Allergen Skin Test Research Articles

Variability In Measurement Of Allergen Skin Testing Results Among Allergy-Immunology Specialists

Epicutaneous skin testing for sensitization to aero-allergens in patients with allergic diseases requires measurement of skin wheal and erythema in response to antigens. This may be variable between different providers especially among patients with dark skin pigmentation. Purpose of this study is to determine whether Allergy-Immunology specialists vary in their measurement of epicutaneous skin tests in patients with differential skin pigmentation. 3 patients with differing skin tones were skin tested using various concentrations of histamine to produce increasing sizes of skin wheal and erythema reaction. High quality photographs of these were taken and sent to 20 board certified/eligible Allergy-Immunologists to measure the wheal and erythema size. There was poor agreement among specialists in measurement of both wheal and flare sizes from patient with darkest skin tone. In contrast in patients with lighter skin tones there was fair to good agreement and excellent agreement from specialists in measurement of wheal and flare sizes respectively. Measurement of skin test results in patients with dark skin pigmentation may have significant variability even among specialists and in vitro tests may be more appropriate in these patients.

Correlación entre la magnitud de la reactividad cutánea por punción y las concentraciones de IgE sérica específica a pólenes en pacientes con alergia respiratoria

Antecedentes: para el diagnóstico etiológico de las enfermedades alérgicas respiratorias se realizan pruebas cutáneas o determinación de IgE sérica específica.Objetivo: determinar la correlación entre la magnitud de la reactividad a las pruebas cutáneas por punción y las concentraciones de IgE sérica específica para pólenes en pacientes con alergia respiratoria.Pacientes y métodos: estudio prolectivo, descriptivo y transversal efectuado en pacientes de uno y otro sexo, con edades de 2 a 60 años, que acudieron por primera vez al servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla con diagnóstico presuntivo de alergia respiratoria. A todos los pacientes se les realizó historia clínica, pruebas cutáneas por punción con extractos alergénicos estandarizados y cuantificación de IgE sérica específica para pólenes por método de quimioluminiscencia. Se estimó el índice de correlación r con el método estadístico coeficiente de correlación producto-momento de Pearson, un valor de r igual o mayor de 0.70 se consideró una relación notable o una correlación elevada.Resultados: se incluyeron 91 pacientes, 58.2% eran mujeres. Los diagnósticos fueron: rinitis alérgica (79.1%), asma y rinitis (16.5%) y únicamente asma (4.4%). Sólo se encontró una correlación significativa en pacientes con rinitis alérgica para Rumex crispus (r = 0.702) y en pacientes con asma y rinitis para Ambrosia trifida (r = 1).Conclusión: sólo para Rumex crispus y Ambrosia trifida, las pruebas epicutáneas o la determinación de las concentraciones de IgE sérica específica son métodos equiparables en el diagnóstico etiológico de la enfermedad alérgica respiratoria.

Drug-induced anaphylactic reactions in Indian population: A systematic review.

Background:Epidemiological data on drug-induced anaphylactic reactions are limited in India and are largely depending on studies from developed countries.Aim:The aim was to analyze the published studies of drug-induced anaphylaxis reported from India in relation with causative drugs and other clinical characteristics.Materials and Methods:The electronic databases were searched for Indian publications from 1998 to 2013 describing anaphylactic reactions. The information was collected for demographics, set up in which anaphylaxis occurred, causative drugs, incubation period, clinical features, associated allergic conditions, past reactions, co-morbid conditions, skin testing, IgE assays, therapeutic intervention and mortality. Reactions were analyzed for severity, causality, and preventability. Data were extracted and summarized by absolute numbers, mean (95% confidence interval [CI]), percentages and odds ratio (OR) (95% CI).Results:From 3839 retrieved references, 52 references describing 54 reactions were included. The mean age was 35.31 (95% CI: 30.52–40.10) years. Total female patients were 61.11%. Majority reactions were developed in perioperative conditions (53.70%), ward (20.37%) and home (11.11%). The major incriminated groups were antimicrobials (18.52%), nonsteroidal antiinflammatory drugs-(NSAIDs) (12.96%) and neuromuscular blockers (12.96%). Common causative drugs were diclofenac (11.11%), atracurium (7.41%) and β-lactams (5.96%). Cardiovascular (98.15%) and respiratory (81.48%) symptoms dominated the presentation. Skin tests and IgE assays were performed in 37.03% and 18.52% cases, respectively. The fatal cases were associated with complications (OR =5.04; 95% CI: 1.41–17.92), cerebral hypoxic damage (OR =6.80; 95% CI: 2.14–21.58) and preventable reactions (OR =14.33; 95% CI: 2.33–87.97).Conclusion:Antimicrobials, NSAIDs, and neuromuscular blockers are common causative groups. The most fatal cases can be prevented by avoiding allergen drugs.

Pain perception and performance of three devices for single-site allergen skin testing

Skin testing remains the preferred method for most allergists for establishing the presence of allergen sensitization. This study examined the performance of a new single-site skin test device that incorporates initial pressure to reduce the sensation of pain. Comparators were a conventional skin testing system and a smallpox needle. Twenty subjects were tested on the back, four sites with histamine and four sites with saline with each of the three skin testing devices. The single-site skin test device was applied with downward pressure, the conventional skin testing system, and smallpox needle (SPN) by pricking at a 45°angle. Outcomes were size and reproducibility of the skin test reactions and discomfort, as graded by the subject. The whealing responses to histamine were larger with the conventional skin testing system than with the single-site skin test device and both produced larger wheals than the SPN. The conventional skin testing system also produced greater intrasubject variability. Only the conventional skin testing system produced wheals of >3 mm with saline. There was no significant difference in perception of pain, which was low with all three devices. All three devices were well tolerated, without a significant difference in perception of discomfort. Testing with histamine revealed differences in wheal size and reproducibility among the three devices and testing with saline revealed differing likelihood of inducing a significantly sized wheal.

Variability in Measurement of Allergen Skin Testing Results among Allergy-Immunology Specialists

Variability in Measurement of Allergen Skin Testing Results among Allergy-Immunology Specialists

Unusual causes of anaphylaxis during surgery: Gelofusin-induced Kounis syndrome.

Sir, In the very interesting report[1] published recently in IJCCM, a 48-year-old female patient, who was planned to have laparoscopic donor nephrectomy, developed atrial premature complexes, flushing of both hands, falling blood pressure, and rising pulse rate after gelofusin infusion. Intravenous hydrocortisone, chlorpheniramine, mephentermine, adrenaline, vasopressors, ipratropiume with salbutamol nebulization and positive pressure ventilation improved her condition. The scheduled surgery was postponed, and the allergic skin tests for antibiotics, anesthetics and gelofusin showed positive skin reaction to gelofusin. This case raises some important points concerning the cause and the type of this reaction and its pathophysiology. Gelofusin is a macromolecule made from succinylated bovine gelatin. Gelatins are proteins derived from collagen and are obtained from cow and pig bones and hides and fish skin. A similar case diagnosed as Type II variant of Kounis hypersensitivity-associated syndrome with peri-operative cardiac arrest due to gelofusin anaphylaxis, confirmed with skin prick tests, has been published recently.[2] It concerned a 57-year-old patient who developed anaphylactic shock during anesthesia and despite initial management with bolus doses of metaraminol and epinephrine intravenously, hypotension worsened, and cardiac output was reduced. The patient recovered gradually with intravenous antihistamines, steroids and myocardial ischemia protocol, thus supporting our view that anaphylactic shock is a manifestation of Kounis syndrome. In another report, anaphylaxis with cardiovascular symptoms such as profound hypotension, tachycardia, and elevated airway pressures have been reported following intraosseous gelatin administration.[3] Drug capsules, suppositories, plasma expanders, and vaccine stabilizers including diphtheria-tetanus-pertussis, measles, mumps, rubella, varicella, yellow fever, rabies, and some influenza vaccines contain bovine and porcine gelatins as heat stabilizers. Since gelatin is contained in various vaccines given in children, then vaccination is regarded as a primary route of sensitization. Indeed, specific gelatin antibodies have been detected in patients following vaccination[4] and Type I hypersensitivity reactions to gelatin have been even reported with specific IgE levels as low as 0.8 kUA/L. When, gelatins are used intravenously as modified fluid gelatins and as plasma substitutes and expanders they can induce severe allergic reactions such as in the described case. The described patient had received, before gelofusin administration, a total 10 different drugs in an effort to induce anesthesia. Despite negative skin tests, substances such as lactated ringer, ranitidine, fentanyl, ondansetron, cefotaxine, thiopentone, suxamethonium, isoflurane, vecuronium, and mannitol, could have acted as antigens and have joined forces with gelofusin in order to induce anaphylaxis and Kounis syndrome. It is known that anaphylaxis resulting in Kounis syndrome occurs when 2000 nearby antibodies attached to mast cell surface are bridged by corresponding antigens and make the critical number of 1000 bridges. On the other hand, IgE antibodies with different specificities can have additive effects and small, even subthreshold numbers of them can join forces and trigger the cells to release their mediators.[5] Therefore, anesthetic drugs used during surgery can join forces with substances acting as antigens and can induce anaphylaxis and Kounis anaphylaxis-associated syndrome. Anesthetists and surgeons should be aware of this consequence in order to timely receive protective, preventive, and therapeutic measures.

Factors Affecting Bronchial Hyperresponsiveness in Rhinitis Patients

Background and ObjectivesZZMany studies have revealed a close relationship between allergic rhinitis (AR) and asthma. This study was designed to evaluate clinical parameters affecting bronchial hyperresponsiveness (BHR) in patients with rhinitis symptoms. Subjects and MethodZZOne hundred thirty-seven patients who visited the outpatient clinic due to rhinitis symptoms were evaluated retrospectively. All patients undertook an allergic skin test, the methacholine bronchial provocation test and were tested for clinical parameters such as allergic symptoms, IgE levels, and sinonasal outcome test-20 were evaluated. ResultsZZPatients with AR had a higher proportion of BHR than the non-allergic group (28.0% vs. 4.5%, p=0.001) did, and children had higher prevalence of BHR than adults (p ＜0.005) did. There was no significant difference according to the type of allergen. Sinusitis or nasal polyp did not influence BHR and there were no significant differences according to the Allergic Rhinitis and Its Impact on Asthma classification. The mean serum eosinophil count was significantly higher in BHR group. ConclusionZZPatients with AR had more BHR, and age and serum eosinophil counts were related to BHR. Hence, the additional evaluation of lower airway might be required in high risk patients of BHR, such as pediatric AR patients and patients with elevated eosinophil counts. � Korean J Otorhinolaryngol-Head Neck Surg 2014;57(3):160-5 Key WordsZZAllergic rhinitis ㆍAsthma ㆍBronchial responsiveness.

Assessment of drug hypersensitivity with non-irritating concentrations of antibacterial agents for allergic skin tests: a review

Hypersensitivity reactions to antibiotics are common with a prevalence of 6-10% of all adverse reactions. There is a lack of guidelines and standardization of skin tests for the screening of hypersensitivity to all antibiotics, in terms of the methodology, dose and time of evaluation of the tests. Literature from Europe and America suggests the use of non-irritating concentration (NIC) of antibiotics for skin testing such as intra dermal test (IDT), skin prick test (SPT). These are concentrations at which the drug is unlikely to produce irritation by virtue of its chemical nature resulting in false positive reactions. These concentrations have been validated by trials in their populations. Due to the increase of antibiotic resistance in our country, declaring a patient allergic to a specific class of antibiotics based on positive skin tests can further narrow the therapeutic armory. These individuals have an increased incidence of infections with resistant organisms as well as increased cost of hospitalization. This is due to the use of alternative broad spectrum antibiotics. Therefore, there is a need for a standardized protocol for the use of skin tests in screening of hypersensitivity, with validated NIC of all antibacterial agents. The aim of this article is to review literature of protocols for assessment of drug hypersensitivity with NIC of antibacterial drugs for SPT, IDT and also establish the need for research in this area in our country.

Variability of Offending Allergens of Allergic Rhinitis According to Age: Optimization of Skin Prick Test Allergens

PurposeThis study evaluates offending allergens in patients with allergic rhinitis (AR) according to age that establish a minimal panel for skin prick test (SPT) allergens required to identify if a patient is sensitized.MethodsWe retrospectively analyzed SPT results according to age to determine the minimum test battery panel necessary to screen at least 93%-95% of AR patients. Allergic skin tests (common airborne indoor and outdoor allergens) were performed on 7,182 patients from January 2007 to June 2011. All patients were classified into 9 groups according to age; subsequently, we investigated offending allergens by age group.ResultsA total of 5,032 (70.1%) patients were found sensitized to at least one of the 55 aeroallergen extracts tested. The annual ranking of offending allergens was not significantly different from each other over the past 5 years. House dust mites (HDM) were the most prevalent allergens ranked from first to third for all 5 years. The allergens in the minimum test panel differed slightly among all age groups; in addition, the types of sensitized allergen sources were more diverse in the older versus younger age group. HDM covered a larger proportion of the sensitized allergens in the younger age group versus the older age group. Testing with 5 allergens (Dermatophagoides farinae, Tetranychus urticae, oak, mugwort and cockroach) adequately identified over 90% of the sensitized patients.ConclusionsA SPT with around 5-7 allergens adequately detected most of the sensitization in the majority of the age groups in Korea. However, this study suggests that physicians perform the SPT with appropriately selected allergens in each age category for the screening of AR.

Clinical evaluation of multi-function “rapid” allergic skin test instrument for application in drug allergy testing

To evaluate the multi-function rapid allergic skin test instrument for application in drug allergy testing. Three hundred patients were planned to be treated with cephalosporins Injection were divided randomly into 3 groups, the new allergic skin test instrument group, normal allergic skin test instrument group, and traditional skin test group, the true positive rate and false positive rate were calculated. Using multifunctional rapid allergy skin test was carried out on 210 cases of volunteers preliminary clinical evaluation of traditional Chinese medicine injections skin test. There were no significance difference between the new allergic skin test instrument group and control group in the true positive rate. As compared with the control group, a significance difference was found between the new allergic skin test instrument group and control group in false positive rate respectively (P < 0.05). The multi-function rapid allergic skin test instrument is safe and easy to use, with a higher rate of accuracy and lower false positive rate.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma

There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. To describe the results of the flow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, flow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Racial differences in the association of CD14 polymorphisms with serum total IgE levels and allergen skin test reactivity

BackgroundThe CD14 C-159T single nucleotide polymorphism (SNP) has been investigated widely as a candidate genetic locus in patients with allergic disease. There are conflicting results for the association of the CD14 C-159T SNP with total serum immunoglobulin E (IgE) levels and atopy. There are limited data regarding the association of the CD14 C-159T SNP in subjects of African ancestry. The aim of the study was to determine whether the C-159T SNP and other CD14 SNPs (C1188G, C1341T) were associated with total serum IgE levels and with allergy skin test results in nonatopic and atopic subjects; as well as in Caucasian and African American subjects.MethodsA total of 291 participants, 18–40 years old, were screened to determine whether they were atopic and/or asthmatic. Analyses were performed to determine the association between CD14 C-159T, C1188G, or C1341T genotypes with serum IgE levels and with the number of positive skin tests among Caucasian or African American subjects.ResultsWe found no significant association of serum total IgE level with CD14 C-159T, C1188G, or C1341T genotypes within nonatopic or atopic subjects. Subjects with CD14-159 T alleles had significantly more positive allergen skin tests than subjects without CD14-159 T alleles (P = 0.0388). There was a significant association between the CD14 1188 G allele, but not the CD14 1341 T allele, with the number of positive skin-test results in Caucasians, but not in African Americans.ConclusionThese results support a possible association between CD14 polymorphisms and atopy. CD14-159 T or CD14 1188 G alleles were associated with atopic disease. For subjects with CD14 1188 G alleles, the association with atopic disease was stronger in Caucasians compared to African Americans.

Early skin testing is effective for diagnosis of hypersensitivity reactions occurring during anesthesia

Allergic skin tests have to be performed 4-6 weeks after an allergic anesthetic reaction. Patients with allergic reactions during anesthesia were prospectively included (n = 44). Skin tests were performed in two stages: (i) Stage 1 (S1), 0-4 days after the reaction; and (ii) Stage 2 (S2), 4-8 weeks after. Five (11.5%) surgical procedures were suspended due to the reaction. Positive skin tests were obtained in 25/44 patients (57%). Allergic diagnosis was carried out at S1 in 15/25 (60%) and at S2 in 10/25 (40%). Three patients resulted positive only in S1. Overall agreement among S1 and S2 skin tests was 70.45%. The kappa statistic was 0.41 (P-value = 0.002). Odds ratio of obtaining a false negative in S1 (compared with S2) was 3.33. Early allergological study is useful, could minimize false negatives, but should be considered as a complement to late skin tests.

Polyvinylpyrrolidone microneedles enable delivery of intact proteins for diagnostic and therapeutic applications

We present a method of fabricating microneedles from polyvinylpyrrolidone (PVP) that enables delivery of intact proteins (or peptides) to the dermal layers of the skin. PVP is known to self-assemble into branched hollow fibers in aqueous and alcoholic solutions; we utilized this property to develop dissolvable patches of microneedles. Proteins were dissolved in concentrated PVP solution in both alcohol and water, poured into polydimethylsiloxane templates shaped as microneedles and, upon evaporation of solvent, formed into concentric, fibrous, layered structures. This approach of making PVP microneedles overcomes problems in dosage, uniform delivery and stability of protein formulation as compared to protein-coated metallic microneedles or photopolymerized PVP microneedles. Here we characterize the PVP microneedles and measure the delivery of proteins into skin. We show that our method of fabrication preserves the protein conformation. These microneedles can serve as a broadly useful platform for delivering protein antigens and therapeutic proteins to the skin, for example for allergen skin testing or immunotherapy.

Skin Scrape Test: An Inexpensive and Painless Skin Test For Recognition Of Immediate Hypersensitivity In Children And Adults

Background: Skin testing is a mainstay in allergology, and its importance is increasing in several fields. The ability to choose the most suitable technique according to the clinical setting is an advantage for the medical team. Objectives: To describe in detail an alternative technique of the coetaneous allergy test (skin scrape test) conceived as a variation of the former skin scratch test; to evaluate its value as a tool for diagnosis of immune sensitization; and to compare its accuracy with the skin prick test. Methods: The skin scrape test and skin prick test were performed side by side with the same allergen extracts in 162 human subjects classified in two groups according to the known presence or absence of serum specific-IgE to these allergens. Results: The sensitivity of the skin scrape test to detect immediate reactions was 85.0%. The sensitivity of the skin prick test was 86.5%. The sensitivity of both techniques analyzed together as a unique procedure was 94.2%. The specificity of the skin scrape test was 90.1%.The specificity of the skin prick test was 72.9%.The specificity of both tests analyzed together as a unique procedure was 70.5%. Conclusions: The skin scrape test is an alternative and complementary technique for allergic skin testing, and it is able to detect IgE-specific immune sensitization without the disadvantages of the skin scratch test. The skin scrape test has similar outcomes to the skin prick test.

Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water‐damaged building

Water damage in buildings has been associated with reports of upper airway inflammation among occupants. This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages. Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females. In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.

Prevalence of IgE Specific to Profilin in a Texas and California Population

Panallergens like profilin are proteins that have very similar sequences and conserved structure. People can develop IgE specific to these highly cross reactive panallergens. The purpose of this study was to determine the prevalence of profilin sensitivity and the contribution to multiple allergen skin test responses. Sensitivity to profilin was established by IgE binding to purified profilins. Possible effects on skin test results were studied by including a low probability Queen palm (QP) allergen in skin prick testing panels as a possible source of profilin.

Evaluation of Clinical and Immunological Responses: A 2-Year Follow-Up Study in Children with Allergic Rhinitis due to House Dust Mite

Background. Allergic rhinitis is a disease with polarization towards Th2 and a defect of regulatory T cells. Immunological changes have been reported after immunotherapy treatment. However, there is not much known about the natural course of allergic rhinitis with respect to clinical manifestation and the relation with immunological responses. Objective. To evaluate clinical symptoms of allergic rhinitis, in relation to in vivo allergen-specific skin responses and in vitro allergen-specific effector and regulatory T cells determined at baseline and after two years. Methods. From a large trial, 59 children were randomly selected. The following variables were compared: clinical symptoms, allergen skin tests, specific IgE, T-cell proliferation, IL-5, IL-13, IFN-gamma, IL-10, TGF-beta, CD4+CD25hi cells, and Foxp3 expression. Results. Allergic symptoms had decreased after two years. Whereas skin test reactions correlated between years 0 and 2, there was no change in the size of the reaction. Also, proinflammatory reactions did not change after two years, with a positive correlation between years 0 and 2. No relevant changes were observed with respect to regulatory cells. Conclusion. Whereas, comparable to immunotherapy, allergic complaints decrease, the immunological changes of specific T-cell activity (both effector cells and regulator cells) which are observed after immunotherapy, do not change.

Multiple cross-reactivity to several types of neuromuscular blocking agents in a patient with rocuronium anaphylaxis

Anaphylaxis that occurs during anesthesia is a major cause of morbidity and mortality. Muscle relaxant is the most frequent cause of perioperative anaphylaxis [1]. Although it is believed that there is a risk of anaphylaxis to the drug in some patients, a similar incidence of anaphylaxis has been observed with use of other members of the same drug class. We report on a case of anaphylactic reaction to rocuronium in a male patient confirmed as having multiple cross-reactivity to various neuromuscular blocking agents (NMBAs) on an allergic skin test at three months after discharge. A 31-year-old, 174 cm, 85 kg man with congenital cystic ad enomatoid malformation was scheduled to undergo lobectomy of the right lower lung. He did not have a history of allergy or surgery. Results of routine preoperative tests showed no abnormalities. In the operating room, routine monitoring devices, including a blood pressure (BP) cuff, pulse oximetry, and elec trocardiography (ECG) were placed on the patient. He showed stable vital signs, including oxygen saturation (SpO2) 100%, BP 115/78 mmHg, and heart rate (HR) 90 beats/min. Epidural catheter insertion was performed for control of intraoperative and postoperative pain. Propofol target-controlled infusion was performed for induc tion of general anesthesia. After loss of eyelash reflex, rocuronium 60 mg was administered, and endotracheal intubation was performed after two minutes of facemask ventilation. After endotra cheal intubation, his vital signs showed moderate hypotension; BP 85/40 mmHg, HR 75 beats/min. However, his breath sounds were normal. A 20-gauge arterial cannula was inserted into the left radial artery for continuous monitoring of arterial BP and a central venous catheter was placed in the right subclavian vein. He was treated with intravenous injection of ephedrine 10 mg and rapid infusion of Ringer’s lactate solution. BP did not improve; therefore, we stopped propofol infusion. We injected midazolam 3 mg and rocuronium 20 mg. A few minutes after injection, his vital signs indicated severe hypotension (BP 50/30 mmHg). We observed a skin rash, urticaria, and edema on his face, neck, arms, and legs. On arterial blood gas analysis, the measured values were pH 7.230, PCO2 50.4 mmHg, PO2 124 mmHg and SpO2 98%. The patient was treated with intravenous injection of epinephrine 0.1 mg and continuous infusion of dopamine, dobutamine, and phenylephrine. After a few minutes of infusion, his vital signs became stable; BP 90/45 mmHg, HR 105 beats/min, and SpO2 100%. Hydrocortisone 100 mg and chloropheniramine 4 mg were administered intravenously. Seventy

Allergy skin test results of an outpatient pulmonary clinic in Gaziantep

Environmental factors play an important role in allergic sensitization. The aim of this study was to determine the spectrum of aeroallergen sensitivity of patients. The skin prick test results of patients with symptoms compatible with allergic diseases between March 2002 and December 2004 were retrospectively evaluated in Gaziantep University Pulmonary outpatient clinic. Of 1627 patients in whom skin prick tests (Stallergenes, France) were performed, 528 (32.5%) patients had at least one positive result among 8 allergens. The mean age of patients who had positive allergic skin test was 33.03 ± 11.80 (16-69), and 335 (63.4%) of those were female. Two hundred twenty five (52%) patients had positive skin prick test for one allergen tested, while 253 (48%) patients had positive skin prick test for multiple allergens. Phleum pratensis was the most common allergen found to be positive in 221 (41.8%) patients. The prevalence of positive tests were as follows; cockroach (32.9%), Dermatophagoides pteronyssinus (32.7%), Olea europea (27%), cat dander (14.9%), Parieteria officinalis (11.7%), Cladosporium (9.8%) and Alternaria (8.9%).Phleum pratensis and cockroach were the most common allergens causing a sensitivity reaction detected in our clinic.