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.

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.

The Effect of Acupuncture on Allergic Rhinitis: A Randomized Controlled Clinical Trial

2004 ◽  
Vol 32 (01) ◽  
pp. 105-115 ◽  
Author(s):  
Anna-Lena Magnusson ◽  
Rita E. B. Svensson ◽  
Carin Leirvik ◽  
Ronny K. Gunnarsson
Keyword(s):  
Allergic Rhinitis ◽  
Drug Therapy ◽  
Skin Test ◽  
Clinical Symptoms ◽  
Specific Ige ◽  
Sham Acupuncture ◽  
Controlled Clinical Trial ◽  
Test Reaction ◽  
Positive Skin ◽  
Test Reactions

Allergic rhinitis is a common health problem usually treated with drug therapy. Some patients experience side effects of drug therapy while others fear the use of drugs. Acupuncture is an interesting alternative to traditional treatment. The few studies evaluating acupuncture indicate a possible clinical effect on allergic rhinitis. This study compared active versus sham acupuncture in 40 consecutive patients with a history of allergic rhinitis and a positive skin test. Patients were randomized and assessed prior to treatment and then reassessed after 12 months. Improvements in symptoms using visual analogue scales, reduction in skin test reactions and levels of specific immunoglobin E (IgE) were used to compare the effect of treatment. For one allergen, mugwort, a greater reduction in levels of specific IgE ( p =0.019, 0.039) and skin test reaction ( p =0.004) was seen in the group receiving active acupuncture compared to the group receiving sham acupuncture. However, this finding might be an artifact. No differences in clinical symptoms were seen between active versus sham acupuncture, thus the conclusion being that the effect of acupuncture on allergic rhinitis should be further evaluated in larger randomized studies.

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).

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.

Coccidioidomycosis of the Larynx in Infants and Adults

1977 ◽  
Vol 86 (5) ◽  
pp. 655-660 ◽  
Author(s):  
Paul H. Ward ◽  
David Morledge ◽  
George Berci ◽  
Harmon Schwartz
Keyword(s):  
United States ◽  
Amphotericin B ◽  
Clinical Symptoms ◽  
Skin Testing ◽  
Fungal Disease ◽  
Southwestern United States ◽  
Positive Skin ◽  
Life Threatening ◽  
Primary Form

Coccidioidomycosis is a fungal disease endemic to the southwestern United States. The primary form of the disease is relatively benign and many patients, after exposure by inhalation of the sapyrophytic form of the organism, convert from negative to positive skin testing without significant clinical symptoms. The less common disseminated form represents a serious life-threatening disease and can present with granulomatous changes in the larynx. The authors' experience with disseminated coccidioidomycosis presenting in the larynx of adults and infants successfully treated with amphotericin B are presented and discussed.

Meglumine antimoniate-induced DRESS: original case with a positive skin test

2018 ◽  
Vol 63 (4) ◽  
pp. 845-847 ◽  
Author(s):  
Amel Chaabane ◽  
Haifa Ben Romdhane ◽  
Hajer Ben Brahim ◽  
Nadia Ben Fredj ◽  
Zohra Chadli ◽  
...  
Keyword(s):  
Skin Test ◽  
Clinical Picture ◽  
Drug Withdrawal ◽  
Skin Tests ◽  
Positive Skin ◽  
Meglumine Antimoniate ◽  
Blood Tests ◽  
Intradermal Tests ◽  
Original Case ◽  
Hepatic Cytolysis

Abstract We report a case of a 64-year-old woman treated with meglumine antimoniate (Glucantime®). On day 20, she developed fever, a pruriginous skin rash and myalgia. The blood tests showed eosinophilia and hepatic cytolysis. The clinico-biological picture improved gradually and the symptoms disappeared 4 weeks after the drug withdrawal. Six weeks later, intradermal tests to Glucantime® were performed and were positive at 48 hour-reading. This clinical picture suggests DRESS induced by meglumine antimoniate. To the best of our knowledge, only one case of meglumine antimoniate-induced DRESS has been reported in the literature and we are the first to report a case confirmed by skin tests.

THE RELATIONSHIP BETWEEN PARENTAL AND CHILDREN'S SERUM IMMUNOGLOBULIN E (IgE) AND ASTHMA

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 329-329
Author(s):  
Stanley P. Galant
Keyword(s):  
Bronchial Asthma ◽  
Immunoglobulin E ◽  
Skin Tests ◽  
Z Score ◽  
Significant Determinant ◽  
Positive Skin ◽  
Asthmatic Children ◽  
Children With Asthma ◽  
Z Scores ◽  
The Relationship

Purpose of the Study. To examine parental factors that influence bronchial asthma and immunoglobulin E (IgE) levels in their children. Methods. The data in this study were derived from the Tucson Epidemiological Study of Airways Obstructive Diseases since 1972. Eleven evaluation periods have been performed since that time. Asthma histories were established by questionnaire. IgE levels were obtained in 738 children, 1043 fathers, and 1261 mothers. IgE levels were determined by paper radioimmunosorbent (PRIST) technique. IgE Z scores were established. An IgE Z score is the number of standard deviations IgE differs from matched age and sex-matched subjects and log corrected. Skin tests were performed by prick technique to house dust, mold, grass, tree and weed mix and appropriate controls. Results. The percentage of children with bronchial asthma increased with the presence of asthma in parents so that 11.5% of children with asthma occurred in families with no parental asthma compared with 48.6% when both parents had asthma. The rate of childhood bronchial asthma was significantly related to parental IgE levels only when the mother and father had bronchial asthma (43% vs 20%) and much less so (22% vs 10%), when there was no parental asthma. In addition, asthma in the child proved to be a highly significant determinant of the child's IgE Z score, even after correcting for parental IgE Z score. The presence of atopy (ie, positive skin tests) was also not a significant determinant of IgE levels in asthmatic children. Discussion. The authors conclude that the inheritance of IgE is only one factor related to the development of asthma, and is limited as a predictor.

SKIN TEST REACTIVITY TO BEE HIVE PRODUCTS (HONEY BEES, HONEY, ROYAL JELLY AND POLLEN)

2016 ◽  
Vol 78 (5-10) ◽  
Author(s):  
Mai Shihah Abdullah ◽  
Nasuruddin Abdullah
Keyword(s):  
Skin Test ◽  
Honey Bee ◽  
Honey Bees ◽  
Royal Jelly ◽  
Skin Testing ◽  
Positive Skin Prick Test ◽  
Positive Skin ◽  
Skin Test Reactivity ◽  
Bee Pollen ◽  
Allergen Extracts

Bee hive products such as honey bees, honey, royal jelly and pollen are widely consumed as a health supplement. There has been several cases of allergic reactions to bee hive products reported worldwide. Consumption of bee hive products is common among Malaysians, but the degree of its sensitization is not known. The aim of this study is to determine the prevalence of skin test reactivity to Apis mellifera, domesticated locally and the bee hive products such as honey bees, honey, royal jelly and pollen among a group of volunteers. Four types of honey collected from different locations with different plant sources; one sample of imported honey from Australia, one sample of royal jelly, four different sources of bee pollen, and honey bee derivatives were used to prepare allergen extracts for skin testing. 2522 volunteers were skin tested to these allergen extracts. 271 (10.75%) of the subjects had a positive skin prick test result to at least one honey bee derivative or bee hive product allergen. Individuals with skin test positivity to honey bee are most likely to be sensitized to bee pollen followed by honey and royal jelly. Skin test reactivity to honey bee and bee hive products is prevailed to be high in Malaysia. This study has proven that bee hive products sensitization individuals are mostly to be also sensitized to honey bees. Therefore, is recommended these allergens to be included in the skin prick panel

scholarly journals Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

2020 ◽  
Vol 48 (5) ◽  
pp. 404-408
Author(s):  
James F Preuss ◽  
Catherine E Goddard ◽  
Russell C Clarke ◽  
Peter R Platt ◽  
Paul HM Sadleir
Keyword(s):  
Skin Testing ◽  
Recovery Period ◽  
Parent Compound ◽  
Alternative Formulation ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Detailed History ◽  
Intravenous Paracetamol ◽  
Potential Trigger ◽  
The Individual

Investigation of intraoperative anaphylaxis includes the exclusion of potential trigger agents the individual was exposed to within a plausible interval preceding the reaction. Occasionally, none of these agents will test positive. In this situation it is important to consider that excipients may be responsible for anaphylaxis, that the dilutions prepared to test the medication may not contain an appropriate concentration of the excipient to induce a positive skin reaction, or if an alternative formulation of the medication is tested, it may not contain the culprit excipient. This case describes a patient, who previously experienced an anaphylactic reaction to Betadine® (Sanofi-Aventis Australia Pty Ltd, North Ryde BC, NSW) experiencing anaphylaxis in the recovery period after general anaesthesia where Betadine was avoided. The recently administered therapeutics were excluded by skin testing, however further investigation determined that a povidone-containing formulation of paracetamol had been administered. Skin testing with povidone-containing paracetamol resulted in a positive reaction in the patient, but not in a volunteer control. Pharmaceutical excipients are added to medications to increase absorption, shelf-life and efficacy. Different brands of the same drug may contain different excipients. When testing for anaphylaxis with such compounds one must be sure the dilution is appropriate for both the parent compound and the excipient to ensure the accuracy of skin-prick and intradermal testing. This case demonstrates the potential for excipients to cause severe allergy and the importance of detailed history pertaining to previous allergic episodes as even the most unlikely of medications can potentially result in anaphylaxis due to excipients.

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.

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