Immediate Hypersensitivity Skin Test Research Articles

Virtual Reality as a Form of Interactive Distraction for Pediatric Patients Receiving Immediate Hypersensitivity Skin Tests: A Randomized Controlled Trial

Children receiving Immediate Hypersensitivity Skin Tests (IHST) often experience intense itchiness at the test site prior to completion of the procedure, which can lead to incompliance and increased stress. This study assessed low-cost virtual reality (VR) with the standard of care (e.g., Look and Find or I Spy books) as forms of interactive distraction on pediatric patient’s cooperation and perception of negative procedural outcomes (i.e., itchiness and distress) for patients receiving IHST. Two hundred and twenty patients five to 12 years of age who received an IHST were randomized to either the VR (experimental) or standard of care (control) group. Compliance, coping, and perceived itch outcomes were compared between groups in addition to being compared by age category and sex. None of the primary outcomes differed significantly for patients in the control versus experimental group, although patients in the experimental group were significantly more likely to fail to complete the assessment (p = 0.034). Despite VR being a novel technology, the results showed that the VR group had similar outcomes compared to the standard of care group regarding patients’ compliance, coping, and perceived itch.

Molecular diagnosis approach in allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a disease that occurs in patients with asthma or cystic fibrosis who have positive skin tests for immediate hypersensitivity against Aspergillus fumigatus, and elevated levels of serum IgE and IgG antibodies against fungal‑specific antigen,​​ determined by fluoroimmunoenzymatic assay. In this review, we present the diagnostic criteria for ABPA revised in the last decade by several expert groups. The officially recognized molecular allergens of Aspergillus fumigatus used in commercially available singleplex and multiplex immunoassays for the determination of serum specific IgE are mitogillin Asp f 1 from ribonuclease family, fibrinogen binding-protein Asp f 2, peroxisomal membrane protein Asp f 3, group 4 fungal allergen Asp f 4, and Mn superoxide dismutase Asp f 6. The detailed evaluation of IgE sensitization molecular profiles, using the panel of recombinant allergenic components of Aspergillus fumigatus, is useful in clinical practice to identify genuine versus cross-reactive sensitization in patients sensitized to Aspergillus fumigatus, including patients with comorbid atopic dermatitis and sensitization to other fungi with cross-reactive allergenic components, for an accurate molecular allergy diagnosis of ABPA, and to distinguish ABPA from asthma with Aspergillus fumigatus sensitization without ABPA.

P077 Incongruity in detecting dog sensitized individuals between skin prick and specific dog IgE testing

Allergies to furry animals is a critically important clinical problem. There are over 70 million dogs in US households alone with the frequency of animal allergies increasing worldwide. The accuracy in the diagnosis of dog allergies is critical. Immediate hypersensitivity skin testing (IHST) with dog extracts and dog specific IgE (sIgE) has been used to identify sensitized individuals. We wished to determine how well IHST results correlate with dog sIgE using a cut off of 0.35kU/L as positive.

Prevalence and factors associated with asthma in students from Montes Claros, Minas Gerais, Brazil.

We investigated the prevalence of asthma and factors related to asthma development in schoolchildren aged 6 to 14, living in central and peripheral areas of the city of Montes Claros, Minas Gerais and who were registered with the Family Health Strategy program. Initially, a standard written questionnaire, based on ISAAC (International Study of Asthma and Allergies in Childhood), was administered to collect personal data, information regarding income, asthma prevalence, allergic rhinitis and eczema (N = 1,131). Secondly, a case-control study was performed by grouping the patients as either asthmatic (A; N = 172) or non-asthmatic (NA; N = 379). Potential factors associated with the occurrence of asthma were evaluated using the complementary questionnaire from ISAAC phase II. Skin tests for immediate hypersensitivity (STIH) and parasitological tests were also performed. The odds ratio, estimated by multivariate analysis, indicated that asthma cases were related to kindergarten attendance, household smoking, family history of asthma, rhinitis and positive STIH. It was concluded that, in the studied population, the prevalence of asthma was related to genetic predisposition, in addition to individual history, social demographics, exposure to pollutants such as tobacco smoke and a positive response to allergy testing.

Chapter 16: Determining the role of allergy in sinonasal disease.

The contributing role of specific IgE sensitization in the pathophysiology of sinonasal diseases including rhinitis, chronic rhinosinusitis (CRS), and nasal polyps is explored. Although it is estimated that sensitization to environmental allergens is present in 75% of patients with rhinitis, the role of allergy in CRS and nasal polyps is less certain. However, when atopy is present in the setting of nasal polyps, it is associated with worse quality of life and a higher incidence of asthma. Several theories have been put forth whereby inhalant aeroallergen exposure could drive the inflammatory response that occurs both in the nose and in the sinuses. Tools available to determine the presence of allergic sensitization include skin tests for immediate hypersensitivity, in vitro testing for allergen-specific IgE, and nasal allergen provocation testing. Whether by skin testing or in vitro testing, the identification of specific IgE requires clinical correlation with the history and physical exam.

516 Profile of Latex Sensitization in Children with Myelomeningocele of São Paulo, Brazil

BackgroundLatex allergy is an important cause of occupational allergy and is responsible for numerous allergic reactions in sensitized individuals.MethodsThe study included 55 children with myelomeningocele followed at a specialized center. In addition to a standard questionnaire and skin tests for immediate cutaneous hypersensitivity to aeroallergens and total latex, the patients underwent determination of serum total and specific IgE to latex and its fraction recombinants.ResultsThe rates observed were 45% for sensitivity and 20% for latex allergy (sensitization with clinical symptoms). Twenty-four (43.6%) patients were atopic and the average age at the first episode of reaction to latex was 44.5 months, with cutaneous reactions being the most frequently reported (72.7%). Specific IgE to fractions rHev b1, 3, 5, 6.1 and 6.2 were detected in more than 50% of patients allergic to latex. The group comprising sensitive and allergic patients was different from non-sensitized subjects regarding the following variables: atopy, rhinitis, angioedema, average number of surgeries, patients with 4 or more surgeries, use of ventricular peritoneal shunt, the presence of at least one skin tests for immediate cutaneous hypersensitivity positive for aeroallergen and serum total IgE greater than 200 KU / l. Multivariate analysis showed as significant: current asthma, atopy and the number of surgeries undergone.ConclusionsOur study documented the raised prevalence of awareness and latex allergy in patients with myelomeningocele. Specific IgE to fractions rHev b1, 3, 5, 6.1 and 6.2 were detected in more than 50% of children with myelomeningocele who are allergic to latex. The number of surgeries that the patients were submitted to determined higher levels of specific IgE, especially rHev b5 and 6.01. History of current asthma, atopy, and having undergone 4 or more surgeries were independent risk factors identified for latex allergy.

Skin testing for immediate hypersensitivity to betalactams: comparison between two commercial kits

Skin testing with major and minor determinants of benzylpenicillin is the recommended standard practice to evaluate subjects with immediate hypersensitivity to betalactams. The withdrawal of these products from the market has set us back to the early days, before the introduction of reagents for in vivo testing. To compare a recently released kit of benzylpenicillin conjugated to poly-l-lysine (PPL) and minor determinants mixture (MDM) with the previously existing kit in a positive control group of subjects sensitized to major and/or minor determinants of benzylpenicillin. Skin tests with both kits were made in a group of positive subjects previously diagnosed with immediate hypersensitivity to penicillins and with positive results to PPL and/or MDM and in a negative control group. Radioallergosorbent test (RAST) inhibition assays with a pool of sera and individual samples were carried out to compare the inhibition capacity of PPL and MDM of both kits. Of 22 cases selected from our historical group, 14 were positive: eight to PPL, three to MDM and three to both. These results were equivalent for both kits. RAST inhibition studies showed similar potencies in the inhibition of PPL and MDM. Both tests show similar results in terms of RAST inhibition assays and skin tests sensitivity and specificity in the groups selected. The new assay can be used for the same purpose and indications as the previous test.

Testes cutâneos de hipersensibilidade imediata com o evoluir da idade

OBJETIVO: avaliacao da positividade aos testes cutâneos de hipersensibilidade imediata em criancas com asma bronquica e/ou rinite alergica em diferentes faixas etarias. CASUISTICA E METODOS: foi observada a positividade aos testes cutâneos de hipersensibilidade imediata, por testes de puntura, frente a diferentes alergenos de mesma procedencia: poeira total e Dermatophagoides sp, Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis, Penicillium sp, Alternaria alternata, Cladosporium herbarium, Aspergillus fumigatus, grama bermuda, capim de pasto, epitelio de cao, epitelio de gato, penas, Blatella germanica, la. Foram selecionadas 713 criancas divididas em grupos conforme a faixa etaria: grupo I (6 a 11 meses), II (1 a 3 anos e 11 meses), III (4 a 8 anos e 11 meses) e IV (9 a 15 anos). Para analise estatistica utilizou-se o calculo do qui-quadrado. RESULTADOS: o total de diferencas significativas entre os varios grupos foi: I e II = 5; II e III = 5; II e IV = 5; III e IV = 6; I e III = 10 e I e IV = 10 CONCLUSAO: concluiu-se que a positividade ao teste de hipersensibilidade imediata foi maior com o evoluir da idade, havendo positividade ja aos doze meses de vida, sendo esta positividade significativamente maior a partir de quatro anos de idade.

Positive skin test and age

OBJECTIVE: To evaluate positive responses to skin tests for immediate hypersensitivity to allergens in children with asthma and rhinitis at different ages. METHOD: We observed positive skin test reactivity in prick tests using fifteen allergens of same origin (total dust and Dermatophagoides sp.; Dermatophagoides pteronyssinus; Dermatophagoides farinae; Blomia tropicalis; Penicillium sp; Alternaria alternata; Cladosporium herbarium; Aspergillus fumigatus; Bermuda grass; forage grass; dog and cat epithelia; feathers; Blatella germanica and wool). We placed 713 selected patients into different age groups - Group I: 6 to 11 months; Group II: 1 to 3 years and 11 months; Group III: 4 to 8 years and 11 months; and Group IV: 9 to 15 years. We used the chi-square test for statistical analysis. RESULTS: The total significant differences between these groups were: I to II = 5; II to III = 5; II to IV = 5; III to IV = 6; I to III = 10; and I to IV = 10. CONCLUSION: Skin test reactivity is acquired progressively with age, and can be observed as early as at 12 months. Reactivity is significantly more positive from the age of 4 on.

Objective measures of allergic disease in children with human immunodeficiency virus infection

Background: Available information suggests that IgE levels are elevated in adults infected with human immunodeficiency virus (HIV), and that increased IgE levels correlate with allergic disease, with decreased CD4 counts, and with a poor prognosis. Data with respect to these factors in children are scant. Objective: We investigated whether serum IgE levels are elevated in children with HIV and, if so, whether the serum IgE level correlates with the degree of immunodeficiency and/or objective indicators of allergic disease. Methods: Serum IgE levels, CD4 counts, absolute eosinophil counts, and immediate hypersensitivity skin test (IHST) results were collected from 43 children with symptomatic HIV infection (mean age 7.2 years). Associations between serum IgE levels, CD4 counts, and eosinophil counts were investigated by multiple stepwise linear regression analysis. Data were stratified according to IHST positivity, and analysis of variance was used to compare mean values for age, CD4 counts, IgE levels, and eosinophil counts between the two groups. Results: Serum IgE values were elevated more than 2 SDs above control age-matched mean values in 17 of 43 patients (40%). IHST results were positive in 12 of 43 patients (28%). CD4 counts were less than 200/mm 3 in 17 of 43 patients (40%). Stepwise linear regression failed to demonstrate any correlation between serum IgE levels and either CD4 or eosinophil counts. With data divided into two groups according to IHST results (positive vs negative), analysis of variance failed to reveal significant differences between means for patient age, CD4 counts, IgE levels, or eosinophil counts. Conclusions: Our findings confirm that serum IgE levels are increased in children infected with HIV, just as in adults. However, an elevated serum IgE level did not correlate with allergic disease as measured by IHST results and eosinophil counts, nor with the degree of immune dysfunction as approximated by CD4 counts. The mechanism and significance of elevated serum IgE levels remain unclear in children with HIV, and warrant further investigation. (J Allergy Clin Immunol 1997;100:707-11.)

Clinical Improvement of Asthma after Anthelminthic Treatment in a Tropical Situation

Intestinal helminths are among the most common infectious organisms of humans, particularly in tropical regions, and can induce the production of large quantities of IgE antibody. Part of this response is directed against the helminths own antigens, but a polyclonal stimulation also occurs that may increase the allergic reactivity toward environmental allergens. The importance of this in the symptomatology of asthma in these regions is, however, uncertain. In the present study we evaluated the effect of regular anthelminthic treatment with albendazol for 1 yr on a group of asthmatic patients in a zone in which these parasites are endemic. The number of asthmatic crises, need for maintenance therapy with inhaled steroids, and use of inhaled beta 2-agonists were compared both with those in the year prior to the study for the treated patients, and with those in a group of asthmatic subjects evaluated in parallel, but in whom the parasitic infections were not controlled. Significant improvement in all of these indicators of clinical status occurred in the treated group, not only for the period of anthelminth administration, but also for the year following. However, after 2 yr without treatment, the severity of asthma reverted to the initial state. No significant changes were observed in the control group over the entire period of evaluation. At the beginning of the study, the patients' pulmonary function was below the levels predicted for normal individuals, but this was not changed by the anthelminthic treatment. The patients' total serum IgE levels, which were elevated at the beginning of the study, were significantly diminished by the anthelminth administration, as were the specific IgE antibody levels and positivity in skin tests for immediate hypersensitivity to the common environmental allergen Dermatophagoides sp. However, the specific response to Ascaris lumbricoides, a common helminth in the area, was maintained despite treatment. These results indicate that intestinal helminthic infections can contribute to the clinical symptoms of asthma in an endemic situation. This may occur via a direct response to the parasite and/or a nonspecific potentiation of allergic reactivity to environmental allergens.

Independent anaphylaxis to cefazolin without allergy to other β-lactam antibiotics

Independent anaphylaxis to cefazolin without allergy to other β-lactam antibiotics

Specific V beta T cell subsets mediate the immediate hypersensitivity response to ragweed allergen.

T and B cell responses after sensitization to ragweed (RW) were examined in a mouse model in which BALB/c mice were exposed to the allergen by ultrasonic nebulization. Sensitization resulted in the stimulation of an IgE anti-RW response and was paralleled by a rise in IgG1 anti-RW titers. Skin testing for immediate cutaneous hypersensitivity revealed the presence of allergic type I reactions to RW. Sensitization to RW in this way was also associated with the development of increased airways responsiveness as determined by electrical field stimulation of preparations of tracheal smooth muscle. Histologic examination of the airways and the lung indicated the presence of a mononuclear cell infiltrate in the mucosa and submucosa of the airways that was accompanied by an enlargement of local draining lymph nodes of the airways and the lung. T cell populations were analyzed for the frequency of V beta-expressing T cells. Such analysis indicated that RW sensitization stimulated the expression of V beta 8.1+, V beta 8.2+, and V beta 13+ T cells in the local lymphoid tissue and of V beta 8.1+, V beta 8.2+, V beta 8.3+, V beta 9+ and V beta 14+ T cells in the spleen. Co-culture of these T cell populations with RW-primed B cells indicated that in the presence of RW, V beta 8.2 T cells stimulated IgE and IgG1 production, whereas the other T cell populations showed a different stimulation profile for Ig isotypes and IgG subclasses. The transfer of V beta 8.2 T cells from sensitized but not from nonsensitized control mice stimulated an allergen-specific IgE and IgG1 response and increased airways responsiveness in naive recipients. These data provide additional support for the pivotal role of specific V beta-expressing T cell subpopulations in the stimulation of IgE/IgG1 production and increased airways responsiveness.

The frequency of skin test reactions to side-chain penicillin determinants

Background: Skin testing for immediate hypersensitivity to penicillins is usually carried out with reagents prepared from benzylpenicillin, and it is believed that side-chain-specific reactions to semisynthetic derivatives are rare. Because some experimental and clinical data suggest that antibodies can be induced to immunogenic epitopes on the side chains of penicillins, we looked for side-chain-specific reactions to skin testing in patients with a history of allergy to penicillins or semisynthetic penicillins. Methods: One hundred twelve patients with a clinical history of allergic reactions to penicillins and other semisynthetic penicillins were skin tested an average of 4.9 ± 0.7 years after their reactions with the major and minor determinants of benzylpenicillin and minor determinant mixtures of ampicillin, amoxicillin, or cloxacillin. Results: In these patients the most common clinical reactions were urticaria and angioedema (36.6%) and exanthema (48.8%). It was found that 21 cases (18.8%) still exhibited immediate hypersensitivity reactions on skin testing. But of these 21 patients, skin test reactivity was limited in 47.6% to the semisynthetic penicillin reagents derived from ampicillin, amoxicillin, or cloxacillin; that is, skin tests were negative with the benzylpenicillin derivatives. Ampicillin and amoxicillin were the semisynthetic l3-lactams causing most clinical reactions (24.1% and 33.9%, respectively), and ampicillin was the most common penicillin derivative to which skin test reactivity occurred (38.1%), other than the benzylpenicillin derivatives (52.3%). Conclusions: IgE antibodies appear therefore to discriminate between benzylpenicillin and ampicillin or other semisynthetic penicillins in a significant proportion of patients allergic to penicillin. Although it has not been proved that side-chain-specific skin reactivity implies the presence of clinically significant immediate hypersensitivity to semisynthetic penicillins, it is possible that side-chain-specific reagents may be required to exclude possible immediate hypersensitivity to the penicillins in patients who reacted to these antibiotics clinically.

Transient hypogammaglobulinemia, elevated immunoglobulin E levels, and food allergy

Four infants presented with the combination of food allergy, transient hypogammaglobulinemia (THI), and elevated serum IgE levels. Food allergy was documented by history, positive skin tests for immediate hypersensitivity, radioallergosorbent test, histamine release studies, and lymphocyte transformation in response to food allergens. THI was probably secondary to decreased production since there was no evidence of protein loss from the gastrointestinal tract. Immunologic studies revealed normal B cell number and function in vitro. T cell number and proliferative response to mitogens and antigen were normal but T cells were deficient in their ability to generate helper factors necessary for B cell maturation into immunoglobulin secretory cells. The THI and the deficient production of T cell —helper factor resolved after the age of 20 to 24 mo. A defect in immunoregulation may be responsible for the immunologic abnormalities observed in these patients and their propensity to develop IgE antibodies to food allergens.

An anomalous effect of allergen concentration on weal size elicited by skin testing for immediate hypersensitivity

We report the finding of anomalous responses in the skin of atopic individuals when prick tested with serial dilutions of cocksfoot grass pollen extracts. Each pollen extract was standardized using RAST inhibition activity related to the WHO standard for IgE. 75% of the patients gave a larger weal area with an allergen concentration of 1:10(5) than with the next higher concentration, i.e. 1:10(4). Possible mechanisms whereby a larger skin weal is elicited with a lower concentration of allergen are discussed. This is not a rare finding and can be observed in patients undergoing routine skin testing in the clinic, even where extracts are diluted over a relatively narrow concentration range.

Hypersensitivity to pancreatic extracts in parents of patients with cystic fibrosis

Because immediate hypersensitivity reactions can occur in individuals exposed to powdered pancreatic extracts, 36 patients with cystic fibrosis and 51 parents of such patients were studied for evidence of sensitization. Sensitivity to the extracts as evidenced by history and skin testing was infrequent in the children with cystic fibrosis. However, skin testing for immediate hypersensitivity with either crude pancreatic extracts or inactivated trypsin correlated well in their parents with a history of clinical symptoms. IgE mediation of these reactions in sensitized individuals was demonstrated by antigen-induced histamine release from leukocytes, passive transfer studies, and immediate response to inhalation challenge.

Skin Testing for Penicillin Allergy: Its Limited Value

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

Selected aspects of penicillin allergy.

SUMMARY.— Skin tests for immediate hypersensitivity with penicillin derivatives and haemagglutination tests for penicilloyl-specific IgG and IgM antibodies are useful in the prevention, diagnosis and management of clinical adverse reactions mediated by IgE antibodies. In rare instances, the skin tests themselves may cause clinical adverse reactions. Under suitable conditions, hyposensitization or temporary loss of skin sensitivity can be successfully brought about, even in individuals with a high degree of immediate hypersensitivity. Delayed hypersensitivity plays a role in mediating certain non-urticarial forms of penicillin allergy, including some cases of exanthematous eruptions. The degree of delayed hypersensitivity consistently fluctuates to lower levels after administration of therapeutic doses of penicillin. Preliminary data are presented which suggest that infants who are given penicillin at birth form IgM penicilloyl-specific serum antibodies much less frequently and in lower titres than occur after penicillin therapy later in life.