did not become positive when tested over a wide range of dilutions. Fifty-eight percent of the patients with house dust allergy reacted to house dust mite (Dermatophagoides farinae). Correlations of 71% to 93% were obtained with ten weed and tree pollens. The only patients in whom positive RASTs were found with negative skin tests to the same antigen had either severe atopic dermatitis or decreased skin response to exogenous histamine. Sera from a group of 20 patients with positive allergy history but negative skin tests also had negative RAST. The radioallergosorbent test appears to add little information to that obtained by a comprehensive allergy history and puncture skin tests in the great majority of children with inhalant allergy. The only exceptions were children with severe atopic dermatitis, suppressed skin reactivity or dermatographism.

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