Positive Intracutaneous Tests Research Articles

Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome.

Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear. This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy. The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen. Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro. The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization. Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients. This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen. IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.

Insulin allergy can be successfully managed by a systematic approach

BackgroundType I insulin allergy can be a challenging condition, and there is no international consensus on how to establish the diagnosis. Measurement of specific IgE and skin testing have been cornerstones in the diagnostic work-up. However, these tests have limitations, mainly lack of correlation between test results and clinical findings. At the Allergy Centre, Odense University Hospital, patients with suspected insulin allergy have been evaluated since 2003. The aim of this study was to establish a systematic approach to diagnose and treat patients with insulin allergy.MethodsThe study was conducted retrospectively by retrieving data from the Allergy Centre database on patients with suspected insulin allergy evaluated from 2003 to 2017. The examination comprised a comprehensive medical history, specific IgE against insulin and intracutaneous tests (ICT) with different insulins.ResultsA total of 144 patients were examined on suspicion of insulin allergy of which 110 had negative specific IgE in serum. Of the remaining 34 patients, 33 had ICT performed; 2 had negative ICTs, while 31 had one or more positive ICT. All 34 patients had mild symptoms, and 4 could obtain symptom relief with antihistamines or local steroids, 9 could be managed with oral antidiabetics, and 7 were switched to other insulins. The final 14 patients were offered an insulin pump because of reactions to many different insulins, many positive ICTs, unmanageable diabetes, young age and compliance, or convenience.ConclusionInsulin allergy can be managed by a systematic approach, and symptom relief is obtainable in most patients.

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

BackgroundDiagnostic workup of penicillin allergy comprises skin testing with penicillins, and patients are deemed allergic if skin test is positive. However, the literature suggests that skin test-positive patients may be challenge-negative, indicating that the skin test may be falsely positive.ObjectiveTo investigate real-time histamine release from a positive intracutaneous test induced by penicillin in patients with positive and negative challenges to penicillin.MethodsSkin microdialysis was performed in 21 penicillin-allergic patients with positive skin test, 13 non-allergic volunteers serving as negative controls, and 7 grass pollen-allergic patients serving as positive controls. Histamine was measured by microdialysis after skin test with penicillin/grass/NaCl. Penicillin challenge was subsequently performed in 12 of the patients.ResultsOnly 10/21 patients (47.6%) were skin test positive at microdialysis. During microdialysis 13 single intracutaneous tests were positive and histamine was detected in 4/13 occurring in four challenge positive patients. Thirteen/21 patients (61.9%) were deemed allergic to penicillin; eight had positive skin test. Two patients with positive skin test were challenge negative. In grass pollen allergic patients, 7/7 had a positive intracutaneous test to grass and all released histamine in the wheals. All 13 negative controls had negative intracutaneous test to penicillin and no histamine release.ConclusionHistamine was only detected in the minority of positive intracutaneous tests with penicillin in penicillin-allergic patients. Other mediators may be involved.

Allergenicity and safety of recombinant human C1 esterase inhibitor in patients with allergy to rabbit or cow's milk

Recombinant human C1 inhibitor (rhC1INH) for on-demand treatment of hereditary angioedema is purified from milk of transgenic rabbits. It contains low amounts (<0.002%) of host-related impurities, which could trigger hypersensitivity reactions in patients with rabbit allergy (RA) and/or cow's milk allergy (CMA). This study is an assessment of allergenicity and safety of rhC1INH in patients with RA and/or CMA. Patients with CMA and/or RA underwent skin prick test (SPT), intracutaneous test (ICT), and, when results for both were negative, subcutaneous (SC) challenge with up to 2100U (14mL) rhC1INH. The negative predictive value of the skin test protocol was calculated, defined as the ratio of patients without systemic symptoms of hypersensitivity following SC challenge, over the number of patients having tested negative for both the SPT and the ICT. Adverse events after exposure to rhC1INH were recorded. Twenty-six patients with RA and/or CMA were enrolled. Twenty-four had negative SPT and ICT results for rhC1INH, whereas 2 had negative SPT result but positive ICT result to rhC1INH (only the highest concentration). Twenty-two patients with negative SPT and ICT results underwent SC challenge. None developed allergic symptoms. Local treatment-emergent adverse events occurred in 7 patients (32%) after SC challenge. In 5 these were considered drug related. All were mild. None of the patients with negative SPT and ICT results for rhC1INH had allergic symptoms during rhC1INH challenge. The negative predictive value of the combination of SPT and ICT for the outcome of the SC challenge was 100% (95% CI, 84.6%-100%). SC administration of rhC1INH was well tolerated.

Intracutaneous injection of autologous serum with specific IgE against penicillin followed by intracutaneous test with penicillin, does not elicit a positive intracutaneous test

Background In patients allergic to penicillin only a minority of those who have specific IgE against penicillin also have a positive intracutaneous test (ICT) to penicillin and vice versa. This is in contrast to findings in patients with allergy to classical type 1 allergens, e.g. grass or peanuts. Besides that, our investigations indicates that histamine is only released in the minority of positive intracutaneous tests. The reason for this is not known. A hypothesis could be that the specific IgE against penicillin measured in serum is not present in the skin. The aim of this project is to investigate, if you by priming the skin with autologous serum in patients with specific IgE to penicillin subsequently are able to develop a positive ICT upon testing.

Age-dependent sting recurrence and outcome in immunotherapy-treated children with anaphylaxis to hymenoptera venom.

AI Stritzke, PA Eng. Clin Exp Allergy. 2013;43(8):950–955 The goal of this study was to investigate the rate of sting recurrence and outcome of Hymenoptera venom anaphylaxis in children treated with venom immunotherapy (VIT). The study included a cohort of 83 Swiss children consecutively referred for Hymenoptera venom anaphylaxis between 1990 and 2007. Inclusion criteria were diagnosis of Hymenoptera anaphylaxis followed by commencement of VIT. Diagnosis of Hymenoptera anaphylaxis required a sting followed by a systemic adverse reaction affecting the respiratory and/or cardiovascular system, a positive intracutaneous test result with European honey bee (BV) and/or Vespula (VV) venom, and specific IgE (>0.7 kU/L) to …

AS01-04 - Post orgasmic illness syndrome: indications for an auto-immune pathogenesis

Post-orgasmic unwell being denoted as postorgasmic illness syndrome (POIS) was for the first time reported by Waldinger and Schweitzer in 2002 [1]. Recently, Waldinger et al. investigated 45 Caucasian males with complaints of POIS and categorized their symptoms in 5 preliminary criteria [2,3]. POIS is characterized by local mucosal manifestations (nasal congestion, itching eyes), and systemic features (flu-like syndrome with feverishness, muscle tension, exhaustion, foggy head, concentration difficulties, and mood irritability), occurring within 30–60 minutes after ejaculation. The symptoms always starts off after ejaculation, often reaching its peak severity at the second day and gradually diminishes within 1–7 days [3]. Affected males usually try to avoid ejaculating by planning intercourse or by abstaining from sexual activity. Waldinger et al. showed that 88% of the males had a positive intracutaneous (IC) skin-prick test for autologous semen and postulated that POIS is an expression of an auto-immune process. Support for this hypothesis comes from positive effects of hyposensitization treatment with diluted autologous semen in two men with POIS.

Delayed-Type Heparin Allergy: Diagnostic Procedures and Treatment Alternatives-A Case Series Including 15 Patients

Delayed-type hypersensitivity reactions (DTHRs) after subcutaneous application of unfractionated heparins or low-molecular-weight heparins are not uncommon. Standard allergological testing usually includes intracutaneous skin tests and patch testing of different heparins, heparinoids, and thrombin inhibitors followed by subcutaneous and/or intravenous challenge with skin test-negative drugs. We present data from a single-center case series of 15 patients with DTHR after low-molecular-weight heparin administration. Intracutaneous testing that can be considered as gold standard identified the suspicious elicitor in 11 (73.4%) of 15 of the patients. Patch testing was positive in 5 (33.4%) of 15 of the patients and was only positive in patients who were also reacting in the intradermal testing. Intravenous challenge with heparin sodium was performed in 10 of 15 patients and was well tolerated in all cases, despite prior positive intracutaneous tests with the same substance. Intracutaneous documentation of DTHR was not an adequate predictor of intravenous challenge.

Association of heparin-induced skin lesions, intracutaneous tests, and heparin-induced IgG.

Cutaneous heparin-induced allergic reactions to subcutaneous heparin may begin 2-5 days after administration. The relation of the delayed-type hypersensitivity and a systemic immunologic response is controversial. The present investigation aimed to analyze the occurrence of thromboembolic complication, pathologic heparin-induced platelet activation (HIPA), and the presence of circulating heparin-induced IgG in patients with heparin-induced skin reactions. Intracutaneous tests, HIPA assay, and heparin-heparin IgG antibodies were performed in nine patients with heparin-induced skin lesions. Six of eight patients showed positive intracutaneous tests to heparin and to four low-molecular-weight heparins. Three of six heparin-positive patients presented hypersensitivity to a heparinoid, too. Two of three patients had a positive HIPA test and elevated heparin-induced IgG antibodies. Both patients developed complications presenting as heparin-induced skin necrosis or arterial thrombosis. Two of nine patients were treated with danaparoid, 4/9 patients received r-hirudin, and 1/9 received oral coumarin. In 2/9 patients, anticoagulant therapy was stopped, but these patients will receive r-hirudin if indicated. On the basis of the coincidence of local and systemic hyperreactivity to heparin and danaparoid, patients with heparin-induced skin lesions should receive r-hirudin, a nonheparin compound, for anticoagulant treatment.

Increased specificity of diagnostic tests with recombinant major bee venom allergen phospholipase A2

In diagnosis of type I allergy recombinant allergens have potential advantages over conventional allergenic extracts, both regarding specificity and reproducibility. We therefore decided to study honey bee venom (BV) and its major allergen phospholipase A2 (PLA) in native and recombinant form for diagnosis of bee sting allergy. We investigated 85 patients with a history of a recent systemic allergic bee sting reaction and positive intracutaneous skin test to BV, and 21 controls with no history of allergic bee sting reaction and negative skin test to BV. Intracutaneous skin tests and determination of specific IgE by ImmunoCAP(R) to BV, native PLA (nPLA) and recombinant PLA (rPLA) were done in all patients and controls. In skin testing 84 (99%) of the 85 patients reacted to nPLA and 81 (95%) to rPLA, while none of the 21 controls was positive with nPLA or rPLA. Specific serum IgE to BV could be detected in 82 of the patients (96%), to nPLA in 73 (86%) and to rPLA in 66 (78%). Four (19%) of the controls had a positive CAP to BV, one (4.8%) to nPLA and none to rPLA. Analysis of discordant results in CAP showed, that most patients with specific IgE to BV, but not to nPLA and rPLA, had positive skin tests to both PLA preparations and low levels of BV specific IgE. Patients with specific IgE to nPLA but not to rPLA were usually sensitized to minor allergens of BV which contaminated the commercial nPLA. PLA is the major allergen in BV. While diagnostic tests with BV are more sensitive, the specificity of tests with PLA, especially rPLA is clearly increased as compared with BV.

654 Positive intracutaneous and oral provocation test in a child with an anaphylactoid reaction to paracetamol

654 Positive intracutaneous and oral provocation test in a child with an anaphylactoid reaction to paracetamol

Food-Induced Asthma in China: An Analysis in 40 Cases: Original Articles

Forty patients with a history of recurrent attacks of asthma after ingesting certain foods are described. All of these individuals had positive intracutaneous skin tests to at least one of the food allergens which was suggested by their history to cause an attack. In four of these patients, a bronchoprovocational challenge was performed with an aerosolized extract of the potential offending food. Clinical manifestations, possible mechanisms, and diagnostic measures for food-induced asthma are discussed.

Generalized Rash Induced by Sulfhydryl Drug in Guinea Pigs

Adverse reactions produced by sulfhydryl compounds with active thiol groups have generally formed a distinctive pattern in man when they are viewed as a class. It has been reported that cutaneous SH-induced drug eruptions have a wide variety of clinical presentations; histologically, they show a pattern of eosinophilic necrosis and/or satellite necrosis similar to that seen in cutaneous graft vs host reactions. In the present experiments, guinea pigs were sensitized with cephalothin (CET) and thiol compounds such as tiopronin (TP), D-penicillamine, gold sodium thiomalate or thiomalate, using a method similar to that described previously. In lymphocyte stimulation tests, lymph node cells from the sensitized animals responded positively to spleen cells pulsed with each thiol compound. Intracutaneous tests revealed some positive reactions to each thiol compound; there was a tendency to produce a tuberculin type reaction with indurated erythema rather than the Jones-Mote type seen in CET-induced reactions. The dose-requirements for positive intracutaneous tests and generalized rash (GR) due to thiol compounds were lower than for CET, which required relatively large doses. Histologically, infiltration of basophilic cells was prominent in the skin lesions induced by intracutaneous tests with CET and in those of CET-induced GR. On the other hand, intracutaneous tests with TP following the induction of TP-induced GR revealed eosinophilic degeneration of epidermal cells, which was similar to the eosinophilic necrosis seen in cutaneous GVHR. Intracutaneous tests after the induction of CET-GR did not show any eosinophilic changes in the epidermal cells. These findings are reminiscent of the characteristics of eruptions induced by thiol compounds in man, which differ from the eruptions induced by CET.

Expression of OKM5 Antigen on Human Keratinocytes in Positive Intracutaneous Tests for Delayed-Type Hypersensitivity

Antigenic characteristics of human keratinocytes (HK) were studied in positive intracutaneous tests for delayed-type hypersensitivity in vivo using murine monoclonal antibodies against human OKM5, OKM1, OKT6, Leu-7 and HLA-DR antigens and compared with those of negative skin reactions. By contrast to negative intracutaneous tests, keratinocytes displayed both OKM5 and HLA-DR antigens in all positive skin reactions above the dermal inflammatory infiltrate. OKM5 recognizes an 88-kilodalton cell surface determinant of monocytes, which could also be induced in vitro in keratinocytes upon incubation with gamma-interferon. We demonstrate here for the first time that the expression of this macrophage marker can also be induced in vivo in the HK.

Lung function of workers exposed to antigens from a contaminated air-conditioning system.

Following the manifestation of humidifier fever in a number of workers in a carpet yarn texturing plant, a comparative study was begun of a group of workers exposed to fungi from the air-conditioning system and a control group not so exposed. For both group of workers anamnestic data were collected, intracutaneous skin tests were performed, certain lung function parameters were determined, and the presence of antibodies to a number of antigens from the system was tested for. It was found that the group of exposed workers had a significantly higher rate of positive intracutaneous skin test than non-exposed workers. Additionally, their serology was more often positive. Both positive skin test and positive serology were more frequent in non-smokers than in smokers. A positive immediate skin reaction among exposed workers was found to correlate with an FEF25-75 reduction during the working week. A positive delayed skin reaction among exposed workers correlated with a lower FVC prior to the start of the working week than recorded for non-exposed workers. A positive serology in exposed workers did not correlate with a difference in lung function compared with non-exposed workers, nor was there a correlation with a change in lung function in the course of the working week. When humidifier fever is diagnosed, steps should be taken to reduce exposure. It would also appear desirable to keep exposed workers under medical observation and to monitor the subsequent development of their lung function.

Successful Long-term Immunotherapy for Human Seminal Plasma Anaphylaxis

Anaphylactic sensitivity to her husband's seminal fluid occurred in a 46-year-old woman six weeks after a hysterectomy. Her husband was azoospermic as a result of an elective vasectomy. A pooled sample of his seminal fluid was used for skin and laboratory tests. Fractionating (Sephadex G100) chromatography was also performed on his seminal fluid. The patient showed positive intracutaneous skin tests to his unfractionated seminal plasma and a Sephadex G100 fraction designated No. 3. This fraction was also passively transferable to a nonallergic volunteer and it stimulated histamine release from the patient's leukocytes. The dose-response effects of this fraction compared with unfractionated seminal plasma in these assays showed greater bioactivity. After informed consent was obtained, the patient was immunized to fraction 3 in a classic desensitization protocol. Two weeks after the final dose of immunotherapy, intercourse was performed without condoms in a medical facility and under the supervision of a physician. No adverse symptoms were experienced by the patient on this occasion. Regular and frequent sexual activity is required to maintain her tolerant state.

The role of penicillin in the pathogenesis of chronic urticaria.

Intracutaneous tests with penicilloyl-polylysine (PPL) and benzyl-penicillin G (PG) were performed in 245 patients suffering form chronic recurrent urticaria, including physical urticaria. Positive results were observed in fifty-nine patients (24%). Sera from fifty-seven of these fifty-nine patients were investigated for circulating anti-penicilloyl antibodies by an enzyme-linked immunosorbent assay (ELISA) and a passive haemagglutination test (HA). The results were compared to those form the ELISA and HA in a control group of thirty-five patients who had shown clinical allergic reactions to penicillin and had positive skin tests to PPL and/or PG. The in vitro tests revealed positive results in 12.3% and 37.1% respectively. In forty-three patients the course of the positive intracutaneous tests to penicillin, together with the duration of chronic urticaria, was followed over a period of time up to 3.5 years. In twenty-two out of forty-two patients with positive intracutaneous tests to penicillin, a diet free of dairy products proved to have a curative effect, compared to two out of forty control subjects with chronic urticaria and negative skin tests to penicillin. These studies indicate that penicillin has an important role in the aetiology and maintenance of chronic urticaria.

Skin testing in chronic urticaria.

In 164 patients with chronic recurrent urticaria, the value of skin tests was investigated, Patch tests carried out with the standard series of the International Contact Dermatitis Research Group and with a series of penicillins revealed positive reactions in 22 (35/162) and 6.9% (11/158), respectively. IN 21.5% (33/152) positive intracutaneous tests to cilligen and/or penicillin G were observed. 35% (51!147) of the patients had one or more positive intracutaneous tests with inhalants. Scratch tests with food allergens showed positive reactions in 12.5% (12/95). There was no difference in results between patients with idiopathic urticaria or angio-oedema and those with physical urticaria. The value of these findings is discussed. Most of the patients with penicillin allergy, were recommended to be on a diet free from milk and milk products. In 50% this was successful.

RAST in the diagnosis of hypersensitivity to dog and cat allergens A comparison of different extract preparations with clinical history, skin test and provocation tests

A comparison was made of clinical signs and provocation tests with the RAST for allergy to dog in eight and cat in twenty patients. Twenty-two had high IgE levels and all gave positive reactions to provocation tests. A commercially available dog epithelium extract gave more positive RASTs than five other dog allergen preparations, and there were no positive reactions to dog serum. The RAST was negative in patients with a low degree of sensitivity. All twenty patients allergic to cat gave positive intracutaneous test reactions and in the RAST the cat epithelial allergen showed 90% agreement with the in vivo findings.

Reappraisal of intracutaneous tests in the diagnosis of reaginic allergy

In an attempt to determine the clinical relevance of positive intracutaneous tests when epicutaneous tests are negative, 34 patients with symptoms of perennial rhinitis who had negative epicutaneous but positive intracutaneous tests were evaluated by radioallergosorbent (RAST) test, nasal provocation (NP) tests and leukocyte histamine release (LHR) assay. Nineteen patients with perennial rhinitis who had positive epicutaneous tests and 13 normal healthy volunteers were also studied as positive and negative controls, respectively. None of the 34 patients with negative epicutaneous but positive intracutaneous tests had positive RASTs or LHR assays, but 1 patient had a positive NP test. In contrast, of the 19 patients with positive epicutaneous tests. 12 patients had positive RASTs, 17 had positive LHR assays, and 17 had positive NP tests. In the negative control group of 13 subjects, none had positive RAST, LHR assays, or NP tests, although 3 subjects showed positive intracutaneous tests. These results indicate that when epicutaneous tests are negative in patients with perennial rhinitis, positive intracutaneous tests are not likely to indicate the presence of reaginic allergy.