Positive Skin Prick Test Results Research Articles

Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy.

BP Vickery, AM Scurlock, M Kulis. J Allergy Clin Immunol. 2014;133(2):468–475 The goal of this study was to determine if long-term treatment with oral immunotherapy (OIT) will result in sustained unresponsiveness to peanut. The study enrolled 39 children, ages 1 to 16 years, with peanut allergy defined as a clinical history of a reaction to peanut within 60 minutes of ingestion, a positive peanut skin prick test (SPT) result ≥3 mm, and peanut-specific immunoglobulin (Ig)E ≥15 kU/L or with a positive SPT result and peanut IgE ≥7 kU/L and a clinical reaction within the previous 6 months. Subjects with poorly controlled …

Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy

Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy

Indoor environmental factors associated with wheezing illness and asthma in South Korean children: phase III of the International Study of Asthma and Allergies in Childhood

Background: The relationship between exposure to indoor environmental pollutants and incidence of asthma and wheezing illness in children is unclear. This study aimed to clarify this relationship by identifying the risk factors associated with these conditions in South Korean children aged 6–7 years. Methods: The parents or guardians of 3810 children aged 6–7 years who had participated in the International Study of Asthma and Allergies in Childhood and met the study criteria completed validated questionnaires regarding their children's asthma and wheezing illness, risk factors and exposure to indoor pollutants. The data were subjected to chi-square and multivariate logistic regression analysis to identify the factors significantly associated with asthma and wheezing illness. Results: Parental history of allergic disease (odds ratio [OR]: 1.729; 95% confidence interval [CI]: 1.447–2.066), living on the basement or semi-basement floor (OR: 1.891; 95% CI: 1.194–2.996) and living in housing that had been remodeled within the last 12 months (OR: 1.376; 95% CI: 1.101–1.720) were found to be significantly associated with wheezing illness. Parental history of allergic disease (OR: 2.189; 95% CI: 1.483–3.231), male sex (OR: 1.971; 95% CI: 1.369–2.838) and positive skin prick test (SPT) result (OR: 1.583; 95% CI: 1.804–3.698) were found to be significantly associated with current asthma. Conclusions: Although the risk factors for current asthma appear to be more related to the non-modifiable risk factors like sex, parental history of allergic diseases, SPT, the two groups are associated with exposure to modifiable indoor environmental factors.

Association between atopy, mastoid pneumatization and tympanometric findings

The purpose of this study was to reveal whether the presence of atopy plays any unfavorable role in the development of a healthy middle ear as evaluated by tympanometry or in the degree of mastoid pneumatization as measured by mastoid volume. 33 atopic patients with positive skin prick test results (atopic group) and 30 healthy subjects (control group) were included in this study. Tympanometric tests were performed in all participants, and the results were classified as type A to C. Mastoid cell volumes were measured by three-dimensional temporal computed tomography. Both the right and left mastoid volumes were significantly lower in the atopic group than in the control group. Tympanogram types among all participants showed that the number of individuals with abnormal tympanograms was significantly higher in the atopic group than in the control group. Moreover, the presence of atopy was found to be associated with an almost 4.5-fold increased risk of having an abnormal tympanogram. Individuals with abnormal tympanograms (type BB or CC) demonstrated significantly lower right and left mastoid volumes than did individuals with normal type A tympanograms. Atopic individuals demonstrated significantly lower right and left mastoid volumes than did subjects in the control group. This study suggests a direct association between atopy and mastoid cell volumes. It was found that the mastoid cell systems of atopic individuals are less pneumatized, and tympanometric measurements are worse in atopic subjects. Therefore, the authors suggest that when a medical or surgical treatment is planned for ear disease in atopic individuals, atopy is an important factor that should be taken into consideration.

Management of food allergy: A survey of Australian paediatricians

The prevalence of Immunoglobulin E (IgE)-mediated food allergy in the developed world is increasing, overwhelming tertiary allergy services. Alternative models of care are required. General paediatricians could provide this care but may require further training to do so. We aimed to determine Australian general paediatricians': (i) knowledge and management of IgE-mediated food allergy; (ii) access to and use of diagnostic services; and (iii) interest in further training. Members of the Australian Paediatric Research Network completed an online survey in 2011/12. A case study elicited paediatrician's knowledge of diagnostic history taking, testing and key management principles. Study-designed questions assessed paediatricians' current practice, access to allergy services and interest in further training. One hundred sixty-eight (43%) of 390 paediatricians responded; 93 paediatricians reported managing food allergy. Diagnostic and management practices varied widely. Paediatricians had high levels of agreement (>90%) for only three of 13 questions pertaining to diagnosis and management. Only 56 (61%) correctly identified that a diagnosis of IgE-mediated food allergy requires a history consistent with a clinical reaction and a positive specific serum IgE antibody or skin prick test result. Reported waiting times for tertiary allergy services ranged from 5.4 (private) to 10.6 months (public). Most (91%) paediatricians expressed interest in further training. General paediatricians would benefit from further training if they are to practice allergy care as their diagnosis and management is often inconsistent with international guidelines. Training could be delivered online to maximise reach and uptake. If effective, such a model could relieve some of the burden experienced by Australian tertiary allergy services.

Medical treatment of allergy in children with recurrent or chronic sinusitis.

Background:Diagnosis and treatment of chronic and recurrent sinusitis in children is of potential importance and many factors can havean influence on it. This study assessed the chronic and recurrent sinusitis and affecting factors, as well as the role of allergy in its course and treatment in children.Materials and Methods:A total of 106 children with the diagnosis of chronic or recurrent sinusitis, referred to specialty clinics of otolaryngology and allergy of Tabriz Children Educational-Medical centres since 2010 to 2012, were enrolled. The history and physicalexamination findings were recorded for all patients and allergy Prick test was done for all. Response to treatment was evaluated during the follow-up visits.Results:The mean age of studied patients was 6.5 ± 2.9 years. Of all the patients, 54 (50.9%) were male and 52 (49.1%) were female. Skin Prick test was positive in 69.8%. Response to treatment was seen in 86.8% of the patients while 7.5% did not have any favourable outcome. Anti-allergic treatment caused better outcomes in patients with positive Skin Prick test than those with negative results.Conclusion:The prevalence of allergic disease in children with chronic or recurrent sinusitis is considerable and anti-allergic treatments can result infavourable therapeutic outcomes in children with sinusitis, especially with positive skin prick test results.

Suppressor of cytokine signaling 3 expression is diminished in sinonasal tissues from patients with chronic rhinosinusitis with nasal polyps

Suppressor of cytokine signaling 3 expression is diminished in sinonasal tissues from patients with chronic rhinosinusitis with nasal polyps

Prediction of new-onset asthma and nasal allergy by skin prick test and RAST in a cohort of adults

Limited information exists regarding the incidence and predictors of asthma and nasal allergy in adulthood. We determined the incidence rate of asthma and nasal allergy in adults and assessed the predictive value of skin prick tests (SPTs) and radioallergosorbent tests (RASTs) for these two outcomes. Two German centres involved in the European Community Respiratory Health Survey conducted a follow-up assessment in 2012 of the baseline participants (1185 adults aged 21-47 years assessed in 1990). The predictive value of SPTs and RASTs on new-onset asthma and nasal allergy was assessed by Cox regression and by calculating the positive or negative predictive value. During the 20 years between baseline and follow-up, 3.1 and 4.4 per 1000 person-years of new-onset asthma and nasal allergy cases were recorded, respectively. The hazard ratios for SPTs of any specific and of all aeroallergens combined were slightly higher than those of RASTs for asthma and nasal allergy. The negative predictive values of both the SPT and RAST were very high and similar (0.94-0.96), whereas the postive predictive values were low (0.09-0.20). Positive SPT results showed a better association with new onset asthma and nasal allergy than positive RAST either to any specific aeroallergens or to all combined.

The Negative Predictive Value of Typing Safe Local Anesthetics

Background: Although allergy to local anesthetics (LA) is rare, patients often report unwanted reactions after their administration. A history of anaphylaxis or an atypical reaction related to LA is an indication for typing a safe anesthetic for future surgical or dental procedures. Aim: The aim of the study was to determine the negative predictive value (NPV) of typing safe LA. Methods: A total of 154 patients with a history of an unwanted reaction to LA were enrolled into the study. Stepwise typing of a safe anesthetic included skin prick tests (SPT) and intracutaneous tests (ICT) with two or three of the following LA: lidocaine, bupivacaine, mepivacaine, and articaine. Skin tests were followed by provocations with one or two LA. Telephone follow-up visits were performed 4-12 months after drug typing. On the basis of follow-up questionnaire results, the NPV of the protocol was calculated. Results: The full protocol was performed in 148 patients. Positive results of SPT were observed in 2, of ICT in 19 and of provocations in 11 cases. Lidocaine was found safe in 44, bupivacaine in 14, mepivacaine in 34 and articaine in 61 patients. The drug typed at the clinical visit was administered in 78 patients, and 76 reported no reactions (NPV = 97%). Conclusion: Stepwise approach including SPT, ICT and provocations is safe and allows typing a safe anesthetic in a vast majority of patients.

Prediction of obeche wood-induced asthma by specific skin prick testing

It has previously been shown that a positive skin prick test (SPT) result is a good predictor of a positive specific inhalation challenge (SIC) in patients with occupational asthma (OA) related to wheat or rye flours. This association has not been previously studied in OA attributable to obeche wood. To describe a clinical series of patients with OA induced by obeche wood. To investigate if the SPT result can be used as a predictor for the outcome of SIC tests. OA was diagnosed according to patient history, lung function examinations and SIC tests, as well as the determination of obeche SPTs. We analysed sensitivity, specificity and positive (PPV) and negative predictive values (NPV) at different wheal sizes of the SPTs and drew receiver-operating characteristic plots using the SIC test result as the gold standard. Obeche wood SIC tests were performed on 34 symptomatic workers. Of these, 27 workers had a positive test result and were diagnosed as having OA. The minimal cut-off value with a PPV of 100% was an SPT wheal of 3.5 mm from obeche wood. This means that all workers with a wheal size of ≥ 3.5 mm from obeche wood had a positive SIC. Positive SPT results in symptomatic workers were good predictors of a positive SIC. SIC with obeche wood may be unnecessary in strongly sensitized workers.

Evaluation of atopy in patients with COPD

OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood.

Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization?

BackgroundThe use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell–mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. ObjectiveTo determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. MethodsQuestionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. ResultsIncreasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. ConclusionHand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves.

Omalizumab as a Steroid-Sparing Agent in Chronic Eosinophilic Pneumonia

Chronic eosinophilic pneumonia (CEP) is an idiopathic eosinophilic pulmonary disease characterized by an abnormal and marked accumulation of eosinophils in the lung. Common presenting complaints include cough, fever, dyspnea, wheezing, and night sweats. Common laboratory abnormalities are peripheral blood and BAL eosinophilia. The pathognomonic radiographic finding is bilateral peripheral infiltrates. Corticosteroids are the mainstay of therapy, and dramatic improvement follows treatment. Relapses are common, and most patients require prolonged therapy. Side effects associated with chronic corticosteroid therapy must be monitored. Our case was that of a 36-year-old woman who had characteristic clinical and radiologic features. She was treated with corticosteroids but she needed prolonged therapy, and side effects occurred. Because the patient had high IgE levels and a positive skin prick test result, we used omalizumab for the treatment. The patient responded well. To our knowledge, this is the first CEP case in the literature successfully treated with omalizumab.

House dust bioactivities predict skin prick test reactivity for children with high risk of allergy

Although evidence suggests that ambient exposures to endotoxin and other immunostimulants during early life influence allergic risk, efforts to understand this host-environment relationship have been hampered by a paucity of relevant assays. These investigations determined whether parameters of house dust extract (HDE) bioactivity were predictive of allergen skin prick test (SPT) reactivity for infants at high risk of allergy participating in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS). We conducted a nested case-control study, selecting 99 CCAAPS children who had positive SPT results to at least 1 aeroallergen at age 3 years and 101 subjects with negative SPT results. HDEs were prepared from dust samples collected from the subjects' homes at age 1 year. Murine splenocytes and bone marrow-derived dendritic cells were incubated with HDEs, and supernatant cytokine concentrations were determined by means of ELISA. Alternatively, bone marrow-derived dendritic cells were preincubated with HDEs, and then LPS-induced IL-6 responses were assessed. HDE endotoxin levels were determined by using the limulus amebocyte lysate assay. HDEs derived from the homes of children with positive (cases) and negative (control subjects) SPT results had similar bioactivities. However, when cases were considered in isolation, HDEs with higher levels of bioactivity were significantly associated with children who had lower numbers of positive SPT results. Analogous statistical analyses did not identify any association between HDE endotoxin levels and the aeroallergen sensitization profiles of children included in this study. HDE immunostimulatory activities predicted the aeroallergen sensitization status of CCAAPS subjects better than HDE endotoxin levels. These results provide the first published evidence that HDE bioassays have clinical relevance in predicting atopic risk.

Characterization of occupational sensitization by multiallergen immunoblotting in workers exposed to laboratory animals

BackgroundStudies have estimated that 10% to 23% of workers exposed to laboratory animals report symptoms of laboratory animal allergy. ObjectivesTo determine the level of occupational sensitization in workers exposed to laboratory animals and to develop a diagnosis system based on a multiallergen IgE immunoblot. MethodsA total of 75 workers exposed to laboratory animals were initially studied with skin prick tests performed with animal epithelia extracts. The workers with suspected occupational disease and positive skin prick test results were further studied with the ImmunoCAP system to determine specific IgE levels to urine and epithelia allergens and with multiallergen IgE immunoblotting to detect specific IgE levels to epithelia allergens and bovine serum albumin. ResultsTwenty of the 75 workers were studied with ImmunoCAP and multiallergen IgE immunoblotting. Nine were polysensitized and 3 were sensitized to only one animal. The results obtained by ImmunoCAP and multiallergen IgE immunoblotting were concordant except for in 3 workers, who had low or negative values of specific IgE determined by ImmunoCAP but positive allergen detections by immunoblotting. On the basis of the results of the study and the clinical symptoms related by workers, 16% were diagnosed as having occupational allergy. ConclusionsMultiallergen immunoblotting by means of a unique test offers a graphic representation of sensitization to the different animals to which workers are exposed, providing additional information on the clinical symptoms caused by the involved allergens. The results presented suggest that this system can improve the diagnosis of laboratory animal allergy by obtaining a sensitization profile for each exposed worker.

20 Cross-Reactivity Between Olive Pollen and 3 Species of Grasses in Madrid, Spain

BackgroundThe most common allergenic pollens in patients with pollinosis in Central Spain are grasses and olive pollen, with a prevalence of positive skin prick test results of 94 and 61%, respectively. Shared proteins have been described in olive and grasses, such as profilins, polcalcin and trypsin inhibitors, but there are few in vitro studies analyzing the potential cross reactivity between both species. The aim of the present study was to analyze the protein composition of both allergen extracts, and the allergenic cross-reactivity between O. europaea and different grass pollen species.MethodsSeventy-two (72) patients (mean age 10.4 years) were included in the study. All of them suffered rhinoconjuntivitis and/or asthma and were sensitized to olive and/or grass pollen. Specific IgE of the individual patients against O. europaea, and to the grass species: Dactylis glomerata, Phleum pratense and Trisetum paniceum were determined by ELISA. Inhibition assays were performed to verify allergenic crossreactivity between grass species and olive. Mass spectrometry analysis was performed to characterize the extracts and establish if there are common proteins in both, grass and olive pollens, that could act as cross reactive proteins.ResultsThree different sensitization patterns were observed: 1) sensitization to olive and grass pollen, 2) sensitization to olive and not to grasses and 3) sensitization to grasses and not to olive. Different pools of sera were mixed according to this classification and used for the different assays. Correlation coefficients found for the 3 grass species were significant (P < 0.0001; Spearman), but not for olive pollen (P = 0.14; Spearman). Proteomic analysis revealed the presence of more than 40 common proteins in grasses and olive pollens, but inhibition assays demonstrated no allergenic cross-reactivity between both families.ConclusionsThere is no in vitro crossreactivity between O. europaea and Grass pollen extracts, in spite of the allergens and the large number of common proteins shared by these pollens. We can conclude that sensitization to olive and grasses is species specific.

Sensitization Rate and Clinical Profile of Congolese Patients with Rhinitis

In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continent.

The relationship between symptoms and the results of the skin prick test in patients with allergic rhinitis

To determine the relationship between skin prick test results and allergic symptoms and to discover which symptom or symptoms are more commonly associated with the skin prick test. Materials and methods: Of the 1462 patients with a prediagnosis of allergic rhinitis (AR) who underwent the skin prick test, 495 subjects completed the symptoms inquiry form and were included in the study. Results: Out of 495 cases, the skin prick test was found to be positive in 358 and negative in 137. No significant relationship was found between sneezing, runny nose, itchy nose, nasal obstruction, headache, postnasal drip, and skin prick test positivity (P > 0.05). There was a significant relationship between ocular complaints (watering, itching, discharge) and skin prick test results (P = 0.027). The groups with positive and negative skin prick test results were compared in terms of symptom severity. While the difference between itchy nose and ocular symptoms was found to be significant, this difference was not significant in terms of nasal obstruction, postnasal drip, and sneezing. Conclusion: While no significant relationship was found between symptoms accepted as allergic, such as sneezing and itchy nose, symptoms such as eye itching and watering were found to be related to allergy. We recommend performing the skin prick test routinely on patients presenting with AR symptoms. This would also prevent unnecessary antihistamine use.

Correlation of Routine Examinations for the Diagnosis of House Dust Mite Allergic Rhinitis

Objective: To evaluate the correlation between the routine diagnostic tests for house dust mite (HDM) sensitization in Chinese allergic rhinitis (AR) patients, including the skin prick test (SPT), serum HDM-specific immunoglobulin E (sIgE) and nasal smear eosinophilia. Methods: The ImmunoCAP assay was employed to detect serum total IgE and sIgE. The SPT and nasal smear eosinophil counts were performed using standard procedures. Results: Of 82 subjects with HDM-related symptoms and positive SPT results, 55 individuals showed an sIgE level equal to or greater than CAP class 1 for both Dermatophagoides pteronyssinus (Der p) and D. farinae (Der f), and 62 individuals demonstrated positive eosinophils in nasal smears. sIgE of Der p and Der f presented a linear correlation, and the level of serum HDM-sIgE was also positively correlated with total IgE. An increasing sIgE level was correlated with higher SPT grades in both Der p and Der f. Meanwhile, the correlation coefficient exhibited an increase in value with aging, and the 31- to 40-year age group demonstrated the highest value for both Der p and Der f. Conclusion: The positive correlation between SPT and sIgE reaction to HDM varied according to the age of patients with AR.

Occupational allergy to birds within the population of Polish bird keepers employed in zoo gardens

To evaluate the risk factors for the development of occupational allergy to birds among Polish zoo garden keepers. A total of 200 bird zookeepers employed in the Polish zoo gardens in KLódź, Warsaw, Gdańsk, Chorzów and Płock and exposed occupationally to bird allergens were examined using a questionnaire, skin prick tests (SPTs) to common allergens and bird allergens, spirometry and cytograms of nasal swab. The level of total IgE in serum and serum-specific IgE to parrot, canary, pigeon feathers and serum were also evaluated. Eight percent of bird zookeepers were sensitized to at least one of the bird allergens. The most frequent allergens yielding positive SPT results were D. farinae - 32 cases (16%), D. pteronyssinus - 30 cases (15%) and grass pollens (16.5%). In the studied group, allergen-specific IgE against bird allergens occurred with the following frequency: 87 (43.5%) against canary feathers and/or serum, 80 (40%) against parrot feathers and/or serum and 82 (41%) against pigeon feathers and/or serum. Occupational allergy was diagnosed in 39 (26.5%) cases, occupational rhinitis was present in 22 (15%) cases, occupational asthma in 20 (13.6%) subjects, occupational conjunctivitis in 18 (12.2%) cases, whereas occupational skin diseases in 11 (7.5%) cases. More eosinophils were found in nose swab cytograms among bird zookeepers with occupational airway allergy. The findings indicate that occupational allergy to birds is an important health problem among zoo bird keepers in Poland.