scholarly journals Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Manzo Suzuki ◽  
Hajime Kawase ◽  
Azusa Ogita ◽  
Hiroyasu Bito
Keyword(s):  
General Anesthesia ◽  
Skin Testing ◽  
Blocking Agent ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Intradermal Test ◽  
Skin Tests ◽  
Prick Test ◽  
Causative Drug ◽  
Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

scholarly journals 162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kendall J Tucker ◽  
YoungYoon Ham ◽  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Ellie Sukerman ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
First Line ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Oral Amoxicillin ◽  
Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions < 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction > 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽  
1959 ◽  
Vol 24 (6) ◽  
pp. 1009-1015
Author(s):  
Richard L. London ◽  
Jerome Glaser
Keyword(s):  
Skin Test ◽  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Etiologic Factor ◽  
Initial Reaction ◽  
Age Group ◽  
Positive Skin ◽  
Clinical Sensitivity ◽  
Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

scholarly journals Immediate Reactions to Iodinated Contrast Media Prevalence of IgE-mediated Hypersensitivity

2020 ◽  
Author(s):  
Juliette Caron ◽  
Maxime SEYNAVE ◽  
Sahara GRAF ◽  
Tomas MORALY ◽  
Christine DELEBARRE-SAUVAGE
Keyword(s):  
Contrast Media ◽  
Skin Testing ◽  
Skin Tests ◽  
Iodinated Contrast Media ◽  
Provocation Tests ◽  
Iodinated Contrast ◽  
Intradermal Tests ◽  
Ige Mediated ◽  
Low Prevalence ◽  
Work Up

Abstract BackgroundAfter administration of iodinated contrast media (ICM) some patients develop an immediate hypersensitivity reaction (IHR). A specific allergic IgE-mediated mechanism may be involved. ObjectiveTo determine the prevalence of allergic patients among ICM reactors and to evaluate the negative predictive value (NVP) of skin testing for ICM.MethodsAll patients who attended a single center for an allergy work-up between 2010 and 2019 due to a prior IHR after an ICM injection were included retrospectively. ICM allergy was diagnosed if prick tests or intradermal tests were positive. Further information concerning secondary exposure to ICM was obtained from all patients with negative skin tests to determine whether ICM re-exposure led to an IHR.ResultsSkin tests identified ICM allergy in 7 out of 85 patients (8.2%). Frequency of IgE-mediated hypersensitivity among patients increased with increasing reaction severity. The NPV of skin testing for ICM allergy was 87.8% [95%CI 75.2;95.4.ConclusionThe low prevalence of IgE-mediated hypersensitivity among patients with IHR to ICM should not delay allergy workup. Earlier skin tests and provocation tests with skin-test negative ICM may help allergists to find a reliable alternative ICM.

Anaphylactic and Anaphylactoid Reactions Occurring during Anesthesia in France in 1999–2000

2003 ◽  
Vol 99 (3) ◽  
pp. 536-545 ◽  
Author(s):  
Paul Michel Mertes ◽  
Marie-Claire Laxenaire ◽  
François Alla ◽  
Keyword(s):  
Predictive Value ◽  
Immunoglobulin E ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Diagnostic Value ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Skin Tests ◽  
Expert Advice ◽  
Anaphylactoid Reactions

Background Anaphylactic and anaphylactoid reactions occurring during anesthesia remain a major cause of concern for anesthesiologists. The authors report the results of a 2-yr survey of such reactions observed during anesthesia in France. Methods Between January 1, 1999, and December 31, 2000, 789 patients who experienced immune-mediated (anaphylaxis) or nonimmune-mediated (anaphylactoid) reactions were referred to one of the 40 participating centers. Anaphylaxis was diagnosed on the basis of clinical history, skin tests, and/or specific immunoglobulin E assay. Results Anaphylactic and anaphylactoid reactions were diagnosed in 518 cases (66%) and 271 cases (34%), respectively. The most common causes of anaphylaxis were neuromuscular blocking agents (NMBAs) (n = 306, 58.2%), latex (n = 88, 16.7%), and antibiotics (n = 79, 15.1%). Rocuronium (n = 132, 43.1%) and succinylcholine (n = 69, 22.6%) were the most frequently incriminated NMBAs. Cross-reactivity between NMBAs was observed in 75.1% of cases of anaphylaxis to an NMBA. No difference was observed between anaphylactoid and anaphylactic reactions when the incidences of atopy, asthma, or drug intolerance were compared. However, atopy, asthma, and food allergy were significantly more frequent in the case of latex allergy when compared with NMBA allergy. Clinical manifestations were more severe in anaphylaxis. The positive predictive value of tryptase for the diagnosis of anaphylaxis was 92.6%; the negative predictive value was 54.3%. The diagnostic value of specific NMBA immunoglobulin E assays was confirmed. Conclusions These results further corroborate the need for systematic screening in the case of anaphylactoid reaction during anesthesia and for the constitution of allergoanesthesia centers to provide expert advice to anesthesiologists and allergists.

High Histamine Control Concentration Leads to False Negative Allergy Skin Testing

2021 ◽  
pp. 194589242110086
Author(s):  
Amulya Amirneni ◽  
Jody Tversky
Keyword(s):  
Skin Prick Test ◽  
Skin Test ◽  
Skin Testing ◽  
False Negative ◽  
The Other ◽  
Skin Tests ◽  
Prick Test ◽  
Timothy Grass ◽  
Significant Difference ◽  
Dust Mite

Background Allergy skin test reliability depends on the reagents and controls selected. Histamine is used at 1 mg/ml and 6 mg/ml concentration but few studies address the rationale for selecting one versus the other and how this may impact diagnostic accuracy. Objective To determine the rate of false negative allergen skin tests responses between UniTest PC (using the 1 mg/mL histamine) and Quintip devices (using 6 mg/mL) for 4 common aeroallergens. Methods Subjects aged 18-65 with symptoms of allergy to cat and/or ragweed received skin testing with 4 aeroallergens (dust mite mix, timothy grass, ragweed, cat), histamine and control diluent. Those individuals who tested positive to cat or ragweed with one skin prick test (SPT) device but not the other then proceeded to nasal allergen challenge (NAC). The primary outcomes were the aeroallergen false negative rates and sensitivities of the skin test devices followed by nasal allergen (NAC). Results Twenty-five individuals were recruited and underwent a total of 300 SPTs. SPT to allergens (ragweed, dust mite, cat, and timothy grass) resulted in a statistically significant difference in wheal size among the two skin testing devices ( p value <0.0001, 0.0001, 0.0006, and 0.0053 respectively). Six NAC procedures were performed to cat/ragweed and 5 of 6 (83% were positive). The overall allergen sensitivity rate for UniTest and Quintip were 97% and 78% respectively with most false negatives due to the use of 6 mg/ml histamine control reagent. Conclusion Our study shows that 6 mg/ml concentration of histamine control reagent may contribute to a false interpretation of aeroallergen skin prick test results.

scholarly journals Anaphylaxis to Glatiramer Acetate

2015 ◽  
Vol 8 (1) ◽  
pp. 23-25 ◽  
Author(s):  
By Stefan Wöhrl ◽  
Felix Wantke ◽  
Wolfgang Hemmer
Keyword(s):  
Multiple Sclerosis ◽  
Skin Prick Test ◽  
Glatiramer Acetate ◽  
Intradermal Test ◽  
Positive Skin Prick Test ◽  
Positive Skin ◽  
Prick Test ◽  
Asthma Attack ◽  
Anaphylactoid Reactions ◽  
Ige Mediated

Glatiramer acetate (Copaxone, Teva Pharma) and interferon beta are the two only disease-modifying therapies for multiple sclerosis. Glatiramer acetate is known for frequently simulating mild, anaphylactoid reactions while true, IgEmediated allergic reactions have been hardly reported so far. Herein, we report two females suffering from multiple sclerosis who experienced rapidly aggravating hypersensitivity-reactions upon treatment with glatiramer acetate. Patient one experienced an asthma attack, patient two an exacerbation of her urticaria and angioedema. An IgE-mediated mechanism could be demonstrated by a positive intradermal test to a 1:1000 dilution in the first 31-year old and by a positive skin prick test to a 1:10 diluted skin prick test in the second 32-year old second woman.

scholarly journals Immunoglobulin E Antibodies to Rocuronium

2007 ◽  
Vol 107 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Didier G. Ebo ◽  
Lennart Venemalm ◽  
Chris H. Bridts ◽  
Frederik Degerbeck ◽  
Hans Hagberg ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Decision Threshold ◽  
Reliable Technique ◽  
Total Ige ◽  
Blocking Agents ◽  
And Control

Background Diagnosis of allergy from neuromuscular blocking agents is not always straightforward. The objectives of the current study were to investigate the value of quantification of immunoglobulin E (IgE) by ImmunoCAP (Phadia AB, Uppsala, Sweden) in the diagnosis of rocuronium allergy and to study whether IgE inhibition tests can predict clinical cross-reactivity between neuromuscular blocking agents. Methods Twenty-five rocuronium-allergic patients and 30 control individuals exposed to rocuronium during uneventful anesthesia were included. Thirty-two sera (total IgE &gt; 1,500 kU/l) were analyzed for potential interference of elevated total IgE titers. Results were compared with quantification of IgE for suxamethonium, morphine, and pholcodine. Cross-reactivity between drugs was assessed by IgE inhibition and skin tests. Results Sensitivity of IgE for rocuronium, suxamethonium, morphine, and pholcodine was 68, 60, 88, and 86%, respectively. Specificity was 100% for suxamethonium, morphine, and pholcodine IgE and 93% for rocuronium IgE. ROC analysis between patients and control individuals changed the threshold to 0.13 kUa/l for rocuronium, 0.11 kUa/l for suxamethonium, 0.36 kUa/l for morphine, and 0.43 kUa/l for pholcodine. Corresponding sensitivity was 92, 72, 88, and 86%, respectively. Specificity was unaltered. Interference of elevated total IgE with quantification of IgE was demonstrated by the analysis in sera with a total IgE greater than 1,500 kU/l. IgE inhibition did not predict clinical relevant cross-reactivity. Conclusions The rocuronium ImmunoCAP constitutes a reliable technique to diagnose rocuronium allergy, provided an assay-specific decision threshold is applied. IgE assays based on compounds bearing ammonium epitopes are confirmed to represent reliable tools to diagnose rocuronium allergy. High total IgE titers were observed to affect specificity of the assays.

scholarly journals The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

2021 ◽  
Vol 19 (2) ◽  
pp. 78-83
Author(s):  
Özge Can Bostan ◽  
Mehmet Erdem Çakmak ◽  
Saltuk Buğra Kaya ◽  
Ebru Damadoğlu ◽  
Gül Karakaya ◽  
...  
Keyword(s):  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Clinical Value ◽  
Radiocontrast Media ◽  
Iodinated Contrast ◽  
Culprit Drug ◽  
Keywords Allergy ◽  
Clinical Dilemma

ABSTRACT Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

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