Allergen Skin Test Research Articles

Ultrafiltered dog allergen skin test compared with acetone precipitated and conventional dog: A retrospective study.

Background: Various formulations of dog allergen extracts, including conventional dog (also known as dog epithelium) and acetone precipitated (AP) dog, have been used for skin-prick testing (SPT), with AP dog showing improved antigen content but experiencing stability issues due to precipitant formation. Ultrafiltered (UF) dog extract has been developed to address these concerns by offering comparable allergen content to AP dog. This study retrospectively compared UF dog with conventional dog and AP dog in SPT. Objective: To compare the efficacy of UF dog extract with conventional dog and AP dog extracts in detecting dog sensitization through SPT. Methods: Retrospective analysis of SPT results from a single U.S. allergy clinic was conducted. Tests performed between October 2022 and March 2024 were included. Primary and secondary outcomes were analyzed by using descriptive statistics and statistical tests. Results: UF dog, AP dog, and conventional dog showed positivity rates of 24.2%, 23.5%, and 16.3%, respectively. UF dog demonstrated significantly higher average wheal and erythema sizes compared with conventional dog and AP dog, but UF dog was not statistically different from AP dog in terms of test positivity. Conclusion: UF dog extract showed comparable number of positive tests to AP dog and a greater number of positive tests to conventional dog. Results of the study suggest UF dog as a viable alternative to AP dog, which offered improved stability and similar test responses. Further research with larger sample sizes is recommended to confirm these findings.

Rank correlation between atopic comorbidity and laboratory parameters in allergic rhinitis

One of the current cutting-edge problems in allergy and ENT is the study of comorbidity in allergic rhinitis, which is the most common atopic disease among all other atopies. Two decades ago, a new endotype of the disease, local allergic rhinitis, was discovered. In the past, some patients with typical complaints of chronic nasal congestion, persistent runny nose, and other similar symptoms, did not display such characteristic diagnostic criteria as positive allergy skin tests and an increased value of serum total IgE and specific IgE antibodies. They were qualified by allergists and ENT specialists as individualists with non-allergic rhinitis and, accordingly, did not receive adequate treatment. However, their symptoms remained, prompting them to abuse decongestants and resulting in an increased burden on the cardiovascular system. This, along with the burden of concomitant pathology, including other atopies, can be considered a significant medical and social problem. With the purpose to study rank correlation between comorbidity and three laboratory biomarkers, 46 patients with allergic rhinitis were examined. The list of parameters included two routine items such as serum total IgE and eosinophilic cationic protein, and rarely studied IL-4 in skin exudate. Clinical analysis showed that significantly more often allergic rhinitis in patients was combined with bronchial asthma (in 39.1%, p 0.05), less often with food allergy (in 19.6%), atopic dermatitis (in 10.9%), insect allergy (in 8.7%), and allergic urticaria (in 4.5%). In one case, local perennial rhinitis was identified, accompanied by conventional seasonal rhinitis with a high content of serum total IgE and positive allergic skin tests with pollen allergens. Skin tests with household allergens, including house dust mite products, showed a negative result. This case was regarded as a manifestation of the so-called “double” allergic rhinitis. The Spearman correlation demonstrated a negative mean strength relationship between comorbidity and serum IgE and eosinophilic cationic protein (p 0.05). The seemingly paradoxical result can be interpreted quite logically, taking into account immunopathogenetic mechanisms of allergic inflammation. In particular, with an increase in the frequency of atopic comorbidity, the migration of eosinophils from the blood to sites of eosinophilic inflammation increases.

Allergen skin test responses in broad U.S. asthma population in those with and without rhinitis.

Background: Asthma and allergic rhinitis are pathologically interlinked conditions. Despite skin testing (ST) being pivotal for evaluating allergic sensitization, U.S. data that date back to 1960s on ST reactivity patterns in subjects with asthma remain sparse. Objective: The purpose of this study was to elucidate seasonal, perennial ST responses, and their relationship with asthma severity, early versus late onset disease, and immunoglobulin E (IgE) levels. Methods: Five hundred patients with asthma were randomly selected from the National Jewish Health electronic medical record over a 3-year span. Demographic, clinical, and allergen ST reactivity data for a battery of seasonal and perennial allergens were procured, including total IgE levels, asthma onset, and severity, by using t-tests, χ² tests, and Analysis of Variance (ANOVA), patterns of reactivity were assessed for overall, seasonal, and perennial allergens in relation to IgE levels, asthma onset, and severity. Results: Of the 500 patients, 398 were analyzed. 63.3% were women, 50.1% had adult-onset asthma, and 86.1% had rhinitis; 75.3% tested positive to one or more allergens, with men demonstrating higher overall (p = 0.039) and perennial (p = 0.035) sensitization. ST reactivity varied based on the presence of rhinitis for seasonal (p = 0.028) but not perennial (p = 0.733) allergens. Asthma severity was not significantly associated with ST reactivity (p > 0.10). ST positivity for perennial (p < 0.001) but not seasonal (p = 0.128) allergens was higher in childhood-onset asthma versus adult-onset asthma despite both groups having a large percentage of reactors. Elevated IgE levels correlated with ST reactivity (p < 0.01). Conclusion: Our study represents a unique comprehensive evaluation of ST reactivity in a U.S. asthma population, which is lacking in the literature, when factoring in asthma onset, severity, and IgE levels. Our findings underscore the importance of allergen sensitization in asthma, regardless of severity, concurrent rhinitis symptoms, or asthma onset, which challenge some of the prevailing assumptions about the relationship between allergen sensitization and asthma onset.

Molecular diagnostic strategies and management of dust mite allergy

Dust mites are one of the most important allergens, widely distributed around the world, especially in household environments. Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis are the most common species of dust mites. There are more than 35 known sensitization components of dust mites, among which Der p 1, Der p 2 and Der p 23 are the major components. Clinically, allergen skin test and serum specific immunoglobulin E (sIgE) detection are widely used in the preliminary diagnosis of dust mite allergy. However, these methods cannot accurately identify specific dust mite sensitization components. Considering that there are significant differences in the allergenic components of dust mites in different regions and populations, component-resolved diagnosis of dust mite is particularly important in accurately determining the allergenic components. This is not only of guiding significance for allergen avoidance, but also important for determining the immunotherapy regimen for dust mites. In order to strengthen the understanding of the molecular diagnosis of dust mites and promote the integration of allergy science in China with the international standards, this article interprets the "Allergy Molecular Allergology User's Guide 2.0" published recently by the European Academy of Allergy and Clinical Immunology.

Prévalence de l’asthme éosinophilique dans la population asthmatique pédiatrique lors du diagnostic d’asthme léger à modéré

In children, the etiology of asthma is multifactorial and the prevalence of eosinophilic asthma remains poorly understood. AimEstimating the prevalence of eosinophilic asthma among the pediatric asthmatic population when diagnosed with mild to moderate asthma, and comparing the outcome of the exhaled fraction of nitric oxide (FeNO) and allergic skin tests to eosinophilia. MethodsSeventy children aged 5 to 18 years, consulting for the first time for asthma symptoms without treatment, were included. Each patient underwent a medical history, physical examination, allergic skin tests, lung function tests, measurement of the exhaled fraction of nitric oxide and biology with blood count and specific IgE. ResultsAn eosinophilic asthma prevalence of 37% has been found in our population. Eosinophilia ≥ 400/mm3 was correlated with FeNO ≥ 20ppm (≥ 25ppm in children ≥ 12 years old) (p<0.001) and allergic sensitization (p=0.002). Sixty-nine percent (18/26) of patients with eosinophilia ≥ 400/mm3 had FeNO ≥ 20ppm (≥ 25ppm in children ≥ 12 years old) and eighty-eight percent (23/26) had at least one allergic sensitization. Eosinophilia was significantly higher when FeNO was ≥ 20ppm (≥ 25ppm in children ≥ 12 years old) (p<0.001) and during an allergic sensitization (p=0.004). ConclusionOur study confirms the link between 3 markers of Th2-type inflammation: eosinophilia, allergic skin tests positivity and FeNO elevation, to be confirmed by larger studies.

Эозинофильные заболевания желудочно-кишечного тракта. Эозинофильный энтерит у детей

Aim. To analyze current data on epidemiology, pathophysiology of eosinophilic gastrointestinal diseases (EGID) in children with focus on small intestinal affection. Key points. EGID are inflammatory conditions of the gastrointestinal tract, characterized by tissue eosinophilia with a depth of organ damage from the mucous layer to the muscular and serous layer, resulting in severe damage to their structure and function. Importance of food allergy is still underestimated, although it affects about 5% of children and up to 3–4% of adults. Eosinophilic diseases of the digestive tract are receiving close attention from experts all over the world. A few decades ago, these diseases were described as rare and articles presented isolated clinical cases, but nowadays the publications have increased by several times. There is increasing evidence of the role of aeroallergens and food allergens in the pathogenesis of eosinophilic esophagitis, gastritis, and enteritis, as children and adults with EGID are often found to have positive skin tests for food allergens and/or a family history of allergic diseases. Keywords: eosinophilic disorders of the gastrointestinal tract, eosinophilic gastrointestinal diseases, eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis, food allergy, atopy

ИЗУЧЕНИЕ ЦИТОКИНОВОГО ПРОФИЛЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК 5-Й СТАДИИ И ТУБЕРКУЛЕЗОМ

In the recent years detection and diagnosis of TB has widely involved such immunological tests as the recombinant tuberculosis allergen (RTA) skin test (Diaskintest®) and interferon gamma release assay (IGRA) tests. However, numerous defects of cellular and humoral immunity in patients with stage 5 chronic kidney disease (CKD) lower sensitivity of the above tests for TB detection (42% and 47% respectively). The altered immune response in stage 5 CKD patients dictates the need for search for other biomarkers of TB infection for this specific category of patients. The review analyzes literature data for the recent 30 years related to scientific research into cytokine profiling in stage 5 CKD patients with TB infection as a specific comorbid group. We have compared data on immunological studies of TB patients without uremia, including quantitative evaluation of innate immunity cytokines (some interleukins, tumor necrosis factor α) and enzyme immunoassay, analysis of cytokine gene expression using real-time polymerase chain reaction. The data on immune defects in CKD patients on renal replacement therapy (hemodialysis) are represented. The data on elevated concentrations of inflammation markers in dialysis patients and the information about the correlation between dialysis duration and cytokine concentrations are provided. False negative results of immunological tests for TB in CKD patients are partially explained. The current tendencies in search for TB infection biomarkers in CKD patients, including those on renal replacement therapy, are shown, as well asthe tendencies in search for TB activity markers and responses to TB treatment. Despite the controversial data, we believe that our study of immune responses of stage 5 CKD patients can provide the basis for the development of new tools for detection and diagnosis of TB infection in this immunocompromised group. The study of cytokine production in stage 5 CKD patients provides opportunities for the development of new diagnostic tests and/or markers of TB infection activity in this specific group of patients.

FROM CVID TO AERD: ADDRESSING EPITHELIAL BARRIER DYSFUNCTION FROM NON-TYPE-2 TO HIGH-TYPE-2 AIRWAY INFLAMMATION

<h3>Introduction</h3> We describe two severe asthmatics on opposite ends of the Type 2 inflammatory spectrum. One patient with high Type 2 signature including AERD. The other with low Type 2 inflammation with CVID and infection-driven asthma. Both experienced significant improvement of upper and lower respiratory symptoms with tezepelumab. <h3>Case Description</h3> A 46-year-old male AERD patient suffered from severe asthma and nasal polyposis with anosmia. His symptoms persisted despite high-dose inhaled corticosteroid/long-acting beta₂-agonist, systemic corticosteroids, budesonide saline sinus rinses, and multiple nasal polypectomies, causing a significant impact on QoL. Three months post-tezepelumab treatment resulted in 1,000 mL increase in FEV₁. He no longer needed systemic corticosteroids or use of his rescue inhaler. Anosmia resolved and taste returned. A 14-year-old female CVID patient with low peripheral eosinophil count, low total IgE, allergen skin test negativity, and low FeNO had poorly controlled asthma despite subcutaneous immunoglobulin therapy. Three months post-tezepelumab, her spirometry values normalized for the first time in years. Her FEV₁ increased by 500 mL. After tezepelumab, she was able to resume competitive sports without symptoms, no longer required corticosteroid bursts, and rare rescue inhaler use. <h3>Discussion</h3> These cases illustrate tezepelumab's ubiquitous efficacy of treating respiratory symptoms ranging from AERD to CVID. TSLP released from epithelial barrier disruptions may be a commonality across asthma endotypes. This provides insight about the unified airway and creates exciting new possibilities for the treatment of both Type 2 and non-Type 2 respiratory diseases.

Effects of combination treatment with tezepelumab and allergen immunotherapy on nasal responses to allergen: A randomized controlled trial

Thymic stromal lymphopoietin (TSLP) has been shown to play a central role in the initiation and persistence of allergic responses. We evaluated whether tezepelumab, a human monoclonal anti-TSLP antibody, improved the efficacy of subcutaneous allergen immunotherapy (SCIT) and promoted the development of tolerance in patients with allergic rhinitis. We conducted a double-blind parallel design trial in patients with cat allergy. Atotal of 121 patients were randomized to receive either intravenous tezepelumab plus subcutaneous cat SCIT, cat SCIT alone, tezepelumab alone, or placebo for 52 weeks, followed by 52 weeks of observation. Nasal allergen challenge (NAC), skin testing, and blood and nasal samples were obtained throughout the study. At week 52, the NAC-induced total nasal symptom scores (TNSS) (calculated as area under the curve [AUC0-1h] and as peak score [Peak0-1h] during the first hour after NAC) were significantly reduced in patients receiving tezepelumab/SCIT compared to SCIT alone. At week 104, one year after stopping treatment, the primary end point TNSS AUC0-1h was not significantly different in the tezepelumab/SCIT group compared to SCIT alone, while TNSS Peak0-1h was significantly lower in those receiving combination treatment versus SCIT. Transcriptomic analysis of nasal epithelial samples demonstrated that treatment with the combination of SCIT/tezepelumab, but neither monotherapy, caused persistent downregulation of a gene network related to type 2 inflammation that was associated with improvement in NAC responses. Inhibition of TSLP augments the efficacy of SCIT during therapy and may promote tolerance after a 1-year course of treatment. (ClinicalTrials.gov NCT02237196).

Respiratory Symptoms, Allergies, and Environmental Exposures in Children with and without Asthma.

Background: Epidemiological data concerning the level of asthma morbidity indicate that in Poland, asthma is diagnosed in 5–10% of the pediatric population. Aim The purpose of this study was to compare the prevalence of respiratory symptoms and allergies in a group of children with and without asthma and to evaluate the association between exposure to environmental factors and the prevalence of bronchial asthma in a pediatric population. Material and Methods: A cross-sectional study was conducted on a group of 995 children attending primary schools in the province of Silesia in 2018–2019. The research tool was an anonymous questionnaire developed based on the form used in The International Study of Asthma and Allergies in Childhood (ISAAC). Children’s health status, the prevalence of bronchial asthma, and the performance of allergic skin tests were assessed based on parents’ indications in a questionnaire. Environmental exposures such as mold and dampness in apartments or ETS were similarly assessed. Analyses were performed using Statistica 13.0; p < 0.05. Results: A total of 88 subjects (8.8%) suffered from bronchial asthma. Parents of children with asthma, compared to parents of children without the disease, were more likely to rate their children’s health as rather good (43.2% vs. 38.0%) or average (21.6% vs. 3.1%). All analyzed respiratory symptoms, as well as allergies, were statistically more frequent in children with bronchial asthma. Conclusions: The parent’s subjective assessment of the child’s health varied significantly according to the asthma diagnosis. Asthma is also associated with other diseases: allergic reactions to pollen, house dust, hay fever, and AD (atopic dermatitis) were statistically significantly more frequent among children diagnosed with bronchial asthma.

A Pragmatic Primary Practice Approach to Using Specific IgE in Allergy Testing in Asthma Diagnosis, Management, and Referral

Asthma afflicts an estimated 339 million people globally and is associated with ill health, disability, and early death. Strong risk factors for developing asthma are genetic predisposition and environmental exposure to inhaled substances that may provoke allergic reactions. Asthma guidelines recommend identifying causal or trigger allergens with specific IgE (sIgE) testing after a diagnosis of asthma has been made. Allergy testing with sIgE targets subpopulations of patients considered at high risk, such as those with frequent exacerbations, emergency visits or hospitalizations, or uncontrolled symptoms. Specific recommendations apply to preschool children, school-age children, patients with persistent or difficult-to-control asthma, patients needing oral corticosteroids or high-dose inhaled steroids, patients seeking understanding and guidance about their disease, and candidates for advanced therapies (biologics, allergen immunotherapy). Allergen skin testing is common in specialized settings but less available in primary care. Blood tests for total and sIgE are accessible and yield quantifiable results for tested allergens, useful for detecting sensitization. Results are interpreted in the context of the patient’s clinical presentation, age, and relevant allergen exposures. Incorporating sIgE testing into asthma management adds objective information to identify specific allergies and can guide personalized treatment plans, which reinforce patient-doctor communication. Test results can also be used to predict exacerbations and response to therapies. Additional diagnostic information can be gleaned from (i) eosinophil count ≥300 μL, which significantly increases the odds of having exacerbations, and emerging eosinophil biomarkers (eg, eosinophil-derived neurotoxin), which can be measured in plasma or serum samples, and (ii) fractional exhaled nitric oxide (FeNO), with values ≥25 ppb regarded as the cutoff for diagnosis, evaluating inhaled corticosteroid response, and of probable response to anti-IgE, anti-IL4 and anti-IL5 receptor biologics. Referral to asthma/allergy specialists is warranted when the initial diagnosis is uncertain, and when asthma symptoms, impairment, or exacerbations are repeated or severe.

Effect of BCG Vaccination on Childhood Tuberculosis in a Region with High Prevalence of Tuberculosis

Introduction. BCG vaccination is included in the vaccination schedules of many countries. Numerous studies show its high efficacy, especially in regions with a high prevalence of the disease, and the limited efficacy of revaccination.The objective of the study: to estimate the occurrence of clinical forms of childhood tuberculosis (TB) depending on BCG vaccination in regions with a high prevalence of TB.Materials and Methods. The research design is a retrospective continuous comparative study. We analyzed the data of registration forms No. 089/y-tub of children aged 0 to 17 years with primary active tuberculosis (n = 450) over the period from 2017 to 2020 in Primorsky Territory. Children were divided into groups: 0-3 years old (n = 124), 4-6 (n = 88), 7-10 (n = 61), 11-14 (n = 75), and 15-17 (n = 102).Results. Contact with TB patients was a significant risk factor for children aged from 0 to 3 years.The study revealed a significant predominance of primary tuberculosis among non-BCG-vaccinated children aged 0 to 17 (60.7 and 84.2%, χ2 = 8.234, p = 0.005). Secondary tuberculosis prevailed in vaccinated children (32.3 and 5.6%, χ2 = 12.094, Pearson's contingency coefficient was 0.134 for primary forms and 0.162 for secondary forms).There were no significant differences between the generalized and extrapulmonary forms depending on the vaccination. At the same time, extrapulmonary forms were more common in unvaccinated children (4.9 and 10.5%, χ2 = 2.217, p = 0.137). Revaccination had no significant effect on the occurrence of clinical forms of TB.Conclusions. BCG vaccination has a protective effect against TB. The main preventive measures are early diagnosis of latent tuberculosis using a recombinant tuberculosis allergen skin test. Also, preventive therapy protects against endogenous and secondary TB. No convincing evidence of an additional protective effect of BCG revaccination was obtained.

Helminth Infections in Children.

Helminth Infections in Children.

Urticarial drug eruption following tocilizumab administration

Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration. Herein, we report a case of urticarial drug eruption following tocilizumab administration. Interleukin 6 (IL-6) plays a vital role in the pathogenesis of various inflammatory diseases, especially rheumatoid arthritis.1 Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction2, 3 and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration.4 Herein, we report a case of urticarial drug eruption following tocilizumab administration. A 50-year-old woman had developed rheumatoid arthritis 5 years ago and was treated with methotrexate and certolizumab. She had no history of urticaria. Because her arthritis was intractable by these treatments, tocilizumab was administrated. One month after the repeated tocilizumab administration, she recognized urticarial eruption in trunk and extremities after the second-time administration of tocilizumab (Figure 1). Her eruption occurred in several hours and disappeared within 24 h after the tocilizumab administration. Her eruption continued to repeat the occurrence of urticaria following repeated tocilizumab administration. Blood examination showed that eosinophil frequency in peripheral blood (11.9%) and IgE-RAST (443 U/ml) were elevated, while the white blood cell count (6,000/μl) and CRP (0.04 mg/dl) were within normal ranges. Although an anti-histamine agent showed less response to her eruption, her urticaria completely diminished after switching into certolizumab without the recurrence of her eruption. Tocilizumab was administrated in total 12 times before switching into certolizumab. Because her urticaria was reproducible following every tocilizumab administration recognized as a positive reaction to challenge test, we diagnosed her skin eruption as urticaria following tocilizumab administration. Tocilizumab shows various cutaneous adverse reactions, and the majority of these cases are type IV delayed hypersensitivity reactions. However, this case showed an unusual clinical manifestation of type I allergic reaction. As a reason to cause urticarial eruption, we thought there were several possibilities. The first one is an immune response to additives in this drug. Tocilizumab contains polysorbate 80, which is a synthetic nonionic surfactant and is used in various medications. Polysorbate 80 is also known as one of the representative agents to cause type I allergic reactions.5 Indeed, polysorbate 80 containing medication induces urticaria.6 Although allergic skin test could be conducted in our case, it should be kept in mind a possibility to cause the same skin eruption following polysorbate 80 containing biologic agents. The second one is a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway. However, IL-6 increases in various types of urticaria,7 suggesting that a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway might not contribute to the development of urticaria. As another possibility, tocilizumab might become a trigger to produce tocilizumab-specific anti-IgE production and contribute to the development of urticaria. Since there is no case report of urticaria responding to biologics itself, a further case study is expected to conclude the possibility. The authors declare no conflicts of interest. Approval of the research protocol: No. Informed Consent: N/A. Registry and the Registration: N/A. Animal Studies: N/A.

A case of pediatric perioperative anaphylaxis to neuromuscular agents and its management

Background Perioperative anaphylaxis is one of the most challenging complications in anesthesiology. The key role is to determine the causative agent of the reaction. Neuromuscular agents are ones of the most common causes of anaphylaxis. Skin tests including prick and intradermal reaction tests are gold standard for definite diagnosis. Case presentation: We present a case of a child undergone several operations due to congenital esophageal atresia. Later on, attempts to perform a definitive repair failed because of perioperative anaphylaxis. Allergic skin tests were performed and rocuronium was found to be positive and atracurium – negative. The operation was successfully performed with atracurium. Conclusion: In patients who have gone through multiple surgeries the risk of anaphylaxis development is higher. The most common cause is considered to be neuromuscular blocking agents. In our case, after thorough examination of the anesthesiology cards, rocuronium and pipecuronium were defined as causes of anaphylaxis in our patient, so the surgery was done with atracurium which had been seen negative on a skin prick test. Eventually, the surgical procedure was performed successfully.

Evaluation of effectiveness of mass screening for tuberculosis infection in children from 1 to 7 years old in Moscow

The objective: to evaluate effectiveness of mass screening for tuberculosis infection in children aged 1 to 7 years in different periods – before and after the use of tuberculosis recombinant allergen skin test (TRA) in primary health care as an additional diagnostic method.Subjects and Methods. The study was designed as continuous observational prospective-retrospective study. Two different periods were assessed: the first one was 2014-2016 when screening for tuberculosis infection was performed in all children from 1 to 17 years (inclusive) using Mantoux test with 2 TU PPD-L in pediatric primary health care, and then children suspected to have a positive reaction were referred to TB dispensary where they were examined with a skin test with TRA if necessary. The second period was from 2018 to 2020 when children of 1-7 years old were given Mantoux test and if tuberculosis infection was suspected, a skin test with TRA was done both in primary health care network and TB units. In the first 3 years, 1,864,137 children were examined and in the second 3 years, 2,078,800 children from 1 to 7 years old were examined.Results. Among children of 1-7 years old who were screened by two stages (initial Mantoux test, and then in those who had a positive reaction, the TRA test was used), only 10-12% of those referred to a phthisiologist were subject to dispensary follow-up. Thus, with the implementation of the new edict on screening for tuberculosis infection in children with two tests, this proportion has not changed compared to previous years, when screening was carried out only with one Mantoux test. The reason why almost 90% of the children who were referred to TB Dispensary were not subject to dispensary follow-up is the following: children who have had previous conversion of tuberculin tests, along with everyone else are again screened with Mantoux test despite being previously followed up by TB dispensary due to the primary infection.Recommendations:Currently, there is no division of Group VI into Subgroups A, B, C in the dispensary follow up grouping. Why should conversion of Mantoux test reaction from negative into positive not be considered an infection, and the increase in the reaction must be at least 6 mm.Since Order No. 124n of the Russian Ministry of Health allows testing with TRA in the primary health care in case of suspected infection, it is advisable to refer those who have already had this test to a phthisiologist.A child with conversion of Mantoux test should not be re-screened with Mantoux test but the TRA test should be used. If a positive reaction to the TRA test occurs for the first time, it should be considered as conversion of this test, and in this case the child should be examined by computed tomography (CT), and preventive therapy should be prescribed. If in subsequent years the TRA reaction increases by at least 6 mm after previous preventive therapy, the child should be re-referred for CT to rule out the development of active tuberculosis.

Outcome of Aeroallergen evaluation by skin antigen testing followed by counselling on preventive behavior in Chronic Respiratory Allergy in a tertiary care setting

Introduction: The burden of illness from chronic allergic disorders like rhinitis(RH), asthma, and RH coexisting with asthma is usually due to recurrent exacerbations. The quality of life of such patients can be improved if we can control such exacerbations. Objective: To assess the outcome of trigger avoidance and drug adherence among chronic respiratory allergy patients who have undergone skin antigen testing followed by counselling. Materials &amp; Methodology: Study design: Observational descriptive study. Study subjects: Chronic Respiratory Allergy patients. Sample size and sampling strategy: 102 consecutive cases of chronic respiratory allergy subjects who have undergone skin antigen testing and counselling. Inclusion and exclusion: Patients of both sexes who have undergone skin antigen testing between the age group 18 to 55 years. Those who have not given consent and those with critical illness were excluded. Outcome measure: Reduction in exacerbation and emergency room visits three months after the intervention. Intervention: Respiratory allergen skin testing followed by counselling on trigger avoidance and drug adherence. Data Collection: Patients were interviewed using a structured questionnaire before and 3 months after antigen testing followed by counseling. Results: Data from 102 cases were analyzed. The male to female ratio was 1: 1.2 with a mean age of 31years with an SD of 7 years. The most common allergen identified was indoor dust allergens. with house dust, 69.6% followed by house dust mite(HDM) 59.8%. Dual drug (preventer and reliever) inhaler therapy and administration of Leukotriene antagonists were the main drugs adhered to and 67.6 % of participants used more than 1 drug for the control of their exacerbations. The mean exacerbation rate before intervention was 4.12 and after was 1.07(p&lt;0.01). The mean ER visit before was 0.76 and after the intervention was found to be nil (p &lt;0.01). Conclusion: Identification of triggers by skin antigen testing and counselling related to prophylactic drug administration has resulted in better preventive and medication behavior. This has led to a reduction in exacerbations and ER visits on short-term assessment. Reduced exacerbation and ER visits may have a positive impact on the quality of life of chronic respiratory allergy patients.

Rhinomanometry: point of care test (POCT) for allergic rhinitis in children?

Allergic rhinitis (AR) is a global health problem: its prevalence is 23% in Europe, although it is underestimated because as many as 45% of the cases remain undiagnosed. Globally, almost 500 million people suffer from AR, which shows its increasing incidences. The diagnostic course of AR is based on clinical history, supported by anterior rhinoscopy. This inspects the anterior part of the nasal cavity accompanied by allergic sensitivity tests (cutaneous allergic skin tests or specific immunoglobulin E levels). The availability of standardised diagnostic procedures is able to provide objective evaluations of inflammatory situation, and the degree of nasal obstruction may give an advantage in reducing the risk of underestimating the diagnosis of AR. Diagnostic tests with a high level of accuracy are able to provide immediate results, which can sustain the doctor in diagnostic-therapeutic framework. The development of Point of Care Tests (POCTs) could be a useful tool. Considering that nasal obstruction is the most common symptom in patients with AR, the rhinomanometry (RM) test is the most indicated objective evaluation for nasal obstruction. Several studies have also shown the practicability of such diagnostic techniques applied in children. So far, no study has evaluated whether all the applicable requirements are fulfilled by RM in order to be considered as a POCT. The purpose of this perspective was to assess whether all the POCT requirements are fulfilled by RM by conducting a narrative review of the existing literature in which RM has been used in the diagnosis and management of AR in children. A few but encouraging results of studies on children supported the potential use of RM in the area of POCT. However, costs of instruments and the training of personnel involved remain to be explored. The studies support the potential use of RM in POCTs.

Safety Evaluation of Recombinant Fusion Protein RP22 as a Skin Test Reagent for Tuberculosis Diagnosis: A PhaseI Clinical Trial.

IntroductionThis phase I clinical trial was conducted to evaluate the safety of RP22 as a skin test reagent for tuberculosis (TB) diagnosis and to explore the appropriate dosage.MethodsWe used a randomized, double-blind, placebo-controlled identification allergen (IA) skin test. A total of 72 healthy adult volunteers with negative chest X-ray results were randomized into six groups and given a QuantiFERON-TB Gold (QFT) test. Of the 12 participants in each group, eight received RP22 and four received placebo. The doses of RP22 in the six experimental groups ranged from 0.1 to 4.0 μg in a single intradermal injection of 0.1 ml. Skin reactions and adverse events were recorded at intervals.ResultsAll doses of RP22 except the highest were well tolerated and safe. No serious adverse events associated with the injection were observed in all groups. There were 11 participants who had positive QFT results, eight had a skin reaction with a redness or induration area diameter of greater than 10 mm at 48–72 h, one had no skin reaction. Among the 60 negative-QFT participants, none had a reaction area diameter of greater than 10 mm.ConclusionThe RP22 skin test was well tolerated and safe, it could play a key role in screening for latent tuberculosis infection (LTBI) by providing a much-wanted alternative to the tuberculin skin test (TST) and interferon-γ release assays (IGRAs).

High Histamine Control Concentration Leads to False Negative Allergy Skin Testing.

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. 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. 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). 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. Our study shows that 6 mg/ml concentration of histamine control reagent may contribute to a false interpretation of aeroallergen skin prick test results.