scholarly journals Pre-vaccination allergy testing with COVID-19 mRNA vaccines predicts tolerance

2021 ◽  
Author(s):  
Florian Stehlin ◽  
Rima Mahdi-Aljedani ◽  
Loris Canton ◽  
Véronique Monzambani-Banderet ◽  
Alix Miauton ◽  
...  
Keyword(s):  
Acute Asthma ◽  
Skin Testing ◽  
Skin Tests ◽  
Positive Skin ◽  
Post Vaccination ◽  
Vaccination Protocol ◽  
Acute Asthma Exacerbation ◽  
History Of ◽  
Negative Skin Test ◽  
Dependent Mechanism

Background: The newly developed mRNA-based COVID-19 vaccines can provoke anaphylaxis, possibly induced by polyethylene glycol (PEG) contained in the vaccine. The management of persons with a history of PEG allergy, or with an allergic-like reaction after the first dose remains to be defined.  Methods: We studied two cohorts of individuals: one pre-vaccination, the second post-vaccination. Skin testing was performed with COVID-19 mRNA vaccines. Upon negative skin test, a two-step (10%-90%) vaccination protocol was performed. Positive skin tests were confirmed with basophil activation tests (BAT). Vaccine-sensitized patients were offered a five-step induction protocol. Results: We identified 187 patients with high-risk profiles for developing anaphylaxis. In parallel, among 385’926 doses of vaccine, 87 allergic-like reactions were reported to our division for further investigations: 18/87 (21%) were consistent with anaphylaxis, 78/87 (90%) were female, and 47/87 (54%) received the BNT162b2 mRNA vaccine. Vaccine skin tests were negative in 96% and 76% in the pre- and post-vaccination cohorts, respectively. A two-step vaccination was tolerated in 232/236 (98%) of individuals with negative tests. Four individuals experienced acute asthma exacerbation during the two-step challenge. Vaccine-positive skin tests were consistently confirmed by BAT; CD63 and CD203c expression was selectively inhibited with ibrutinib, suggesting an IgE-dependent mechanism. Finally, 13 sensitized patients were successfully vaccinated with a five-step vaccination protocol. Conclusion: A two-step 10%-90%-vaccination protocol can be safely administered upon negative skin testing. Yet, it should be delayed in individuals with poorly controlled asthma. Importantly, mRNA vaccine sensitized individuals may receive a five-step vaccination protocol.

Skin Testing for Penicillin Allergy: Its Limited Value

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 309-309
Author(s):  
Renee K. Bergner
Keyword(s):  
American Academy ◽  
Skin Testing ◽  
Skin Tests ◽  
Penicillin G ◽  
Study Group ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
American Academy Of Pediatrics ◽  
History Of ◽  
Therapeutic Administration

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2

scholarly journals Sodium metabisulfite hypersensitivity in urticaria

2021 ◽  
Vol 12 (2) ◽  
pp. 106-112
Author(s):  
Beata Sadowska ◽  
Marlena Sztormowska ◽  
Marika Gawinowska ◽  
Marta Chelminska
Keyword(s):  
Skin Testing ◽  
Food Additives ◽  
Oral Challenge ◽  
Skin Tests ◽  
Sodium Metabisulfite ◽  
Positive Skin ◽  
Patch Tests ◽  
Detailed Medical History ◽  
History Of ◽  
Skin Prick Tests

Background: Sodium metabisulfite is a recognized, but rare, trigger of urticaria, wherein the IgE mechanism has been sporadically proven. The aim of this study was to identify the potential reaction to sodium metabisulfite (MBS) based on a placebo-controlled oral challenge in patients with urticaria and suspected hypersensitivity to food additives. Materials and Methods: A total of 110 adult patients (76 females and 34 males with a mean age of 46 years) were included in the study between 2017 and 2019. All subjects underwent MBS skin prick tests (SPT) and patch tests (PT). Patients with a positive skin test or suspected MBS hypersensitivity were qualified for a placebo-controlled oral challenge (OC). Results: Skin testing was positive in 24 patients: SPT in 20% (n = 22), PT in 5% (n = 6). Out of 64 oral challenges, 13 positive results were obtained. Patients with a positive challenge typed sulfite foods twice as often as a culprit compared to those with a negative OC. Conclusions: In patients with urticaria, both the IgE and non-IgE mechanism of MBS hypersensitivity has been demonstrated. Skin tests with a detailed medical history of potentially guilty foods may be helpful in determining sulfite hypersensitivity.

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).

scholarly journals Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis

Heliyon ◽  
2021 ◽  
pp. e08401
Author(s):  
Wasurat Sungworn ◽  
Orathai Theankeaw ◽  
Aree Jameekornrak Taweechue ◽  
Chamard Wongsa ◽  
Torpong Thongngarm ◽  
...  
Keyword(s):  
Skin Testing ◽  
Skin Tests ◽  
History Of

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.

Scar Formation and Tuberculin Conversion Following BCG

2021 ◽  
Vol 15 (11) ◽  
pp. 3056-3057
Author(s):  
Muhammad Sarfraz ◽  
Zahid Jamil ◽  
Muhammad Naim Ashraf ◽  
Saima Arshad ◽  
Zirwa Sarfraz ◽  
...  
Keyword(s):  
Skin Testing ◽  
Case Series ◽  
Operational Definition ◽  
Scar Formation ◽  
Bcg Vaccine ◽  
Base Line ◽  
Positive Skin ◽  
Post Vaccination ◽  
Vaccination Programs ◽  
Bcg Vaccination

Objective: To determine frequency of scar formation and positive tuberculin conversion test following BCG vaccine administered within 0-28 days of life in children in 6 months to 6 years of age presenting at outpatient department of Fauji Foundation Hospital Lahore. Study Design: Descriptive case series. Place and Duration of Study: Outdoor Department of Pediatrics, Fauji Foundation Hospital, Lahore from 1st July 2020 to 30th December 2020. Methodology: Ninety seven children were included. Base line demographic information of patients (age, gender, weight on weight machine) was recorded. 0.5 ml BCG was administered in right arm. Tuberculin skin test was assessed as per operational definition. After 48 to 72 hours, scar formation was assessed after 1 month. Data regarding scar formation and positive tuberculin conversion test was recorded. Results: The mean age was 3.20±1.46 years, 39 (40.21%) were male whereas 58 (59.79%) were females. The scar formation following BCG vaccine administered within 0-28 days of life in children in 6 months to 6 years of age was 59 (60.82%) and positive tuberculin conversion test following BCG vaccine administered within 0-28 days of life in children in 6 months to 6 years was recorded in 47 (48.45%). Conclusion: Most babies have developed a post-vaccination scar. The combination of the BCG scar and the positive skin testing tuberculin was very important. The development of BCG scars had no effect on age or sex. Greater trials are advised in order to detect the true extent of the problem and to evaluate regularly the BCG vaccination programs. Keywords: Infants, Tuberculosis, BCG vaccination, Scar formation, Positive tuberculin conversion test

scholarly journals Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy

2014 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Manish D Shah ◽  
Sarah K Wise ◽  
Melissa R Rotella ◽  
Avani P Ingley ◽  
Michael M Johns
Keyword(s):  
Retrospective Review ◽  
Skin Testing ◽  
Causal Link ◽  
Skin Tests ◽  
Insufficient Evidence ◽  
Positive Skin ◽  
Nasal Symptoms ◽  
Significant Difference ◽  
Inhalant Allergy ◽  
Allergy Skin Testing

ABSTRACT Background The effect of environmental allergy on laryngeal and pharyngeal complaints is not well understood. The goal of this study was to determine the prevalence of laryngeal and pharyngeal symptoms in patients with environmental inhalant allergy. Methods A retrospective review was conducted of all patients undergoing allergy skin testing between 2006 and 2009. Patients with positive skin tests were included and were classified as ‘mild’ or ‘extensive’ reactors based on skin testing results. Data regarding laryngeal and pharyngeal complaints, as well as ocular and nasal symptoms, had been systematically documented for all patients. The prevalence of these complaints was calculated in each group of reactors and overall. Results The prevalence of laryngeal and pharyngeal complaints was 42.0% overall, 45.5% among the mild reactors, and 39.3% in the extensive reactors. No patients complained of hoarseness or were felt to have dysphonia. There was no statistically significant difference between the mild and extensive reactors (p = 0.78). The prevalence of ocular and/or nasal symptoms was 96.0, 90.9 and 100%, respectively. Conclusion The prevalence of laryngeal and pharyngeal complaints in allergy sufferers was low in this study. Given the conflicting literature on this topic, there is insufficient evidence to establish a causal link between environmental allergy and laryngeal and pharyngeal symptoms. How to cite this article Shah MD, Wise SK, Rotella MR, Ingley AP, Johns MM. Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy. Int J Phonosurg Laryngol 2014;4(1):1-4.

scholarly journals Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
A. Piccorossi ◽  
G. Liccioli ◽  
S. Barni ◽  
L. Sarti ◽  
M. Giovannini ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical History ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Drug Reactions ◽  
Positive Skin ◽  
History Of ◽  
Work Up ◽  
Immediate Reactions

Abstract Background and objective Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs. Methods The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs. Conclusion Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Skin testing in allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 366-368
Author(s):  
Gayatri Patel ◽  
Carol Saltoun
Keyword(s):  
Skin Test ◽  
Immunoglobulin E ◽  
Clinical Symptoms ◽  
Skin Testing ◽  
Smooth Muscle Contraction ◽  
Skin Tests ◽  
Test Reaction ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Clinical Sensitivity

Skin tests are used in addition to a directed history and physical examination to exclude or confirm immunoglobulin E (IgE) mediated diseases, such as allergic rhinitis, asthma, and anaphylaxis, to aeroallergens, foods, insect venoms, and certain drugs. There are two types of skin testing used in clinical practice: percutaneous testing (prick or puncture) and intracutaneous testing (intradermal). Prick testing involves introducing a needle into the upper layers of the skin through a drop of allergen extract that has been placed on the skin and gently lifting the epidermis up. Various devices are available for prick testing. Intracutaneous (intradermal) testing involves injecting a small amount of allergen into the dermis. The release of preformed histamine from mast cells causes increased vascular permeability via smooth-muscle contraction and development of a wheal; inflammatory mediators initiate a neural reflex, which causes vasodilatation, which leads to erythema (the flare). Prick testing methods are the initial technique for detecting the presence of IgE. These may correlate better with clinical sensitivity and are more specific but less sensitive than intradermal testing. Sites of skin testing include the back and the volar aspect of the arm. By skin testing on the arm, the patient can witness the emergence and often sense the pruritus of the skin test reaction. Because more patients are sensitized (have IgE antibodies and positive skin test reactions) than have corresponding symptoms, the diagnosis of allergy can be made only by correlating skin testing results with the presence of clinical symptoms.

AstraZeneca ChAdOx1-S COVID-19 Vaccine Can Be Safely Administered in Patients with EDTA Allergy

2021 ◽  
Author(s):  
Syed Basharat Ali ◽  
Griffith Perkins ◽  
Dongjae Ryoo ◽  
Maverick Lee ◽  
Matthew Tunbridge ◽  
...  
Keyword(s):  
Skin Testing ◽  
Local Anaesthetics ◽  
Intradermal Test ◽  
Disodium Edta ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Radiocontrast Media ◽  
Oral Medications ◽  
Ethylenediaminetetracetic Acid ◽  
History Of

Abstract Background: Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are potentially found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products.Currently patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. We present two cases of previously confirmed EDTA anaphylaxis, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine.Case 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3mg/mL IDT were negative. However, following EDTA 3mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses.Case 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations.Conclusion: Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.

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