Intradermal Test Research Articles

The Patent Blue V Paradox: Hidden Offender, Serial Culprit.

Background: Patent Blue V (PBV) is extensively used in sentinel lymph node identification in cancer surgery, potentially leading to an increased incidence of hypersensitivity reactions. Methods: A retrospective analysis was conducted on patients with suspected PBV hypersensitivity, at our center from 2010 to 2023. Skin prick tests (SPT) were performed on all patients, followed by intradermal tests (IDT) if SPT was negative. Results: Of 160 patients with suspected perioperative hypersensitivity reactions (POH), 15 (9.4%) had received PBV. All patients were female, with a median age of 50 years. None had been previously exposed to PBV. In 2 cases, there was no registry of PBV use. In vivo tests were mostly performed 6-9 months after the index reaction (53%). PBV allergy was confirmed in 80% of cases via positive skin tests (SPT [n = 10] or IDT [n = 2]). In PBV allergic patients, anaphylaxis occurred in 7 patients (58%). A rising incidence of PBV allergy in the POH setting was observed from 2010 to 2023. Conclusions: PBV is a significant allergen in POH, with increasing incidence. SPT is effective and frequent enough for diagnosis, suggesting an IgE-mediated mechanism. Despite its allergenic potential, PBV's clinical utility supports its continued use with appropriate precautions.

Value of anatomopathological examination in goats with a positive comparative intradermal tuberculin test as part of a tuberculosis control programme.

Caprine tuberculosis is a chronic infectious disease caused by Mycobacterium bovis and Mycobacterium caprae. A tuberculosis control programme has been implemented using the comparative intradermal tuberculin (CIT) test. However, infection with Corynebacterium pseudotuberculsis and infection with or vaccination against Mycobacterium avium subspecies paratuberculosis (MAP) may have a negative impact on specificity. Therefore, a postmortem examination is necessary to verify the tuberculosis status of each animal where positive predictive value is low. Thirty-seven CIT-positive goats from 14 herds with a previously tuberculosis-free status were slaughtered between 2015 and 2020, and postmortem examination was carried out at the School of Veterinary Medicine of Murcia. Anatomopathological examination ruled out the presence of tuberculosis lesions. In 23 of the goats, the anatomopathological examination revealed the presence of the paucibacillary form of paratuberculosis (associated with MAP infection), and in another six goats, Corynebacterium pseudotuberculosis infection was confirmed. Positive reactors have not reappeared in any of the herds in the annual CIT tests up to the year 2023. Only those herds that sent their positive animals to the veterinary school were included in the study. Participation in the postmortem analysis was not mandatory for farmers. Anatomopathological examination is a useful, rapid and economically viable tool to determine the tuberculosis status of goat herds.

P0490 Diagnosis and treatement of latent tuberculosis infection in patients with chronic Inflammatory Bowel Disease candidates for anti-TNFα therapy in a tuberculosis endemic country

Abstract Background The increasing use of anti-TNFα agents in the management of IBD raises concerns about the increased risk of latent TB reactivation, justifying the need for effective screening recommendations. Our study focuses on IBD patients candidates for anti-TNF therapy aiming to determine the prevalence of latent TB infection, examine factors influencing QantiFERON® outcomes, and describe therapeutic modalities for latent TB in this population. Methods This was a descriptive retrospective study of 87 patients followed up in the gastroenterology department of the Mohammed V Military Training Hospital in Rabat for IBD who were candidates for anti-TNF alpha biotherapy between 2021 and 2024. Results The prevalence of latent tuberculosis TBL identified in patients with chronic inflammatory bowel disease candidates for anti-TNFα therapy in our study was 24.1%, detected by the Quantiferon Gold IT® test. Factors influencing the results of the test found mainly include the various risk factors for tuberculosis in our context of intermediate endemicity, and the use of immunosuppressants, which is associated with a negative test. As the intradermal tuberculin test could not be carried out in Morocco due to a stock shortage, the comparison of the performance of the two tests was not possible. Despite an initially negative Quantiferon Gold IT® test, 4 cases of active tuberculosis were recorded after initiation of anti-TNF treatment. Conclusion The IGRA Quantiferon Gold IT® test is considered a valuable tool for detecting latent tuberculosis in IBD patients who are candidates for anti-TNF treatment. However, its use and interpretation in an endemic country and in vaccinated subjects should be the subject of larger-scale studies aimed at proposing appropriate recommendations based on the risk of latent tuberculosis.

Horse antithymocyte globulin test doses and infusion reactions in adults with aplastic anemia: A multicenter retrospective experience

Introduction Horse antithymocyte globulin carries a black box warning for life-threatening anaphylactic reactions, and prescribing information recommends test doses to identify patients at highest risk of this adverse effect. The predictive value of such test doses is not well validated, and practicality of use is unclear. Methods This was a planned secondary analysis of a multicenter, retrospective cohort study in adults with severe aplastic anemia being managed with horse antithymocyte globulin as part of their treatment regimen. Qualitative and quantitative descriptions of test doses and infusion reactions are summarized, alongside key institutional administration practices. Results Of 49 patients who received intradermal test doses, two experienced positive reactions and went onto receive their full horse antithymocyte globulin course through prolonged infusion time or desensitization. Infusion reaction rate in patients with negative test doses was 61%, corresponding to a negative predictive value of 39%. Premedication, infusion time, and infusion reaction management were similar across institutions. Conclusion Horse antithymocyte globulin has a high risk of infusion reactions that must be monitored and managed closely. However, test doses do not consistently predict who will experience an infusion reaction, and their practicality may be limited with current administration practices.

Challenges in diagnosing polyethylene glycol and polysorbate 80 allergies: implications for allergic reactions in COVID-19 mRNA vaccination program: experience from Qatar.

COVID-19 vaccination has been a key intervention in reducing the severity of symptoms; however, concerns about vaccine safety, particularly regarding allergic reactions, arose early on. Healthcare workers faced the challenge of addressing these concerns to ensure safe vaccine administration. This study aimed to review the practical aspects of using allergy skin testing for COVID-19 vaccine excipients in patients with a history of allergic reactions developed following mRNA COVID-19 vaccination. A retrospective chart review was conducted for patients who reported allergic reactions after the COVID-19 vaccine and underwent allergy skin testing for COVID-19 vaccine excipients in the Adult Allergy and Immunology Service at Hamad Medical Corporation, Doha, Qatar. The testing protocol, developed based on published data during the pandemic, included skin prick (SPT) and intradermal (ID) testing using medications containing polysorbate 80 and polyethylene glycol (PEG), the primary excipients in the COVID-19 vaccines suspected of triggering allergic responses. Of the 88 patients reviewed, 38 reported different types of allergic reactions following mRNA COVID-19 vaccination, with the majority being female. Anaphylaxis was reported in 21.1% of the patients, while the remaining experienced less severe allergic reactions. All patients underwent SPT and ID testing with PEG and polysorbate 80. By SPT, two patients tested positive for PEG and none for polysorbate 80. By ID, seven tested positive for polysorbate 80 and one for PEG. Among patients who experienced anaphylaxis, 50% had positive allergy test results. Twenty-three percent of patients with negative test results could receive additional vaccine doses without adverse reactions. Managing patients with a history of allergic reactions to the COVID-19 vaccine is challenging, as the exact mechanisms and accurate and valid allergy testing are yet to be determined. In our cohort, most patients had mild allergic reactions following vaccination. Excipients' allergy skin testing has helped to reduce vaccine hesitancy despite its questionable utility in clinical practice.

Safety of 1 mcg/mL as the starting dose in cluster protocol for hymenoptera immunotherapy.

Hymenoptera venom allergy is a potentially severe allergic reaction in the general population. The only preventative approach in these cases is venom immunotherapy (VIT), which follows different protocols. The recommended initial dose is 0.001-0.1 mcg of venom extract. However, few reports have declared the safety of 1 mcg venom as the starting dose. The study was conducted on Iranian patients with a history of anaphylaxis to venom. Skin tests confirmed hypersensitivity to honeybee, yellow jacket, and/or paper wasp from subfamily Polistes using Apis melifera, Vespula spp, and Polistes spp venom extracts, respectively. Subsequently, the patients were treated with the cluster protocol. Twenty-two patients (17 males and 5 females, aged 28.3±11.8 years) were enrolled in the study. Skin prick tests and intradermal tests showed positive results for yellow jacket in 17 (77.3%) and 21 (95.4%) patients, honeybee in 14 (63.6%) and 17 (77.3%) patients, and wasp in 14 (63.6%) and 17 (77.3%) patients, respectively. Upon administering the initial dose of 1 mcg/mL, 40.9% (9 cases) of patients presented mild local reactions, including 7 with yellow jacket allergy, 5 with honeybee allergy, and 3 with wasp allergy. One patient with yellow jacket allergy had a mild systemic reaction. Patients with a positive skin test for wasp had significantly lower rate of reactions after the first dose of venom (p=0.026). Throughout the entire build-up phase, more than 90% (20 of 22) of patients experienced mild local reactions, followed by large local reactions (3 cases, 13.6%), mild systemic reactions (1 case at 1 mcg/mL dose), and moderate-to-severe systemic reactions (3 cases, 13.6%). Large local and moderate-to-severe systemic reactions were detected after injecting 50 mcg (each one case) and 100 mcg (each 2 cases) of venom extracts. This study recommends 1 mcg/mL of the venom extract as a safe starting dose for VIT. This accelerated protocol could successfully reduce the time and costs of therapy for patients undergoing out-patient cluster VIT.

Drug Allergy Testing in a Pediatric Patient with Diffuse Cutaneous Mastocytosis

Mastocytosis represents a group of diseases characterized by excessive accumulation of mast cells in one or more tissues. It can affect only the skin or have systemic involvement. It has a low prevalence and the prognosis in children is benign. Patients with pediatric mastocytosis often require sedation or anesthesia for diagnostic and therapeutic procedures. Here, we report our experience with anesthesia in a pediatric patient with diffuse cutaneous mastocytosis undergoing surgical intervention for circumcision. The aim was to determine the risk of anesthetic drugs to be used for general anesthesia in a patient with diffuse cutaneous mastocytosis. A 5-year-old male patient who was consulted with anesthesia for circumcision operation and diagnosed with diffuse cutaneous mastocytosis by skin biopsy was not operated because of the risk of drug allergy and referred to the pediatric allergy and immunology department. Routine hemogram and biochemistry laboratory results were within normal limits. Occasional elevation of serum tryptase level was observed. Skin prick test with lidocaine did not show any significant change compared to the negative control due to dermatographism. However, intradermal tests with lidocaine 1:1 and 1:10 dilutions were negative. For drug allergy provocation test, increasing doses of lidocaine were administered subcutaneously and no reaction developed. Intradermal tests with midazolam and bupivacaine were also negative. There was no early or late reaction to any of these. In conclusion, it has been presented in the literature which drugs can be used without any problem according to intradermal test results as in our case. However, all precautions should be taken against the possibility of anaphylaxis in these patients. Re-consultation 24 hours before surgery regarding the use of prophylactic drugs is appropriate

Successful Desensitization to Irinotecan in a Patient with Metastatic Esophageal Squamous Cell Carcinoma and a History of Anaphylaxis in Response to Irinotecan-Case Report and Literature Review.

Background:Irinotecan is a topoisomerase I inhibitor used for the treatment of various cancers, such as gastrointestinal, pancreatic, pulmonary, ovarian, and cervical cancers. Among chemotherapy agents, it represents a rare trigger of drug hypersensitivity reactions, with few cases being reported until today. Methods: We present the case of a patient with metastatic esophageal cancer and a history of irinotecan-induced grade IV (WAO classification) anaphylaxis. An IgE-mediated reaction was confirmed in our case, as evidenced by a positive intradermal skin test result, and we carried out a successful desensitization protocol, given irinotecan's indispensability in the treatment regimen. Our case underscores the fact that in such situations where the culprit drug is also the only therapeutic option available for such a patient, implementing a desensitization protocol may represent the only viable approach to ensure safe and successful dosing. Results: A comprehensive review of the literature was also conducted to assess previously reported irinotecan-induced hypersensitivity reactions, the utility of skin tests in identifying sensitisation to irinotecan, and the existing desensitization protocols. We found a total of seventeen cases of hypersensitivity reactions to irinotecan in the literature, out of which four provided the skin test results obtained and six performed desensitization protocols for irinotecan. Conclusions: Our literature review highlights that skin testing and desensitization protocols can provide suitable solutions for managing hypersensitivity reactions to irinotecan.

The relationship between drug-induced immunogenicity and hypersensitivity reactions and skin tests related to infliximab, etanercept and adalimumab in patients with rheumatoid arthritis and ankylosing spondylitis.

We aimed to investigate the relationship between serum antidrug antibodies (ADAbs), systemic hypersensitivity, or local injection site reactions to tumor necrosis factor (anti-TNF) drugs and to detect the role of skin tests in the diagnosis of hypersensitivity reactions (HSRs) against anti-TNFs. Sixty-nine ankylosing spondylitis (AS) and 46 rheumatoid arthritis (RA) patients taking infliximab (IFX), adalimumab (ADA), and etanercept (ETN) were enrolled. The demographical data, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) levels of the patients were determined, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) assessment for AS patients and DAS28 (disease activity score) for RA patients were assessed. Serum levels of anti-TNFs and ADAbs to these agents were measured with ELISA. These blood samples were taken 24 h before the next drug dose. The patients with anti-TNF-associated HSRs were evaluated with a skin-prick test (SPT) and intradermal test (IDT). Readings for the SPT and IDT were conducted after 15 min and 24, 48, and 72 h. Heel diameter of 3 mm or more greater than the negative control was considered positive for SPT, and if the size of the initial wheal had increased by at least 3 mm in diameter and was surrounded by erythema it was considered positive for IDT. Symptoms such as urticaria/angioedema and flushing were considered immediate-type HSRs. Findings developed at the injection site such as swelling and erythema were considered injection-site reactions (ISRs). An overall p < 0.05 was considered statistically significant. A statistically significant association was found between HSRs (immediate type and ISRs) and IDT reported by patients taking biological drugs (p = 0.001). In the subgroup analysis, a statistically significant association was found between ISRs and IDT in those taking ADA and ETN (respectively p = 0.012, p = 0.013). No relationship was found between skin test positivity and the presence of IgG ADAbs to anti-TNFs or disease activity scores. This study demonstrates that patients who exhibit ISRs to anti-TNFs produce notably positive results to IDT without maintaining a direct relationship to serum levels of ADAbs.

Use of commercial ELISA for the diagnosis of bovine tuberculosis in animals negative in the intradermal tuberculin test

Tuberculosis is a globally distributed infectious disease of great importance to public health due to its zoonotic nature. In addition to its major impact on public health, bovine tuberculosis causes major economic losses due to reduced herd productivity and carcass losses in slaughterhouses. Given the critical importance of the disease, it is of utmost importance to enhance the accuracy of diagnostic methods in programs aimed at controlling and eradicating bovine tuberculosis in Brazil. The objective of this research project is to diagnose bovine tuberculosis in dairy herds that previously tested negative in the intradermal tuberculin test using commercial ELISA (enzyme-linked immunosorbent assay). Samples from 17,917 cattle from dairy herds distributed across five farms in the Campos Gerais region of the state of Paraná were analyzed. For serological diagnosis, the commercial ELISA/IDEXX® kit was used to detect anti-Mycobacterium bovis antibodies in cattle herds. Of the 17,917 animals tested, the ELISA Mycobacterium bovis Antibody Test (IDEXX®) identified 399 (2.3%) reactive animals and 17,518 (97.7%) non-reactive animals. The highest number of positive animals in the ELISA was observed on farm B, with 375 (2.5%) reactive animals. Given the challenges faced in Brazil regarding the diagnostic confirmation of tuberculosis and the absence of validated reagents and methods, the importance of implementing new validated diagnostic methods is evident. The use of ELIST could serve as a complementary alternative to the official intradermal tuberculin test, potentially detecting false-negative animals and aiding in the control of the disease.

122 Evaluation of the relevance of skin prick test, intradermal test, specific IgE and total IgE levels considering hymenoptera allergy using an own clinical classification

122 Evaluation of the relevance of skin prick test, intradermal test, specific IgE and total IgE levels considering hymenoptera allergy using an own clinical classification

Assessment of the Safety of Alternative Antibiotics in Children with Confirmed Beta-Lactam Antibiotic Allergy

Introduction: Beta-lactam antibiotics (BLAs) are the most common cause of drug hypersensitivity reactions in children, and it is important to find safe alternative antibiotics for these children. This study evaluates the selection, safety to alternative antibiotics in patients with confirmed BLA allergies based on diagnostic tests. Methods: At the Pediatric Immunology and Allergy Clinic of Ankara Bilkent City Hospital, a retrospective evaluation of diagnostic tests (including skin prick, intradermal, and drug provocation tests) was conducted to identify alternative antibiotics for patients with confirmed BLA. Patients were also contacted by telephone to assess their use of these alternative drugs. Results: The study included 80 patients with confirmed beta-lactam allergy (BLA). The BLAs causing reactions were categorized into two groups: penicillins (75%, n = 60) and cephalosporins (25%, n = 20). Among the penicillins, amoxicillin-clavulanic acid (ACA) was the most common at 68.8%, while among the cephalosporins, ceftriaxone was the most common at 16.3%. Of the 55 patients with ACA allergy, 53 underwent controlled administration with clarithromycin, with 52 showing no reaction. In addition, no reaction was observed in patients who received DPT with cefuroxime (n: 16), phenoxymethyl penicillin (n: 9), cefdinir (n: 1), and cefixime (n: 1), while there was no reaction in the controlled administration with clindamycin. Alternative treatments were tested in 13 patients with a confirmed ceftriaxone allergy. No adverse reactions were observed in 9 patients who underwent DPT with ACA and in 10 patients who were exposed to clarithromycin under controlled conditions. Finally, 54 of the 80 patients (67.5%) were successfully contacted and none reported a reaction to the alternative drugs. Conclusion: For patients with confirmed BLA, macrolides may be considered as preferred alternatives. In addition, beta-lactams with different side chains may be safe alternatives after diagnostic evaluation, taking into account the risk of cross-reactivity.

Evaluating the Pathogenic Potential of IgE Targeting Cross-Reactive Carbohydrate Determinants in Dogs.

Cross-reactive carbohydrate determinants (CCDs) are complex N-glycans shared among allergens of plant, insect venom, and nematode origin. In allergic humans, IgE anti-CCD often develop and cause discrepancies between serological and skin tests. Overall, CCD-IgE are believed to be of low pathogenic relevance. IgE-targeting CCDs are also detected in companion animals, but their pathogenic potential and biological relevance are unknown. Herein, we first establish that, in 34 dogs with atopic dermatitis, the presence of serum anti-CCD IgE was detected in 14 pets (41.2%). In dogs, as in humans, IgE-targeting CCDs are heterogeneous, as they differentially recognized four distinct CCD-expressing proteins. The presence of CCD-IgE was associated with a higher and more frequent recognition of plant extracts in serological but not intradermal tests. Two different CCD-expressing proteins did not elicit immediate reactions when injected intradermally in dogs with detectable serum anti-CCD IgE. Similarly, two different CCD-expressing proteins did not induce the activation of mast cells passively transferred with canine anti-CCD IgE. Altogether, these results suggest that in dogs, as in humans, anti-CCD IgE are likely to have little pathogenic potential and blocking them in allergen-specific IgE serological tests is warranted to avoid false-positive results to plant extracts.

Allergic clinical symptoms and distribution of stimulation index of drug lymphocyte stimulation test for local anesthetics.

The Drug Lymphocyte Stimulation Test (DLST), recognized for its safety as an allergy diagnostic modality, has been acknowledged for its utility in diagnosing drug-induced pathological conditions. However, reports elucidating DLST outcomes concerning local anesthetics are notably scarce. An exhaustive analysis was conducted on the DLST results pertaining to local anesthetics derived from 571 patients presenting with suspected allergies to these specific agents. Remarkably, Stimulation Index (SI) > 1.8 was discerned in 11.4% and 7.8% of patients exhibiting hives or swelling subsequent to the administration of local anesthetics, surpassing the incidence observed in those experiencing post-injection discomfort. Additionally, SI > 3.0 was observed in 3 cases with lidocaine, 3 cases with prilocaine, and 1 case with mepivacaine. The distribution of SI exhibited a non-normal pattern for all three tested local anesthetics. Noteworthy is the case of a singular patient registering an SI of 1.84, who also yielded a positive challenge test, conclusively confirming an allergy to lidocaine. The DLST, holding promise as a potentially invaluable tool in identifying the causative factors behind adverse reactions to dental local anesthetics, lacks sufficient evidence to substantiate its efficacy definitively at present. DLST, coupled with intradermal testing and challenge testing, may be elucidated in patients exhibiting indicators of suspected local anesthetic allergy.

Allergic contact dermatitis to chlorhexidine in children.

Hypersensitivity to chlorhexidine is rare in children. The usefulness of different diagnostic tests for allergic contact dermatitis (ACD) is unknown. We aim to describe a case series of children with hypersensitivity to chlorhexidine and to compare the results of different diagnostic tests. Nine children with hypersensitivity to chlorhexidine were included. Only six of these children and their parents consented to a comprehensive allergy assessment, which included the prick test, intradermal test, patch test, and repeated open application test (ROAT). Seven children (78%) presented symptoms of chlorhexidine hypersensitivity within the first 5 years of life; two of them before the age of 1 year. In four children, the dermatitis lesions were suggestive of wound superinfection. All six children who participated in the comprehensive diagnostic evaluation had negative results on the prick test. The immediate-reading intradermal test was positive in one case and uncertain in two cases. The patch test was positive in five cases, and the ROAT was positive in all six cases when using 2% chlorhexidine alcohol solution. ACD to chlorhexidine in children appears to be rare and can be difficult to detect. Clinicians should consider this diagnosis when wounds worsen with chlorhexidine. Although the patch test is the most standardized method for detecting ACD, the ROAT with 2% chlorhexidine alcohol solution was the most sensitive test in our patients.

Bee/Vespula Venom-Specific IgE Ratio Greater Than 5:1 Indicates Culprit Insect in Double-Sensitized Patients

BackgroundVenom-allergic patients are frequently double-sensitized to honeybee venom (BV) and Vespula venom (VV); genuine double allergy is uncommon. ObjectivesTo assess if quantitative comparison of BV and VV-specific IgE levels permits to identify the culprit venom in double-sensitized patients; to evaluate whether independent sensitization to BV- and VV-specific components corresponds to an indication for double immunotherapy. MethodsThis single centre observational study evaluates 1069 consecutive patients; 490 non-allergic controls were available for statistical comparison. The diagnosis (BV allergy, VV allergy, double allergy) based on a comprehensive allergological work-up including patient history, IgE serology, intradermal skin test, and – if required – basophil activation testing. Quantitative allergen-specific IgE to BV, VV, rApi m 1, rVes v 5 was retrospectively compared with the final diagnosis; the ratio of BV/VV-specific IgE levels was considered in double-sensitized venom-allergic patients. ResultsSensitization to whole venom preparations and components was frequent in patients and asymptomatic controls, with higher specific IgE levels in the patient group. An at least 5:1-dominance of the specific IgE to either BV or VV was documented in 239 (52.1 %) of 459 double-sensitized venom-allergic patients; 232 (97.1%) of these patients were diagnosed mono-allergic to only the venom they were dominantly sensitized to. ConclusionsFive:1-dominant specific IgE indicates the culprit venom in double-sensitized allergic patients. Additional component-resolved diagnostic testing can be restricted to cases with double sensitization to whole venoms at a ratio less than 5:1. Double sensitization to rApi m 1 and rVes v 5 per se does not justify double venom immunotherapy.

Allergic rhinitis: a brief overview of the etiopathogenesis and rehabilitation of patients

The article presents a brief overview of modern literature sources concerning the prevalence, etiopathogenetic approaches in the diagnosis and treatment of allergic rhinitis. The relevance of the problem under consideration is due to the high prevalence of this pathology, the variety of etiopathogenetic mechanisms and the variability of classifications. One of the most popular classifications is seasonal. When studying pathogenetic mechanisms, the following patterns were revealed: the nasal mucosa is the main air conditioner of the respiratory tract and the first line of defense against infectious agents transmitted by airborne droplets. These roles require maintaining and restoring epithelial integrity and the ability to initiate immune responses. When conditions or factors are present that compromise the integrity of the mucosa, the epithelium releases alarmins and other molecular patterns associated with damage that trigger repair mechanisms but can also cause protective inflammation. In allergic rhinitis, the same mechanisms can activate the development of the disease. Many authors consider various diagnostic methods for allergic rhinitis. Such as a detailed and competent collection of complaints and anamnesis, including family history, physical examination, endoscopic examination of the nasal cavity, rhinomanometry, skin prick tests, radiological studies, including computed tomography of the paranasal sinuses, intradermal tests, study of total and specific immunoglobulins E in blood serum, basophil activation test, nasal provocation test, nasal cytology and biopsy histology, acoustic rhinometry, nasal inspiratory peak flow testing, and nitric oxide measurements are used. Attention is also paid to laboratory and instrumental methods for the differential diagnosis of rhinitis of pseudoallergic origin; the following methods are used: ultrasound diagnostics of the hepatobiliary system, biochemical blood test, and immunological studies. Treatment of patients with allergic rhinitis requires an integrated and interdisciplinary approach and, of course, requires differential and personalized methods taking into account etiopathogenetic mechanisms.

Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population

BackgroundPenicillin allergy adversely impacts patient care, yet most cases do not have true allergies. Clinicians require efficient, reliable clinical tools to identify low risk patients who can be safely de-labeled. Our center implemented the FIRSTLINE electronic point-of-care decision support tool to help non-allergist practitioners risk stratify patients with penicillin allergy. We sought to explore the reliability and validity of this tool in relation to allergist assessment and actual patient outcomes. We additionally compared it with two other published stratification tools, JAMA and PENFAST, to assess ability to accurately identify low risk patients appropriate for direct oral challenge.MethodsIn this single-center, retrospective, observational study, 181 pregnant females with self-reported penicillin allergy between July 2019 to June 2021 at BC Women’s Hospital, Vancouver, Canada were used to assess the reliability and validity of all three tools. Physician-guided history of penicillin use and symptoms were used for scoring. Results and recommendations were compared to actual patient outcomes after clinician decision for direct oral challenge or intradermal tests. We compared the performance of JAMA, PENFAST and FIRSTLINE.Results181 patients were assessed. 176/181 (97.2%) patients were deemed not allergic. Each risk stratification tool labelled majority of patients as low risk with 88.4% of patients PENFAST 0–2, 60.2% of patients JAMA low risk, 86.7% of patients FIRSTLINE very low risk.ConclusionWe demonstrate that our point-of-care electronic algorithm is reliable in identifying low risk pregnant patients, as compared to an allergist assessment. To our knowledge, this is the first study to provide direct comparison between multiple decision support tools using the same population, minimizing participant bias. Providing clinical algorithms to risk stratify patients, can enable healthcare professionals to safely identify individuals who may be candidates for direct penicillin oral challenges versus needing referral to specialists. This increases the generalizability and efficiency of penicillin allergy de-labeling.

Equivalence in intradermal reactions to histamine and compound 48/80 in dogs before and after sedation with dexmedetomidine or a 1:20 combination of medetomidine and vatinoxan.

Intradermal allergen testing (IDAT) is commonly used to formulate allergen-specific immunotherapy, a pillar treatment for canine atopic dermatitis. Many sedatives have shown histaminergic or anti-histaminergic effects and thus been deemed unsuitable for IDAT. The goal of this study was to determine whether, in healthy dogs, dexmedetomidine (Dexdomitor) or a 1:20 combination of medetomidine and vatinoxan (Zenalpha) will affect intradermal reactions compared to unsedated dogs. Ten privately owned healthy dogs were enrolled in this equivalence study. Wheal formation was subjectively and objectively assessed in conscious then sedated dogs. Dogs were randomly sedated with either Dexdomitor (dexmedetomidine [0.5 mg/m2]) or Zenalpha (medetomidine [1 mg/m2/vatinoxan] 20 mg/m2) intramuscularly. Once sedated, five 10-fold histamine (100-0.01 μg/mL) and compound 48/80 (200-0.02 μg/mL) dilutions were intradermally injected into the lateral thorax. The study was repeated on the opposite side with the alternative sedation 1 week later. Quality of sedation, cardiorespiratory function and rectal temperature were recorded every 5 min. There was no difference in the median values of the reactions with either sedative when compared to unsedated dogs. Dexdomitor and Zenalpha achieved an equivalence in both subjective and objective scoring systems for all concentrations tested. A faster median time to sedation (10 vs. 18 min, p = 0.013) was seen with Zenalpha compared to Dexdomitor. Although both sedatives depressed the cardiovascular function, such parameters were less affected by Zenalpha than by Dexdomitor (p ≤ 0.001). Owing to the lack of effects on wheal formation, both sedatives are appropriate for sedating dogs undergoing IDAT. Although, such results should be validated in allergic dogs. Zenalpha may induce more rapid and reliable sedation than Dexdomitor.

Retrospective analysis of rapid drug desensitization with biologic agents: A single center experience.

Following the increased use of biological agents, a subset of patients experiences hypersensitivity reaction (HSR). We reported our experience with rapid drug desensitization (RDD) to nine biologics (rituximab, infliximab, cetuximab, trastuzumab, pertuzumab, nivolumab, brentuximab, tocilizumab and filgrastim) and identified risk factors for breakthrough reactions (BTRs). This was a retrospective review (2013-2022) of patients with immediate HSRs to biological agents. Initial HSRs were classified as grade 1, 2, or 3 in their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed using implicated agents. The phenotypes of HSRs were defined as Type I, cytokine-release syndrome (CRS), mixed reactions (cytokine-release+type I) based on history, clinical presentations and skin tests with implicated biologicals. A 12-step RDD protocol was used. The study comprised 45 patients (F/M: 31/14, median age: 55 (range: 20-69)). Majority of the patients reacted at the first infusion (n: 29/45, 64.4%). The majority of initial HSRs were grade 3 (n: 24/45, 53.3%) and grade 2 (n: 21/45, 46.6%); none were grade 1. Initial reactions were presented as type I (n: 20/45, 44.4%), CRS (n: 12/45, 26.6%) and mixed (n: 13/45, 28.8%). A total of 258 RDDs were performed and 98.4% of them were completed successfully. BTRs occurred in 36/258 (13.9%) infusions of RDDs. There was no significant association between the BTRs and age, drug cycle, SPT and IDT positivity, gender, comorbidities, or atopy. In our experience, 98.4% of 258 RDDs to biologics were successfully completed; RDD was safe and effective for our population.