Negative Allergy Test Research Articles

Impact of Atopic Status on Clinical Presentation and Treatment Response in Pediatric Patients With Eosinophilic Esophagitis

BackgroundNearly 80% of patients with eosinophilic esophagitis have co-existing atopic disease, yet a subset do not. It is unclear if this lack of atopy impacts presentation or response to therapy. ObjectivesTo characterize the presentation and response to therapy in atopic versus non-atopic pediatric patients with EoE MethodsA case-control study of EoE patients, ages 6 months to 18 years (between 2018-2021) was performed. Patients were eligible if they had allergy testing, assessment of atopic history, and at least one endoscopy following initiation of treatment. Patients were considered non-atopic if they had negative allergy testing and no history of significant atopy. Response to therapy was classified as complete (peak eos < 15/hpf), partial (≥ 15 eos/hpf but at least a 50% reduction in peak eos), or non-response. Results168 participants were enrolled. The majority were white (n=141, 84%), male (n=124, 74%), and non-Hispanic (n=158, 95%). Mean age at diagnosis was 9.4 years (SD: ± 4.8). 123 participants (73.2%) were atopic and 45 (26.8%) were non-atopic. There was no significant difference between atopic and non-atopic for most demographics or presenting symptoms. Non-atopic participants presented younger than atopic participants (8.14 vs. 9.8 years, p=0.046). Swallowed topical corticosteroids (STC) and food elimination diets (FED) were utilized at a similar rate. There were no differences in treatment response between atopic/non-atopic participants in regards to STC, FED, or STC+FED. ConclusionAtopic status does not significantly impact presentation or response to treatment in pediatric EoE, but a lack of atopy may be a risk for earlier onset of disease.

Occupational asthma in the salmon processing industry: a case series

ObjectivesExposure to bioaerosols in salmon processing workers is associated with occupational asthma. IgE-mediated allergy and other disease mechanisms may be involved in airway inflammation and obstruction. Knowledge about disease burden,...

Local allergic rhinitis: considerations.

The term "local allergic rhinitis" has gained popularity as a clinical entity in recent years. Despite the apparent contradiction in the definitions of "nasal" and "local," we offer insights based on our extensive experience in the field. Local allergic rhinitis has been recognized and treated for many years, so it is not a new discovery. The nasal provocation test, which was introduced in the 1980s, was critical in identifying allergic rhinitis cases with suggestive symptoms but negative allergy tests. Our reflections aim to contribute to a precise terminological decision that is consistent with various points of view.

Retrospective investigation of the relationship between clinical and laboratory parameters and allergy tests in children with allergic rhinitis

Background: It was aimed to investigate the relationship between neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), eosinophil-lymphocyte ratio (ELR), serum total immunoglobulin E (IgE) values and allergy test positivity in patients with allergic rhinitis (AR).&#x0D; Methods: The study is a descriptive study with a retrospective design. Data on patients aged 0-18 years with a diagnosis of AR were investigated retrospectively. Age, gender, hemogram parameters (leukocyte, eosinophil, lymphocyte, thrombocyte), total IgE values, allergy history and allergy test positivity were evaluated. A p value of less than 0.05 was considered as a statistically significant result.&#x0D; Results: In the study, the data of 230 pediatric patients with AR were analyzed. The median age of the children was 13 years (10-18). Of the patients 57.4% (n=132) were male, 42.6% (n=98) were female. All laboratory values, except PLR, of the patients with positive allergy test were higher than the patients with negative allergy test. This elevation in WBC, neutrophil, absolute eosinophil, eosinophil percentage, total IgE and ELR values was statistically significant (p

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Evaluation of a pharmacist-led penicillin allergy testing service in a community health system

BackgroundRoughly 10% of the U.S. population has a documented penicillin (PCN) allergy. Among these individuals, over 95% are able to tolerate PCNs. The inability to use PCNs can result in suboptimal outcomes. In August 2019, Lawrence Memorial Hospital Health System implemented a pharmacist-led PCN allergy testing service to assist with delabeling PCN allergies and increase access to this class of antibiotics. ObjectivesThe primary objective was to describe the number of patients who underwent PCN allergy testing and were delabeled from PCN allergy. A secondary objective was to report the number of patients who received and tolerated PCN antibiotics after being delabeled from PCN allergy. MethodsThis retrospective chart review was conducted during the initial 17 months of a pharmacist-led PCN allergy testing service. Eligible patients with a history of an immunoglobulin E (IgE)-mediated reaction underwent a 3-step test that consisted of a scratch test, an intradermal test, and an oral challenge. Eligible patients who did not have a history of IgE-mediated reaction underwent a 2-step graded oral challenge. Descriptive statistics were used for data analysis. ResultsBetween August 2019 and January 2022, 70 patients underwent testing, and 66 patients were delabeled from PCN allergy. Four patients who underwent the 3-step test developed reactions of mild to moderate severity. All patients who underwent the graded oral challenge were delabeled from PCN allergy. The rate of PCN allergy was 5.7%, whereas the rate of type I IgE-mediated reaction was 1.4%. All 23 patients who received an antibiotic from the PCN class after a negative allergy test tolerated the PCN antibiotic without an incident. ConclusionPCN allergy testing is an effective way to delabel PCN allergies from most patients presenting with a PCN allergy history. Skin testing followed by an oral challenge or a graded oral challenge alone are safe methods for conducting PCN allergy testing in the primary care setting.

Mitomycin C allergy after passive and device-assisted hyperthermia for non-muscle invasive bladder cancer treatment: A retrospective cohort from a high-volume center.

Mitomycin C (MMC) is one of the most frequently utilized intravesical chemotherapy drugs for the management of non-muscle-invasive bladder cancer (NMIBC). Allergic reactions (Type 4 delayed hypersensitivity) are seldomly reported in the literature but not so infrequent in daily practice, its incidence has been increasing with the use of device-assisted hyperthermia. This study aims to identify the incidence, risk factors, and clinical characteristics of patients with allergic reactions to MMC. Single-center retrospective cohort from June 2014 to August 2018. Patients with intermediate or high-risk NMIBC were included. Patients received passive MMC (4 weekly and eleven monthly instillations of 40mg of MMC) or Chemohyperthermia (CHT) with MMC (6 weekly and 6-monthly instillations, heated at 43°C [+/- 0.5°C] using Combat BRS). We included 258 patients (MMC = 157, CHT = 101) and found 7 (4.4%) suspected and 4 confirmed (2.4%) allergies in the passive MMC group and 11 suspected (10.9%) and 7 confirmed (6.9%) in the CHT group. The mean number of instillations received before developing the allergy was 6 in the passive MMC and 5 in the CHT group. Seven out of 18 suspected allergy cases were pseudo-allergic reactions with negative allergy tests. Early postoperative MMC instillation was associated with an increased risk of allergy (OR 2.47 [CI 1.39-4.36], P = 0.001), while neither history of atopy nor history of other medications allergy was found to increase the risk. MMC allergy risk is increased with the use of device-assisted hyperthermia with an incidence of 2.4% for passive MMC and 6.9% for CHT. History of prior allergies does not seem to increase the risk of developing MMC allergy. In this series 38% of suspected cases were found to be pseudo-allergic reactions, highlighting the need to confirm the diagnosis before definitively stopping the treatment.

Severity and outcome of COVID-19 disease in patients with allergic rhinitis during the pandemic in Qatar - A preliminary report.

Background: Allergic rhinitis and asthma exacerbation are strongly linked to respiratory viral and bacterial infections. COVID-19 pandemic has raised concerns about the risk of infection and the severity of COVID-19 infection in patients with asthma and allergic rhinitis. However, increasing evidence suggests that atopic disease protects against severe COVID-19 illness owing to the underlying type 2 inflammatory process. Many studies have reported the impact of asthma on COVID-19 disease; however, data on allergic rhinitis are scarce. In this study, we aimed to investigate the severity and outcome of COVID-19 disease in adult patients with allergic rhinitis in Qatar during the first pandemic wave.Methods: We conducted a retrospective chart review of adult patients with a confirmed diagnosis of asthma and/or allergic rhinitis who had a positive COVID-19 RT-PCR between February 01, 2020, and December 01, 2020. Parameters evaluated included the WHO classification of COVID-19 disease severity as mild, moderate, severe, and critical; COVID-19 disease outcome; and mortality. Patients with allergic rhinitis were defined as those with typical allergic rhinitis symptoms and positive skin prick test or specific IgE to perennial or seasonal inhaled allergens. Only data about patients with allergic rhinitis has been presented in this report.Results: We screened 97 EMR Cerner records of patients who had the diagnosis code for allergic rhinitis. Nine patients met the inclusion criteria of allergic rhinitis diagnosis; the remaining either had no allergy testing or had negative allergy tests. Seven (77.7%) patients had mild COVID-19, whereas only one (11.1%) patient each had moderate and severe disease. The length of hospital stays for 6 patients ranged from 5–13 days, and the remaining 3 patients were quarantined at home. No reports of critical cases or death were identified. All the patients recovered from COVID-19 with a favorable outcome.Conclusion: This preliminary data showed that most patients with allergic rhinitis had mild COVID-19 disease. Furthermore, all of them recovered well, similar to the available data from previous studies. A limitation of this study is the small population size.

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity.

Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA ); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB ) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work-up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work-up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA >11 (F1), or >2+1.2×TB (F2), or >3+TB (F3), or >120%TB (F4), were applied. One hundred and sixty-two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut-off value of TA to distinguish positive from negative allergy testing patients was 9.8μg/L with an AUC of 0.817 (95% CI: 0.752-0.882, p<.001). The 93% PPV threshold for TA was 33μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). The optimal cut-off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8μg/L. TA value of 33μg/L was required to achieve >90% PPV.

Prevalence of Self-Reported Dysphonia and Dysphagia in Patients with Allergy

To investigate the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy test in comparison to patients with negative allergy tests. A total of 52 patients who presented to the allergy clinic of a tertiary medical referral center for skin testing between June 2019 and December 2019 were were recruited for this study. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. A control group of 20 subjects was matched according to age and gender. All subjects were asked to fill the voice handicap index -10 and the eating assessment tool (EAT-10) questionnaires. Thirty-six of 52 patients were positive for at least one allergen, and 23 tested positive for at least three allergens. On the other hand, there was no significant difference in the mean score of VHI-10 in patients with allergy to at least one allergen, in comparison to patients with no allergy (3.667 vs 3.066, respectively, P value 0.307). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.305 vs 0.00, respectively, P value 0.270). There was also no significant difference in the mean score of VHI-10 in patients with allergy to at least three allergens in comparison to patients with no allergy (3.304 vs 3.066, respectively, P-value 0.603). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.435 vs 0.00, respectively, P-value 0.667). There was a significant difference in mean VHI-10 scores between patients testing positive for at least one allergen and the control group (P=0.0002). The results of this investigation did not show any significance in the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy skin testing in comparison to those with negative allergy skin-testing. More clinical studies on the prevalence of self-reported phonatory complaints in patients with allergy are warranted.

Study on Allergy to Beta-lactams. Should all the patients be delabeled?

Beta-lactams are a kind of antibiotics frequently used to treat infections. Many people with negative allergy tests for these beta-lactams are still labeled as allergic in their medical records. This research aims to estimate the actual allergy prevalence to these antibiotics. The rate between the quantity of practiced tests and the number of people who have been consequently delabeled as allergic is also to be studied.

&lt;p&gt;Successful Dental Treatments Using Procaine Hydrochloride in a Patient Afraid of Local Anesthesia but Consenting for Allergic Testing with Lidocaine: A Case Report&lt;/p&gt;

BackgroundWe report a case in which effective dental anesthetic management was achieved using procaine hydrochloride for a patient who had an unknown history of allergic reactions to lidocaine.Case PresentationBecause the patient refused to undergo screening tests using any of the amide-type local anesthetics because of her extreme fear against local anesthetics that she had been administered previously, procaine hydrochloride, which is an ester-form local anesthetic, was the only agent to be tested on this patient at the department of dermatology. Consequent to a negative allergy test, we performed complete dental treatment using procaine hydrochloride after additional chairside drug challenge tests using minimum test dose under vital sign monitoring.ConclusionThe success of dental treatment using procaine hydrochloride may have relieved the patient’s fear of local anesthesia. We discuss an important aspect of treatment planning for patients with a history of complications during local anesthesia.

The role of component-resolved diagnosis in Hymenoptera venom allergy.

Component-resolved diagnostics (CRD) is a new tool aiming at detecting IgE-mediated sensitizations against individual, relevant allergens. Here, we discuss recent literature on molecular diagnosis in the field of Hymenoptera venom allergy (HVA) as well as CRD strengths and weaknesses. CRD, using single molecules or panels of allergens, may discriminate between primary sensitization and cross-reactivity in patients with double/multiple positivity in diagnostic tests with whole extracts, allowing the specialist to choose the most suitable venom for specific immunotherapy (VIT), avoiding unnecessary VIT and reducing the risk of side effects. Future availability of the cross-reactive recombinant pairs of allergens of different species may further increase the diagnostic performance. CRD may be useful in patients with negative allergy tests and a proven history of a previous systemic reaction, including those with mast cell disorders, who could benefit from VIT. In honeybee venom allergy, different sensitization profiles have been identified, which could be associated with a greater risk of VIT failure or treatment side effects. CRD is undoubtedly an innovative diagnostic method that leads to a more precise definition of the sensitization profile of the HVA patient. Together with a better knowledge of the molecular composition of different venom extracts, CRD may contribute to optimize patient-tailored therapy.

Intranasal corticosteroids for non-allergic rhinitis.

Intranasal corticosteroids for non-allergic rhinitis.

Clinical aspects of hymenoptera venom allergy and venom immunotherapy.

Hymenoptera venom allergy (HVA) is the most frequent cause of anaphylaxis in Europe, accounting for most of the severe reactions occurring in adults, and being the second cause of anaphylaxis in children. Prevention of further episodes in patients who developed a systemic reaction (SR) is based on the correct management of the allergic emergency, the referral to an allergist for a correct diagnosis, prescription of adrenaline auto-injectors (AAI) and specific venom immunotherapy (VIT), if recommended. Diagnosis is based on the classification of the type of reaction, confirmation of an IgE-mediated pathogenesis and the identification of the offending insect. The use of component resolved diagnostics may be helpful in case of poly-sensitization or negative allergy tests with a proven history of previous SRs. When a severe SR occurs, baseline serum tryptase levels should always be assessed. The prescription of AAI is recommended or suggested for untreated patients, patients undergoing VIT and after discontinuation of treatment, according to multiple evidence. VIT is the most effective treatment available for HVA patients, as confirmed by recent European guidelines. VIT has an early, sustained and persistent protective effect and modifies the natural course of the disease. Moreover, VIT proved to be safe and well tolerated. According to a recent systematic review, no treatment-related fatalities were recorded to date. Compared to AAI, VIT significantly improves the quality of life of HVA patients by reducing the anxiety and limitations in daily activities caused by the fear of stinging insects. The memory of a life-threatening experience is the most likely reason why adherence to VIT is higher compared to immunotherapy with inhalant allergens. Several risk factors in HVA have been identified that can influence not only the severity of sting reactions in untreated patents, but also the occurrence of side effects, treatment effectiveness and the risk of relapse after discontinuation of VIT. Patient and treatment-related risk factors must be considered while selecting the best candidates for VIT, the type and duration of treatment. In this paper we address the most important issues related to HVA and VIT that may have an impact on daily clinical practice.

Réactions allergiques et dermatites à Thaumetopoea pityocampa. Revue critique à propos d’un cas

A case of acute pruritic dermatitis occurring in an adult provided us with an opportunity to review the symptoms associated with pine processionary caterpillars. While out picking mushrooms in a pine forest, the patient developed pruritus (some 30minutes after entering the pine forest in which certain trees were infested with processionary caterpillars) and a papular rash occurred several hours later. The diagnosis was based on patient history, which included previous episodes, the appearance of the lesions, and negative allergy tests for allergens likely to occur in this biotope. Our case report is accompanied by a critical literature review. Allergy to pine processionary caterpillars is not associated with allergy to adult butterflies (imago) of the species. The allergenic protein (thaumetopoein) causes local and regional allergic reactions on exposed areas of skin and in conjunctival and respiratory mucosa (nasal, tracheal, bronchial). The major allergen is Tha p 2; a recombinant allergen, r Tha p 2, exists. Individuals allergic to pine processionary caterpillars may include professionals (forest workers) and non-professionals (walkers, holidaymakers, mushroom gatherers, etc.). Symptoms involve irritation (strophulus-like rash associated with urticating caterpillar hairs) or they may be IgE-dependent (conjunctivitis, rhinitis, asthma, and even anaphylaxis). Diagnosis is made primarily on clinical grounds. Prevention requires both individual and collective measures (nationally coordinated combat against the propagation of processionary caterpillars). It should also be noted that animals (particularly dogs) may also be affected, with potentially extremely serious symptoms in the event of ingestion.

Patient and Prescriber Views of Penicillin Allergy Testing and Subsequent Antibiotic Use: A Rapid Review.

About 10% of U.K. patients believe that they are allergic to penicillin and have a “penicillin allergy label” in their primary care health record. However, around 90% of these patients may be mislabelled. Removing incorrect penicillin allergy labels can help to reduce unnecessary broad-spectrum antibiotic use. A rapid review was undertaken of papers exploring patient and/or clinician views and experiences of penicillin allergy testing (PAT) services and the influences on antibiotic prescribing behaviour in the context of penicillin allergy. We reviewed English-language publications published up to November 2017. Limited evidence on patients’ experiences of PAT highlighted advantages to testing as well as a number of concerns. Clinicians reported uncertainty about referral criteria for PAT. Following PAT and a negative result, a number of clinicians and patients remained reluctant to prescribe and consume penicillins. This appeared to reflect a lack of confidence in the test result and fear of subsequent reactions to penicillins. The findings suggest lack of awareness and knowledge of PAT services by both clinicians and patients. In order to ensure correct penicillin allergy diagnosis, clinicians and patients need to be supported to use PAT services and equipped with the skills to use penicillins appropriately following a negative allergy test result.

Analiza wpływu stosowania kremu z pszczelim pyłkiem kwiatowym na wybrane cechy skóry rąk oceniane subiektywnie i obiektywnie

Introduction. Pollen is a plant-based product and is a rich source of biologically active compounds such as: proteins, amino acids, carbohydrates, fats and fatty acids, phenolic compounds and enzymes, considered as an promising ingredient in cosmetic formulations. Aim. The aim of this study was to analyze the effect of a cream enriched with micronized bee pollen on selected skin characteristics evaluated in subjective and objective manner. Material and methods. The participants were 13 female volunteers (students) who met the following criteria: no dermatological and endocrine diseases, non-smoking and no special or elimination diets up to 3 months before the study, and also a negative allergy test result. Students were randomly assigned to the following groups: the experimental group – subjects using cream with 3% micronized bee pollen and the control one using cream base. Before and after the 5-day treatment, the participants undewent the measurements of skin hydration. The subjective evaluation of selected skin properties was examined by using a 3-grade scale. Results. All skin characteristics evaluated subjectively improved as a result of pollen-enriched formula treatment. The participants of the experimental group have noticed a significant change in the following properties: moisturizing, smoothness and skin tightening. The final measurement of skin hydration has showed an increase of 12.14 units in the experimental group and 4.52 units in the control group, indicating difference between groups (p = 0.0389). Also a positive correlation between application time and moisturizing (R = 0.929) has been found. Conclusions. The micronized bee pollen, as an active ingredient in protective and moisturizing preparations, seems to be an effective ingredient.

Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms.

Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics. We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin allergy. Parents of children aged 4 to 18 years old presenting to the pediatric ED with a history of parent-reported penicillin allergy completed an allergy questionnaire. A prespecified 100 children categorized as low-risk on the basis of reported symptoms completed penicillin allergy testing by using a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval. Five hundred ninety-seven parents completed the questionnaire describing their child's reported allergy symptoms. Three hundred two (51%) children had low-risk symptoms and were eligible for testing. Of those, 100 children were tested for penicillin allergy. The median (interquartile range) age at testing was 9 years (5-12). The median (interquartile range) age at allergy diagnosis was 1 year (9 months-3 years). Rash (97 [97%]) and itching (63 [63%]) were the most commonly reported allergy symptoms. Overall, 100 children (100%; 95% confidence interval 96.4%-100%) were found to have negative results for penicillin allergy and had their labeled penicillin allergy removed from their medical record. All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics.

Diamine Oxidase Deficiency as a Proposed Mechanism for Anaphylaxis After the Third Stage of Labor: A Case Report [2B

INTRODUCTION: Previous case reports have demonstrated post-partum anaphylaxis associated with breast-feeding, thought to be due to destabilization of mast cells, but none associated with delivery of the placenta. The histamine-degrading enzyme diamine oxidase is produced in large amounts by the placenta as a metabolic barrier preventing bioactive histamine from entering the maternal or fetal circulation. METHODS: Case report. RESULTS: A 29 yo G5P3 admitted at 39w1d with ruptured membranes. Her obstetrical history is significant for 3 vaginal deliveries with subsequent anaphylaxis after delivery of the placenta, unrelated to narcotic administration. Medical history includes sensitive skin, seasonal allergies, and negative allergy testing. During her first two deliveries, she experienced angioedema (eye and lip swelling) after delivery of the placenta. After her third delivery, she required supplemental oxygen, steroids and epinephrine secondary to laryngeal edema refractory to diphenhydramine. With her fourth delivery, the patient was given 125 mg IV Solumedrol 2 hours prior to delivery, in addition to IV diphenhydramine. Two hours after delivery, she complained of eye and lip swelling and throat “itchiness” but remained hemodynamically stable. She did not improve with a second dose of IV Diphenhydramine. Due to her history, 0.3 mg Epinephrine IM was given with full resolution of symptoms. CONCLUSION: A proposed mechanism of decreased diamine oxidase after delivery of the placenta may provide insight into the maternal–fetal immune system interface in our unusual case. In retrospect, a proposed prevention of anaphylaxis in this patient would be diamine oxidase supplementation in the third trimester.