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 Cutaneous Anergy in Pregnant and Nonpregnant Women With Human Immunodeficiency Virus

1998 ◽  
Vol 6 (1) ◽  
pp. 13-17 ◽  
Author(s):  
N. L. Eriksen ◽  
A. W. Helfgott
Keyword(s):  
Human Immunodeficiency Virus ◽  
Skin Test ◽  
T Lymphocyte ◽  
Lymphocyte Count ◽  
Skin Testing ◽  
The Other ◽  
Tuberculin Skin Testing ◽  
Test Results ◽  
Significant Difference ◽  
Immunodeficiency Virus

Objective:To determine the prevalence of cutaneous anergy in pregnant and nonpregnant women who are seropositive for human immunodeficiency virus.Methods and materials:The medical records of 159 women seropositive for human immunodeficiency virus were reviewed. Demographic characteristics and tuberculin skin test results were abstracted from the chart. Tuberculin skin testing was performed by the Mantoux method (5 tuberculin units of purified protein derivative injected intradermally). Anergy testing was performed using any two of the three following antigens; tetanus toxoid, mumps, orCandidaskin test antigen. A positive tuberculin test was defined as induration of 5 mm or more, and a positive test for the other antigens was defined as any amount of induration over the skin test area. Anergy was defined as any amount of induration to the other antigens. A CD4+T lymphocyte count was obtained at the time of skin testing. Continuous variables were analyzed using the Mann Whitney—U test. Categorical data were analyzed with the chi-square or Fisher's exact test as appropriate. A two-tailedPvalue <0.05 was considered significant.Results:There were 102 nonpregnant and 57 pregnant women who returned to have their skin test results read. There was no significant difference in the prevalence of positive, negative or anergic skin test results between groups. The CD4+T lymphocyte count (mean ± standard deviation) in patients with anergic results was similar between pregnant (375 ± 256/mm3) and nonpregnant (358 ± 305/mm3) women (P= 0.64).Conclusion:The prevalence of cutaneous anergy is similar among pregnant and nonpregnant women seropositive for human immunodeficiency virus.

Controversial Techniques in Allergy

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 935-937
Author(s):  
GAIL G. SHAPIRO ◽  
JOHN A. ANDERSON
Keyword(s):  
Respiratory Tract ◽  
Physical Examination ◽  
Skin Test ◽  
Skin Testing ◽  
Skin Tests ◽  
Sensitive Test ◽  
Financial Gain ◽  
Specific Antigens ◽  
Laboratory Procedures ◽  
Allergy Skin Testing

Ten years ago a commentary appeared in Pediatrics entitled "Allergy Skin Testing: Science or Quackery?"1 This statement was a rejoinder to a commentary in Pediatrics in 19752 that included allergy skin testing in a list of laboratory procedures that are abused for financial gain. The gist of the reply was that allergy skin tests themselves were not the problem because they were valid bioassays for IgE antibody to specific antigens. Abuse and quackery set in when numerous, indiscriminately chosen skin tests were performed instead of an appropriate history, physical examination, and carefully selected tests based on that evaluation. The allergy skin test was at that time and remains today the most sensitive test for specific allergic antibody in the skin, its presence there reflecting its presence in the blood and respiratory tract.

scholarly journals Analysis of Allergen-Specific T Cell and IgE Reactivity to Different Preparations of Cow’s Milk-Containing Food Extracts

Cells ◽  
2019 ◽  
Vol 8 (7) ◽  
pp. 667 ◽  
Author(s):  
Meng Chen ◽  
Aaron Sutherland ◽  
Giovanni Birrueta ◽  
Susan Laubach ◽  
Stephanie Leonard ◽  
...  
Keyword(s):  
T Cell ◽  
Skin Prick Test ◽  
Food Allergies ◽  
Cow’S Milk ◽  
Cell Reactivity ◽  
Prick Test ◽  
Cow's Milk ◽  
Ige Reactivity ◽  
Significant Difference ◽  
T Cell Reactivity

Background: cow’s milk allergy (CM) is among the most common food allergies in young children and is often outgrown by adulthood. Prior to developing a tolerance to CM, a majority of CM-allergic children may tolerate extensively-heated CM. This study aims to characterize the IgE- and T cell-reactivity to unheated CM and the progressively more heated CM-containing foods. Methods: CM-containing food extracts from muffin, baked cheese, custard and raw, pasteurized CM commercial extract were tested for skin prick test reactivity, IgE binding and T cell reactivity as assessed by IL-5 and IFNγ production. Results: the skin prick test (SPT) reactivity was significantly decreased to muffin extract compared to raw, pasteurized CM. Both IgE- and T-cell reactivity were readily detectable against food extracts from all forms of CM. Western blot analysis of IgE reactivity revealed variability between extracts that was protein-specific. T cell-reactivity was detected against all four extracts with no significant difference in IL-5 or IFNγ production between them. Conclusion: our data indicate that despite reduced clinical reactivity, extracts from heated CM-containing foods retain immunogenicity when tested in vitro, particularly at the T cell level.

scholarly journals Descriptive Study on Skin Prick Test in Allergy Clinic Immanuel Hospital Bandung Indonesia

2017 ◽  
Vol 1 (6) ◽  
Author(s):  
Danny R Garna ◽  
Johan Lucianus ◽  
July Ivone
Keyword(s):  
Skin Prick Test ◽  
House Dust ◽  
House Dust Mite ◽  
Clinical Signs ◽  
Data Retrieval ◽  
Food Allergens ◽  
Allergy Clinic ◽  
Prick Test ◽  
Common Food ◽  
Dust Mite

Allergy is a change of reaction or body's defense response to substances that are actually harmless. An estimated 10-20% of the population had been or are suffering from the disease. The purpose of this study was to thoroughly observe allergic patients on Allergy Clinic Immanuel Hospital Bandung from January 2013–January 2014 based on allergen, clinical sign, age and gender. This study use descriptive methods with retrospective data retrieval from medical record. We gathered 206 skin prick test (SPT) results and found that the highest incidence of allergy was between 31-40 years (22.33%), 64.54% were women, 43.20% of patients with dermatitis as the major clinical signs, 70.59% of patients allergic to house dust mite as a common environmental allergens, 24.84% of patients allergic to shrimp as the most common food allergens. In conlusion, allergic patients with SPT positive common at the age of 31-40 years, women, Dermatitis as a major clinical signs. The most common environmental allergens that cause allergy was house dust mite. The most common food allergens that cause allergy was shrimp.Keywords: allergy, dermatitis, Immanuel Hospital Bandung, skin prick test

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 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.

Neue Charakteristika klinisch manifester Latexallergiker

2019 ◽  
Vol 7 (1) ◽  
pp. 29-31
Author(s):  
Vera Mahler
Keyword(s):  
Medical History ◽  
Skin Test ◽  
Correct Diagnosis ◽  
Natural Rubber Latex ◽  
Specific Ige ◽  
Latex Allergy ◽  
Skin Tests ◽  
Diagnostic Challenge ◽  
Positive Skin ◽  
Significant Difference

Background: Natural rubber latex (NRL) allergy is commonly diagnosed according to medical history, skin allergy tests, and serological analyses. However, skin tests are increasingly being abandoned because of (i) their time-consuming nature, (ii) latex preparations for skin tests being not commercially available, and (iii) the use of in-house prepared test solutions is becoming ever more difficult due to increasing regulatory hurdles. In this light, we have evaluated differences in the profiles of current and former patients with suspected latex allergy. Methods: Sera of skin test-positive patients from a historic cohort (1995-2001, n = 149 patients) and currently (2014-2015, n = 48 patients) were simultaneously analyzed for specific IgE to latex by ImmunoCAP. If the serological screening was positive (≥ 0.35 kU/l), component-resolved diagnostics including profilins and cross-reactive carbohydrate determinants (CCDs) were performed. Results: In contrast to 88% (131/149) of the skin test-positive patients from the 1990s, only 51.1% (24/47) of the current cohort were found positive for specific IgE to latex. While 48.3% (72/149) of the patients had a convincing positive history in the 1990s, current skin test-positive patients rarely reported a relevant medical history (8.5%, 4/47). Specific IgE levels to latex were significantly higher in former patients with suspected latex allergy (p < 0.001) than in former sensitized individuals without allergy. However, this significant difference was lost in current allergic and sensitized patients with positive skin tests. Conclusion: Sensitization profiles in patients with latex allergy have changed significantly over the last 2 decades. Discrimination between NRL sensitization and clinical allergy remains a diagnostic challenge. Our data highlight the need for a combination of all 3 criteria, i.e., patient history, skin test, and analysis of specific IgE, for a correct diagnosis of latex allergy.

scholarly journals Early Skin Test after Anaphylaxis during Induction of Anesthesia: A Case Report

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 394
Author(s):  
Ann Hee You ◽  
Jeong Eun Kim ◽  
Taewan Kwon ◽  
Tae Jun Hwang ◽  
Jeong-Hyun Choi
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Adverse Events ◽  
Skin Prick Test ◽  
Skin Test ◽  
Pulse Rate ◽  
Negative Reaction ◽  
Pituitary Macroadenoma ◽  
Prick Test ◽  
Alternative Agent

Background: It is recommended that a skin test be performed 4–6 weeks after anaphylaxis. However, there is little evidence about the timing of the skin test when there is a need to identify the cause within 4–6 weeks. Case report: A 57-year-old woman was scheduled to undergo surgery via a sphenoidal approach to remove a pituitary macroadenoma. Immediately after the administration of rocuronium, pulse rate increased to 120 beats/min and blood pressure dropped to 77/36 mmHg. At the same time, generalized urticaria and tongue edema were observed. Epinephrine was administered and the surgery was postponed. Reoperation was planned two weeks after the event. Four days after the anaphylactic episode, rocuronium was confirmed to be the cause by the skin prick test. Cisatracurium, which showed a negative reaction, was selected as an alternative agent for future procedures. Two weeks later, the patient underwent reoperation without any adverse events. Conclusions: The early skin test can be performed if there is a need even earlier than 4–6 weeks after anaphylaxis.

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