Positive Oral Challenge Research Articles

Is the Skin Prick Test (SPT) for milk useful for diagnosis of Cow's Milk Allergy (CMA) in infants?

RATIONALE: There is a concept that infants present lower cutaneous reactivity to SPT for food allergy diagnosis. The aim of this study is to describe the results of SPT to cow's milk in infants with suspicion of CMA.METHODS: It was included 39 infants (17F: 22 M) under 2 years old among 170 CMA pediatric patients. Two groups were defined: Group I: patients ≤ 6 months (n = 8) and Group II: from 6 months to 2 years (n = 31). The criteria of CMA diagnosis were: clinical history, presence of specific IgE for milk (SPT ≥ 3 mm or RAST ≥ 3.5 KU/L) and positive oral challenge test for milk (open or double blind placebo controlled). The SPT was done with milk in commercial extract (IPI ASAC) and “in natura”. Histamine was used as positive control. Anaphylatic patients were submitted to SPT after one year of follow up without anaphylaxis episodes.RESULTS: Cutaneous symptoms were present in 31 (79.4%), gastrointestinal in 22 (56.4%), respiratory in 9 (23.0%) and anaphylaxis in 14 (35.8%). SPT was positive in 7 patients (87.5%) from group I and 23 (74.1%) in group II. The wheal ≥ 6 mm was found in 1 patient from group I and 20 from Group II. The comparison between the extracts was favorable to commercial ones (25x17).CONCLUSIONS: In this series the SPT was a useful diagnostic method for IgE-mediated CMA in infants, being the commercial extract more positive than “in natura CM”. The SPT ≥ 6 mm was more frequent in children with age ≥ 6 months. RATIONALE: There is a concept that infants present lower cutaneous reactivity to SPT for food allergy diagnosis. The aim of this study is to describe the results of SPT to cow's milk in infants with suspicion of CMA. METHODS: It was included 39 infants (17F: 22 M) under 2 years old among 170 CMA pediatric patients. Two groups were defined: Group I: patients ≤ 6 months (n = 8) and Group II: from 6 months to 2 years (n = 31). The criteria of CMA diagnosis were: clinical history, presence of specific IgE for milk (SPT ≥ 3 mm or RAST ≥ 3.5 KU/L) and positive oral challenge test for milk (open or double blind placebo controlled). The SPT was done with milk in commercial extract (IPI ASAC) and “in natura”. Histamine was used as positive control. Anaphylatic patients were submitted to SPT after one year of follow up without anaphylaxis episodes. RESULTS: Cutaneous symptoms were present in 31 (79.4%), gastrointestinal in 22 (56.4%), respiratory in 9 (23.0%) and anaphylaxis in 14 (35.8%). SPT was positive in 7 patients (87.5%) from group I and 23 (74.1%) in group II. The wheal ≥ 6 mm was found in 1 patient from group I and 20 from Group II. The comparison between the extracts was favorable to commercial ones (25x17). CONCLUSIONS: In this series the SPT was a useful diagnostic method for IgE-mediated CMA in infants, being the commercial extract more positive than “in natura CM”. The SPT ≥ 6 mm was more frequent in children with age ≥ 6 months.

Fixed drug eruption resulting from fluconazole use: a case report

IntroductionFluconazole is a widely used antifungal agent with a possible side effect of fixed drug eruption. However, this adverse drug effect is absent from the reported list of possible side effects of fluconazole. We are presenting a rare case in our report.Case presentationA 25-year-old Iranian woman developed fixed drug eruptions on different sites of her body after taking five doses of fluconazole to treat vaginal candidiasis. A positive patch test, positive oral challenge test and skin biopsy were all found to be consistent with fixed drug eruption.ConclusionFluconazole is a widely prescribed drug, used mainly to treat candidiasis. Fixed drug eruption as a possible side effect of Fluconazole is not well known and thus, the lesions may be misdiagnosed and mistreated. Based on our findings, which are consistent with a number of other practitioners, we recommend adding fixed drug eruption to the list of possible side effects of fluconazole.

Mapping of the IgE and IgG4 sequential epitopes of milk allergens with a peptide microarray–based immunoassay

Peptide microarray analysis is a novel method that can provide useful information on the nature of specific allergies. We sought to determine the specificity and diversity of IgE and IgG4 antibodies binding to sequential epitopes of alpha(s1)-, alpha(s2)-, beta-, and kappa-caseins and beta-lactoglobulin by using a peptide microarray-based immunoassay. A microarray immunoassay was performed with sera from 31 children with IgE-mediated milk allergy (16 with positive oral milk challenge results [ie, the reactive group] and 15 with negative oral milk challenge results [ie, the tolerant group]). A library of peptides, consisting of 20 amino acids (AAs) overlapping by 17 (3-offset), corresponding to the primary sequences of alpha(s1)-, alpha(s2)-, beta-, and kappa-caseins and beta-lactoglobulin was printed on epoxy-coated slides. A region was defined as an epitope if it was statistically associated with reactive groups and recognized by at least 75% of reactive patients. By using this method, a total of 10 epitopes were identified: alpha(s1), AAs 28 to 50, 75% reactive and 26.7% tolerant; alpha(s2), AAs 1 to 20, 75% reactive and 13.3% tolerant; AAs 13 to 32, 75% reactive and 26.7% tolerant; AAs 67 to 86, 75% reactive and 33.3% tolerant; and AAs 181 to 207, 75% reactive and 20% tolerant; beta-casein, AAs 25 to 50, 75% reactive and 33.3% tolerant, AAs 52 to 74, 81.3% reactive and 26.7% tolerant; and AAs 154 to 173, 75% reactive and 33.3% tolerant; beta-lactoglobulin, AAs 58 to 77, 81.3% reactive and 40% tolerant; and kappa-casein, AAs 34 to 53, 87.5% reactive and 40% tolerant. Several regions have been defined as epitopes, which showed differential recognition patterns between reactive and tolerant patients. Further studies are needed to validate the utility of this assay in clinical practice.

Clinical features of legume allergy in children from a Mediterranean area

Lentils, chickpeas, beans, and peas are the most common consumed legumes in the Mediterranean area. However, there is little information about allergy to these legumes. To describe the clinical features of a Spanish pediatric population allergic to legumes (lentils, chickpeas, peas, white beans, and peanuts), to evaluate the clinical allergy to several legumes, and to determine which legume extract is most appropriate to use in the diagnosis of legume allergy by skin tests. Fifty-four children with allergic reactions after exposure to legumes were studied. The diagnosis of legume allergy was confirmed by positive skin prick test results with legume extracts and food challenges or a recent convincing history of severe reactions. The onset of allergic reactions was at approximately the age of 2 years (median, 22 months). Skin prick test results were positive for at least 3 legumes in 38 children (70%). Positive results were more frequent to boiled extracts than to raw extracts in children with a positive oral challenge. Allergy to lentil was the most frequently diagnosed legume allergy (43 children [80%]), followed by allergy to chickpea (32 children [59%]). Oral challenges with more than 1 legume (median, 3 legumes) were positive in 37 children (69%). The most frequent induced symptoms on challenge were respiratory (rhinitis and/or asthma) and cutaneous. In this population, lentils and chickpeas are the legumes that cause most allergic reactions, clinical allergy to more than 1 legume is common, and boiled legume extracts are most appropriate to discriminate between allergic and tolerant sensitized children.

Hypersensitivity to clavulanic acid in children

We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was based on the confirmation of an IgE-mediated aetiology by an oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloyl G and V, amoxicillin, ampicillin and cefaclor < 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroxime axetil.

Borderline gestational diabetes mellitus and pregnancy outcomes

BackgroundThe impact of borderline gestational diabetes mellitus (BGDM), defined as a positive oral glucose challenge test (OGCT) and normal oral glucose tolerance test (OGTT), on maternal and infant health is unclear. We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes.MethodsWe compared demographic, obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS) who had BGDM and who screened negative on OGCT.ResultsWomen who had BGDM were older (mean difference 1.3 years, [95% confidence interval (CI) 0.3, 2.2], p = 0.01) and more likely to be obese (27.1% vs 14.1%, relative risk (RR) 1.92, [95% CI 1.41, 2.62], p < 0.0001) than women who screened negative on OGCT. The risk of adverse maternal outcome overall was higher (12.9% vs 8.1%, RR 1.59, [95% CI 1.00, 2.52], p = 0.05) in women with BGDM compared with women with a normal OGCT. Women with BGDM were more likely to develop pregnancy induced hypertension (17.9% vs 11.8%, RR 1.51, [95% CI 1.03, 2.20], p = 0.03), have a caesarean for fetal distress (17.1% vs 10.5%, RR 1.63, [95% CI 1.10, 2.41], p = 0.01), and require a longer postnatal hospital stay (mean difference 0.4 day, [95% CI 0.1, 0.7], p = 0.01) than those with a normal glucose tolerance.Infants born to BGDM mothers were more likely to be born preterm (10.7% vs 6.4%, RR 1.68, [95% CI 1.00, 2.80], p = 0.05), have macrosomia (birthweight ≥4.5 kg) (4.3% vs 1.7%, RR 2.53, [95% CI 1.06, 6.03], p = 0.04), be admitted to the neonatal intensive care unit (NICU) (6.5% vs 3.0%, RR 2.18, [95% CI 1.09, 4.36], p = 0.03) or the neonatal nursery (40.3% vs 28.4%, RR 1.42, [95% CI 1.14, 1.76], p = 0.002), and have a longer hospital stay (p = 0.001). More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy (12.9% vs 7.8%, RR 1.65, [95% CI 1.04, 2.63], p = 0.03).ConclusionWomen with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT. Intervention strategies to reduce the risks for these women and their infants need evaluation.Trial registrationCurrent Controlled Trials ISRCTN00416244

Predicting outcomes of oral aspirin challengesin patients with asthma, nasal polyps, andchronic sinusitis

A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult. To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs. A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs. Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs. Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.

Usefulness of oral macrogol challenge in anaphylaxis after intra‐articular injection of corticosteroid preparation

AllergyVolume 63, Issue 4 p. 478-479 Usefulness of oral macrogol challenge in anaphylaxis after intra-articular injection of corticosteroid preparation C. Sohy, Corresponding Author C. Sohy *Service de Pneumo-allergologieCliniques Universitaires UCL de Mont-GodinneB-5530 YvoirBelgiumTel: + 32 81 42 33 51Fax: +32 81 42 33 52E-mail: [email protected]Search for more papers by this authorO. Vandenplas, O. VandenplasSearch for more papers by this authorY. Sibille, Y. SibilleSearch for more papers by this author C. Sohy, Corresponding Author C. Sohy *Service de Pneumo-allergologieCliniques Universitaires UCL de Mont-GodinneB-5530 YvoirBelgiumTel: + 32 81 42 33 51Fax: +32 81 42 33 52E-mail: [email protected]Search for more papers by this authorO. Vandenplas, O. VandenplasSearch for more papers by this authorY. Sibille, Y. SibilleSearch for more papers by this author First published: 03 March 2008 https://doi.org/10.1111/j.1398-9995.2007.01610.xCitations: 27 Positive oral challenge with macrogol 4000 in a patient who experienced immediate hypersensitivity after intra-articular injection of corticosteroid. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume63, Issue4April 2008Pages 478-479 RelatedInformation

Usefulness of intradermal test and patch test in the diagnosis of nonimmediate reactions to metamizol

Metamizole is a pyrazolone derivative, and its most common reactions are IgE-mediated reaction and idiosyncratic reactions. Non-immediate reactions are poorly described and there are very few reports on non-immediate reactions to pyrazolones. We evaluated 12 patients (nine men) who consulted for a non-immediate reaction after metamizol administration. We performed cutaneous tests (skin prick tests and immediate and delayed intradermal tests) and epicutaneous tests, and, if necessary, an oral challenge test. All skin prick and intradermal tests, if necessary, were negative in immediate reading. Delayed intradermal tests were positive in six of 10 patients (60%) and epicutaneous tests were positive in four of 11 patients (36%). Three cases (25%), were diagnosed by a positive oral challenge test. Delayed-reading intradermal tests and patch tests are useful tools in the diagnosis of nonimmediate reactions to pyrazolones and should be considered the first step when evaluating these type of reactions. Intradermal test appears to be more sensitive than patch test. The positivity of skin tests suggests an immunological reaction, probably mediated by T lymphocytes, but further studies are required.

Lipid transfer protein in diagnosis of birch–apple syndrome in children

Lipid transfer protein (LTP) has been reported as an important allergen inducing severe systemic reactions in allergic subjects. The aim of the present study was to estimate the role of LTP in diagnosis of apple allergy in children allergic to birch pollen. The prospective study was carried out on a group of 21 children sensitized to birch pollen and apple allergens, confirmed by presence of specific IgE in the sera of patients. Allergens separated by electrophoresis were probed by Western blotting using hypersensitive patients’ sera. Food hypersensitivity to apple was verified by oral food challenge test. Six patients’ sera were hypersensitive to birch pollen and apple proteins. Almost all sera recognized specifically the main allergen of apple peal Mal d 3 with molecular weight <10 kDa (LTP). Positive oral challenge to apple was found in 52.4% of investigated children. Children allergic to Mal d 1 presented different clinical symptoms. Sensitization to Mal d 3 is very common in children with apple allergy. No correlation between clinical symptoms and sensitization to recombinant apple allergens has been found, LTP may be useful in diagnosis of apple allergy.

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs

Introduction Since the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients. We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccine Materials and methods Children 15 months old with a confirmed diagnosed of egg allergy were included. In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made. If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004). SDS-PAGE immunoblotting was performed with Priorix vaccine. Results A cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction. 5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients. Conclusion Negative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg.

Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance

Because nonsteroidal anti-inflammatory drug (NSAID) intolerance depends on COX-1 inhibition, preferential or selective COX-2 inhibitors have been thought to be well tolerated by these patients. The aim of this study is to evaluate tolerability to nabumetone and meloxicam in patients with NSAID intolerance. Seventy patients intolerant to NSAIDs were selected. Thirty subjects were patients with asthma with respiratory (rhinitis-asthma) intolerance to NSAIDs (group A); 40 patients (group B) had cutaneous-mucous (urticaria-angioedema) NSAID intolerance. Diagnosis was based on clinical histories in all patients, and it was confirmed by positive single-blind placebo-controlled oral challenge test in 36 patients. After written informed consent, a single-blind placebo-controlled oral challenge test with nabumetone in all patients (2 g except for 11 patients who reached 1 g) and meloxicam (15 mg) in 51 patients was performed. Of the total selected, 94.3% tolerated 1 g nabumetone. In those who reached the 2-g dose, the tolerability was 83.6%. With respect to meloxicam, 96.1% of patients, tolerated 15 mg. No significant difference in nabumetone and meloxicam tolerability was observed between groups A and B. The results of this study confirm a high percentage of tolerability to the maximum therapeutic dosage of nabumetone and meloxicam in patients with NSAID intolerance, both in those with cutaneous/mucous manifestations and in those with respiratory disease. Nabumetone and meloxicam are safe alternatives in NSAID-intolerant patients.

Delayed Allergy to Aminopenicillins: Clinical and Immunological Findings

Aminopenicillins are the most used beta-lactam antibiotics. Morbilliform or maculopapular rashes are rather frequent during therapy with aminopenicillins. The pathogenesis of these reactions is often due to a cell-mediated allergy. The aim of this work is to characterize patients with cell-mediated allergy to aminopenicillins and to identify alternative beta-lactam drugs that can be safely administered to these patients. We studied 27 subjects affected by cell-mediated allergy to aminopenicillins. The diagnosis was made on the basis of positivity of patch tests with aminopenicillins. These patients then underwent an allergological evaluation (skin and patch tests, oral and/or intramuscular challenge tests) with a wide spectrum of beta-lactam antibiotics. Our work highlights the following main characteristics of cell-mediated allergy to aminopenicillins: time elapsing between drug administration and onset of symptoms of about 2 days; the maculopapular rash and delayed appearance of urticaria/angioedema were the most typical symptoms (82.8 percent of cases); a cross-reactivity with aminocephalosporins is usually absent, or it is limited to cephalexin (in our study, in fact, just 3 out of 20 patients challenged with cephalexin showed a positive oral challenge test); all the beta-lactams, other than aminopenicillins, are well tolerated. Patch tests represent a specific diagnostic tool with a good predictive value of identifying alternative drugs that can be safely administered to patients with beta-lactam allergy. Our patients could tolerate other beta-lactam drugs after a complete allergological evaluation. On the basis of our study, cell-mediated allergy to aminopenicillins should be considered a well-defined nosologic entity.

A Clinical Trial of Oral Hyposensitization in Systemic Allergy to Nickel

Nickel allergy is the most common contact allergy. Some nickel-sensitive patients present systemic (cutaneous and/or digestive) symptoms related to the ingestion of high nickel-content foods, which significantly improve after a specific low nickel-content diet. The etiopathogenetic role of nickel in the genesis of systemic disorders is, furthermore, demonstrated by the relapse of previous contact lesions, appearance of widespread eczema and generalized urticaria-like lesions after oral nickel challenge test. The aim of this study is to investigate the safety and efficacy of a specific oral hyposensitization to nickel in patients with both local contact disorders and systemic symptoms after the ingestion of nickel-containing foods. Inclusion criteria for the recruitment of these patients were (other than a positive patch test) a benefit higher than 80% from a low nickel-content diet and a positive oral challenge with nickel. Based on the previous experiences, our group adopted a therapeutic protocol by using increasing oral doses of nickel sulfate associated to an elimination diet. Results have been excellent: this treatment has been effective in inducing clinical tolerance to nickel-containing foods, with a low incidence of side effects (gastric pyrosis, itching erythema).

Mild Gestational Hyperglycemia and the Metabolic Syndrome in Later Life

Diabetes and obesity, components of the metabolic syndrome, are common longterm complications in women with previous gestational diabetes (pGDM). Long-term follow-up of women with mild gestational hyperglycemia is lacking. Fifty women with previous positive oral glucose challenge test and negative oral glucose tolerance test (pOGCT+OGTT-), 161 with previous normal glucose tolerance (pNGT), and 182 pGDM were studied after 6.5 years from the index pregnancy. Patients with pGDM showed a worse metabolic pattern than pNGT. Women with pOGCT+OGTT- had significantly higher levels of fasting glucose, homeostasis model assessment (HOMA), percentage of impaired fasting glucose, and low age and high-density lipoprotein (HDL)-cholesterol than pNGT subjects. Prevalence of the metabolic syndrome (MS) was, respectively, sixfold and twofold higher in pGDM and pOGCT+OGTT- than in pNGT. In a Cox proportional hazard model, after multiple adjustments, pGDM was significantly associated with subsequent hyperglycemia (hazard ratio [HR] = 4.2; 95% CI 1.6-11.1), low HDL-cholesterol (HR = 1.7, 1.1-2.8), hypertriglyceridemia (HR = 4.2, 1.2-14.9), hypertension (HR = 2.2, 1.3-3.6), MS (HR = 3.7, 1.3-10.8), while pOGCT+OGTT- was associated with subsequent hyperglycemia (HR = 4.3, 1.3-14.7), and low HDL-cholesterol (HR = 2.0, 1.0-3.8). The metabolic syndrome was present in 52.6% of obese pGDM, 50% of obese pOGCT+OGTT-, and 28.6% of obese pNGT women; the corresponding HRs were, respectively, HR = 2.20, 0.74-6.57 (pGDM), and HR = 3.56, 1.10-11.5 (pOGCT+OGTT-). Women who failed the OGCT, but not the OGTT, showed a subsequent worse metabolic pattern than pNGT subjects, independently of confounding factors. In the presence of obesity, the prevalence of the metabolic syndrome was similar to that of obese pGDM women, and almost twofold higher than in obese pNGT controls.

Drug-Induced Petechial Eruption during Aspirin Therapy in a Patient with Positive Aspirin Allergy History but Negative Oral Challenge

Drug-Induced Petechial Eruption during Aspirin Therapy in a Patient with Positive Aspirin Allergy History but Negative Oral Challenge

Severity of Allergic Reactions to Drugs

RATIONALE: The severity of Allergic and hypersensitivity reactions to drugs is usually considered to be graded from local reactions such as urticaria or exanthema to fatal reactions. However, this consideration has never been reported in detail for a large population of patients. We report the severity of drug allergy/hypersensitivity symptoms in 123 allergic patients who had previously several reaction histories. METHODS: Between January 1997 and April 2005, we prospectively studied all patients who consulted for a suspected hypersensitivity reaction to any drug. Patients underwent a standardized diagnosis (ENDA questionnaire, skin tests and provocation tests). We selected positive patients who had several reaction histories before testing. RESULTS: 1838 patients were tested and 123 had a positive skin test or oral challenge and had two or more previous reactions before testing. The most common drugs involved were beta-lactams and then Non-Steroidal Anti-Inflammatory drugs. 76.2% of patients had 2 reaction histories, and the number of reactions ranges from 2 to 6. 52.8% had a first history of urticaria as a single symptom, 14.6% anaphylaxis, 7.3 anaphylactic shock, 15.4% exanthema, 2.4% respiratory symptoms, 4.1% other skin reactions and 3.4% other symptoms. 65.9% of patients always express the type of reaction. The more severe reaction was the last reaction in 94.3% of patients. CONCLUSIONS: The severity of Allergic and hypersensitivity reactions to drugs grads from local reactions to fatal reactions.

Treatment of Gestational Diabetes Mellitus

Crowther CA, Hiller FE, Moss JR, McPhee AJ, Jeffries WS, Robinson JR, for the Australian Carbohydrate Intolerance Study in Pregnant Women Trial Group: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med352 : 2477-2486,2005 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Objective. To determine whether treatment of women with mild gestational diabetes mellitus (GDM), i.e., GDM that would meet the criteria for impaired glucose tolerance (IGT) in the nonpregnant state, decreases the risk of perinatal complications and to assess the effects of treatment on maternal outcome, mood, and quality of life. Design. At the time this trial was initiated, the World Health Organization (WHO) recommended that the management of IGT during pregnancy should be the same as for diabetes,1 a recommendation that differed from that of the National Diabetes Data Group.2 The trial reported by Crowther et al. and reviewed here enrolled only women who fit into this controversial category. Researchers at multiple centers in Australia and the United Kingdom randomly assigned 1,000 women who were diagnosed with GDM at 24-34 weeks of gestation to either an intervention group or a routine-care group. They admitted to the study only women with one or more risk factors for diabetes or a positive 50-g oral glucose challenge test in addition to a fasting glucose of < 140 mg/dl and a 75-g oral glucose tolerance test 2-hour glucose concentration of 140-199 mg/dl. The intervention group received individualized dietary advice, … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa042973%26rft_id%253Dinfo%253Apmid%252F15951574%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa042973&link_type=DOI [3]: /lookup/external-ref?access_num=15951574&link_type=MED&atom=%2Fdiaclin%2F24%2F1%2F35.atom [4]: /lookup/external-ref?access_num=000229798900003&link_type=ISI

Evaluation of colonoscopic allergen provocation as a diagnostic tool in dogs with proven food hypersensitivity reactions

To evaluate the colonoscopic allergen provocation (COLAP) test as a new tool for the diagnosis of IgE-mediated food allergy. Oral food challenges as well as COLAP testing were performed in a colony of nine research dogs with proven immediate-type food allergic reactions. In addition, COLAP was performed in five healthy dogs. When compared with the oral challenge test, COLAP accurately determined 18 of 23 (73 per cent) positive oral challenge reactions (73 per cent) in dogs with food allergies and was negative in the healthy dogs. The accuracy of this new test may be higher than that for gastric sensitivity testing. Therefore, COLAP holds promise as a new test to confirm the diagnosis of suspect IgE-mediated food allergy in dogs.

The flow-cytometric determination of basophil activation induced by aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) is useful for in vitro diagnosis of the NSAID hypersensitivity syndrome.

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs), manifested by cutaneous symptoms and/or airway manifestations represent 20-25% of all hypersensitivity reactions to drugs. Today, it is still claimed that no in vitro diagnostic tests exist for that condition and that the only way to confirm the diagnosis is a provocation challenge. The objective of this study was to assess whether NSAIDs may provoke blood basophil activation in vitro in such patients, as detected by a flowcytometric technique. Sixty NSAID hypersensitive patients (38 with cutaneous, 20 with airway and two with cutaneous and airway symptoms) and 30 control patients (15 asthmatics) were selected. Their hypersensitivity was confirmed by documented history indicating at least two clinical episodes to two or more different NSAIDs or by positive oral provocation challenge. Isolated buffy coat leukocytes were stimulated in vitro with aspirin, paracetamol, metamizol, diclofenac, and naproxen. The percentage of activated basophils was evaluated by an anti-CD63. Aspirin showed a sensitivity of 43.3%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.4%. For the other NSAIDs, the sensitivity and specificity values were: for paracetamol 11.7% and 100%, for metamizol 15% and 100%, for diclofenac 43.3% and 93.3% and for naproxen 54.8% and 74.1%. When considering the first four NSAIDs, the global sensitivity raised to 63.3% and specificity to 93.3%. If the number of tests is to be limited for practical reasons, the combination of acetylsalicylic acid and diclofenac at two concentrations yields a sensitivity of 58.3% and a specificity of 93.3%. Flowcytometric determinations of basophil activation following stimulation with NSAIDs show a high sensitivity (60-70%) with specificity above 90%. So this test may help avoiding some cumbersome and dangerous provocation challenges.