Positive Test Reactions Research Articles

93 MUNICH ASTHMA-AND ALLERGY SURVEY. IS ASTHMA BEING UNDERDIAGNOSED?

There is evidence that morbidity and mortality from asthma as well as the prevalence of allergic diseases is increasing. As data were missing in Germany, we studied in a crossectional design 9 403 schoolchildren (age 9-11 years) in an urban and rural area of Bavaria using a questionnaire, skin prick tests and pulmonary function tests before and after cold air challenge. The responserates were: 87% for questionnaires, 77% for allergy or pulmonary function tests. Evaluation of the questionnaires gave the following prevalences: 18,1% allergic rhinitis, 19,7% atopic dermatitis, 2,5% asthma and 5,5% recurrent wheezy bronchitis. Beyond this 8,3% had recurrent wheezing and 3,4% chronic cough by night or exercise without any diagnose of asthma or wheezy bronchitis. 42 % of all german children are atopic, ie exhibit at least one positive prick test reaction for the six aeroallergens tested. Bronchial hyperreactivity was found in 9% of german children. Atopic diseases and asthma are more frequent in the urban than the rural area. In summary there is an important underdiagnosis of asthma in this pediatric population.

Gamma/Delta T-Lymphocytes Are Not Increased in Number in Granulomatous Lesions of Patients with Tuberculosis or Sarcoidosis

gamma delta T-lymphocytes have been suggested to play a role in granuloma formation and to participate in the immune responses observed in tuberculosis and sarcoidosis. To further evaluate the role of gamma delta T-lymphocytes in these disorders, we used immunohistochemical techniques and specific monoclonal antibodies to characterize the number of distribution of T-lymphocytes expressing alpha beta and gamma delta T-cell receptors in granulomatous lesions from patients with sarcoidosis (n = 8) or tuberculosis (n = 4). The vast majority of T-lymphocytes present in lymph nodes from patients with tuberculosis or sarcoidosis expressed alpha beta TCR, whereas only rare gamma delta T-lymphocytes were observed inside or at the periphery of the granulomas. Recently formed granulomas induced by positive Kveim test reactions in patients with sarcoidosis also contained only small numbers of gamma delta T-lymphocytes, including those present in biopsies from two patients with increased numbers of circulating gamma delta T-lymphocytes. These observations demonstrate that T-cells involved in immune granulomatous reactions in sarcoidosis and tuberculosis express predominantly alpha beta TCR, and they do not support the conclusion that gamma delta T-lymphocytes necessarily play an important role in granuloma formation.

Association of features of atopy and diagnostic parameters in hymenoptera venom allergy*

In a total of 525 patients with hypersensitivity reactions to hymenoptera stings diagnostic parameters of hymenoptera venom (HV) allergy (severity of reactions, skin test threshold and RAST for bee and vespid venoms) were investigated for their relationship to the following indicators of atopy: positive history of atopic diseases, elevated (less than or equal to 100 kU/l) total serum IgE and positive prick test reactions to common inhalant allergens (CIA) (grass pollen, cat epithelium, house dust mite). There was a conclusive history of atopic disease in 25%, a total serum IgE greater than or equal to 100 kU/l in 48%, and at least one positive reaction to CIA in 53%. Total IgE greater than or equal to 100 kU/l correlated with a higher frequency of RAST classes greater than or equal to 2 (P less than 0.01) and with less severe reactions to hymenoptera stings (P less than 0.05). In the presence of at least one positive reaction to CIA, there were more frequently skin test thresholds less than or equal to 10 micrograms/ml (P less than 0.05) and RAST classes greater than or equal to 2 (P less than 0.01) for HV than in CIA prick test negative individuals. There was no significant, relationship between the other pairs of parameters evaluated. Thus, reactivity to HV in diagnostic tests is increased in the presence of certain indicators of atopy. This has to be considered in the interpretation of skin test and RAST results obtained with HV.

Atopic allergy to chloramine-T and the demonstration of specific IgE antibodies by the radioallergosorbent test

Chloramine-T is a small molecular oxidizing agent that has been widely used as a disinfectant since the beginning of this century. It is generally used in a 5% solution but it is also supplied in powder form. Sporadic case reports of immediate-type sensitization to this agent associated with symptoms of asthma, rhinitis and urticaria have appeared during recent decades. In one of the reports, specific IgE antibodies in sera of four patients who developed asthmatic symptoms after exposure to chloramine-T were demonstrated using a radioimmuno-assay. Three cases of bronchial asthma in workers who had handled chloramine-T powder are described in the present report. Positive skin-prick test reactions to chloramine-T were observed and specific IgE antibodies to human serum albumin treated with chloramine-T were detected using the classic radioallergosorbent (RAST) technique in all three patients.

A three-year photopatch study in Thailand

Photopatch testing was performed on 274 patients who had history of photosensitivity at the Institute of Dermatology Thailand from 1987 through 1989. A total of 92 positive photocontact reactions and 71 positive contact reactions were seen. The most frequent positive photopatch test reactions were to sulfanilamide (18.2%) followed by Jadit (4.4%) chlorpromazine (3.6%) promethazine (3.6%) and fenticlor (3.2%). The most common photodermatoses was polymorphous light eruption (60.9%). Photocontact dermatitis was established in 28 patients (10.2%) while other skin diseases aggravated by sunlight were seen in 47 patients (17.2%).

Cross‐reactivity between sensitivity to thimerosal and photosensitivity to piroxicam in guinea pigs

Piroxicam (PXM) is a nonsteroidal anti-inflammatory drug which may induce a photosensitive eruption shortly after administration. We examined whether animals sensitized to thimerosal developed a photosensitivity to PXM. Male Hartley strain guinea pigs were sensitized to thimerosal, thiosalicylate and PXM separately. The open patch test was used to evaluate sensitization to each drug and cross-reactions between the drugs. Animals sensitized to thimerosal exhibited positive patch test reactions to thiosalicylate and positive photopatch test reactions to PXM. Both those sensitized to thiosalicylate and to PXM showed positive patch test reactions to PXM. This study demonstrated that thimerosal induces cross-sensitivity to PXM in vivo and that the common active component among these compounds may be thiosalicylate.

Photopatch testing: The 5-year experience of the German, Austrian, and Swiss Photopatch Test Group

A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back of patients with suspected photosensivity. After applications for 24 hours, test sites were irradiated with 10 joules/cm2UVA. Unirradiated controls were included. Readings were performed immediately and 24, 48, and 72 hours after irradiation; responses were qualitatively graded on a 4-point scale. All data were stored and processed by a computer. With computer-assisted analysis of reaction patterns photoallergic reactions were identified and distinguished from phototoxic reactions. Data of 1129 patients were evaluated. Among a total of 2859 positive test reactions in 870 patients, 2041 in 778 patients were found to be photoinduced and 818 in 413 patients were contact reactions; 108 reactions in 83 patients were classified as photoallergic. Nonsteroidal anti-inflammatory drugs, disinfectants, sunscreens, phenothiazines, and fragrances caused most often photoallergic reactions. Many unspecific phototoxic reactions were induced by tiaprofenic acid, promethazine, carprofen, chlorpromazine, fenticolar, wood balsam of Peru, and perfumes. Despite the distinction between photoallergic and phototoxic responses, many test reactions lacked relevance for the patients' dermatoses.

Pigmented Contact Dermatitis Due to Musk Moskene

Musk moskene is a soft, sweet fragrance resembling musk ambrette which introduces a very desirable creamy powder note for cosmetic fragrance. Because of its advantages, which include low cost, oil solubility, and less sensitive to sunlight, musk moskene has recently increased its share of the market. In this paper, we reported a case with pigmented contact dermatitis from musk moskene in cheek rouges. Patch test positive reactions to cheek rouges resulted in hyperpigmentation. Both the perfume used in the cheek rouges and musk moskene, which was a component of that perfume, showed strongly positive reactions. Residual hyperpigmentation was seen on the regions of the perfume and musk moskene patch testings. Hyperpigmentation on cheeks of the patient gradually diminished after discontinuing use of the causative cheek rouge.

Drug Eruptions Following Treatment with Prodrugs: A Review of the Reported Cases in Japan from 1984 to 1989

A review of 872 cases of drug eruption reported in the Japanese dermatological journals from 1984 to 1989 has revealed a growing subset related to treatment with prodrugs, in which the responsible agent may be the metabolite rather than the prodrug itself. This situation is the result of the presence in tissues and fluids of only the metabolite following absorption and degradation of the prodrug. Because of this condition, patients with drug eruptions after prodrug treatment may develop positive patch test and/or lymphocyte stimulation test reactions not only with the introduced prodrug but also with the metabolite produced in vivo and further with other prodrugs which degrade into the same metabolite.

Cell Trafficking in Positive and Negative Patch-Test Reactions: Demonstration of a Stereotypic Migration Pathway

The cellular and molecular events taking place during epidermal antigen exposure in sensitized individuals are principally well understood. Epidermal Langerhans cells (LC) are supposed to take up, process, and express a given foreign substance on their cell surface. The antigen is then recognized by T cells bearing the appropriate T-cell receptor (TCR). Because LC do not bear variable antigen (Ag)-specific binding sites, one could postulate that the epidermal exposure of any substance should activate LC and other cells of the skin immune system. To test this hypothesis, we analyzed immunophenotypically the cellular trafficking events in positive (n = 5) and negative epicutaneous patch-test reactions (n = 10), using a panel of monoclonal antibodies against CD1a, CD11c (Ki-M1, LeuM5), CD68 (Ki-M6), Ki-M8, and CD3 (Leu4). We can demonstrate that irrespective of whether or not an antigen will be responded to by the immune system (i.e., positive or negative test reaction), epidermal antigen exposure causes a decrease of LC density in the epidermis and simultaneously causes an increase of LC in the dermis. Moreover, monocytes and T cells immigrate into the dermis both in positive and negative patch-test reactions. As is to be expected, the degree of this cellular traffic is more pronounced in positive test reactions, which may be due to amplification mechanisms caused by antigen recognition of sensitized T cells. This finding demonstrates that human skin contains cell migration programs that ensure that any foreign substance will be accessible to the skin immune and phagocytic system.

Piroxicam-induced photosensitivity and contact sensitivity to thiosalicylic acid

A photocontact dermatitis developed in three patients after the application of gel containing 0.5% piroxicam. Patch tests were positive to thiomersal and thiosalicylic acid. Photopatch tests with piroxicam at several concentrations were positive in the three patients but negative in 62 normal volunteer subjects. Patch tests performed on 14 patients with proved systemic photosensitivity to piroxicam were positive for thiomersal and thiosalicylic acid. Nine of 12 patients previously sensitized to thiosalicylic acid and with no history of exposure to piroxicam showed positive photopatch test reactions to this chemical. These results support a relation between piroxicam-induced photosensitivity and contact sensitivity to thiosalicylic acid. Contact allergic sensitivity to the latter is a marker for patients with a high risk of developing photosensitivity reactions to piroxicam. These reactions may be due to photoproducts of the drug rather than metabolites.

European multicenter study of TRUE Test™, Panel 2

Panel 2 of the standardized, ready-to-apply patch test, the TRUE Test, has been evaluated on 808 patients with suspected contact dermatitis. The patients were tested with 11 different allergens and the negative control, and compared with corresponding allergens in pet. (or aq.) in Finn Chambers fixed with Scanpor. The TRUE Test, Panel 2 and the control were applied symmetrically on the upper back. Left/right application of the respective test varied at random. Most tests were removed after 48 h and evaluated after 72 or 96 h, according to generally accepted recommendations. There were positive test reactions to all 11 allergens tested in the patient group. The concordance of positive reactions (1+, 2+, 3+) was 63% between TRUE Test, Panel 2 and the control method; 17% of positive reactions occurred only with TRUE Test, Panel 2 and 20% only with the compared method. Approximately 75% of all positive test reactions were explained by the patients' present or past history. Irritant/questionable reactions occurred in the same frequency for the 2 methods. Such reactions were recorded in less than 1% of all patches applied. No late reactions were recorded.

Experimental reproduction of skin lesions in lupus erythematosus by UVA and UVB radiation

Sunlight is a well-established factor in the induction and exacerbation of lupus erythematosus. Although experimental reproduction of lupus erythematosus lesions with wavelengths shorter than 320 nm was demonstrated previously, the effect of wavelengths longer than 320 nm was not investigated adequately. In this study we show that the action spectrum of lupus erythematosus reaches into the UVA region. A total of 128 patients with lupus erythematosus underwent phototesting with the use of polychromatic UVB and long-wave UVA. Subsets of the disease consisted of discoid lupus erythematosus (n = 86), subacute cutaneous lupus erythematosus (n = 22), and systemic lupus erythematosus (n = 20). Skin lesions clinically and histologically compatible with lupus erythematosus were induced in 64% of patients with subacute cutaneous lupus erythematosus, 42% of patients with discoid lupus erythematosus, and 25% of patients with systemic lupus erythematosus. The action spectrum of the induced lesions was within the UVB range in 33% of patients, in the UVA range in 14%, and in the UVB and UVA range in 53%. In positive test reactions patchy dark erythema and urticarial plaques developed within a few days. In some patients typical discoid lesions persisted for months.

Batch Variations

One of the basic principles in the investigation of suspected contact dermatitis is always to test with the patient s “own” product or chemical, the one to which he or she was actually exposed. An equally basic second principle is not to rely solely on a positive test reaction. The author discusses a case of contact dermatitis involving only certain batches of a particular branded product.

Detection of contact hypersensitivity to topical corticosteroids with hydrocortisone‐17‐butyrate

We showed earlier that most patients with contact dermatitis due to corticosteroids show cross-reactions when patch tested with hydrocortisone-17-butyrate (H-17-B). To test whether H-17-B could be used for detecting topical corticosteroid allergy, we screened patients undergoing routine patch testing with H-17-B. Patients with clearly allergic or doubtful/mildly irritant patch test reactions to H-17-B, and with a history suggesting topical corticosteroid allergy, were further tested with a large panel of steroid preparations. 20 out of 4039 patients (0.5%) showed definite allergic test reactions to corticosteroids. A further 165 patients with clinically suspected corticosteroid allergy were directly tested with a panel of steroid preparations; 14 patients showed positive patch test reactions. Altogether, 33 out of 34 patients with corticosteroid allergy had positive test reactions to H-17-B. Inclusion of 1.0% H-17-B in ethanol in the standard patch test series improves the diagnosis of topical corticosteroid hypersensitivity.

Patch testing in children.

Over a 3-year period, 533 children aged between 4 months and 14 years were patch-tested with a “pediatric” series of haptens. The children were affected with various types of eczema or with psoriasis of the hands (n = 31). In 78 positive children, there were 112 positive test reactions to various allergens. Nickel, cobalt, ethylenediamine, and potassium dichromate were the most frequent sensitizers. Positive reactions were relevant in 52 (67%) of 78 positive children.

Acidic phiorogludnol test positive reaction in Cultures of isolated mesophyll protoplasts ofBrassica napus L. and with secreted brown exudates

Cultures of isolated mesophyll protoplasts ofBrassica napus L.have shown a positive reaction with the acidic phloroglucinol test for lignin (Wiesner reagent) 30 h after the beginning of the culture period. The reaction was observed in protoplasts and in a very early stage connected with divisions, in which acidic phloroglucinol positive material was primarily deposited like a girdle surrounding the division plane. Brown exudates, which are a serious problem even in young cultures derived from isolated protoplasts, have been secreted into the medium by cells, and also showed a positive reaction. The same staining pattern has been found with toluidine blue 0.

Mast cells and IgE in intestinal mucosa in adult atopic dermatitis patients.

Duodenal biopsies from 29 adult atopic dermatitis (AD) patients with multiple positive skin prick test reactions were examined and the results compared with biopsies from 13 non-atopic controls. The duodenal mucosa showed mild inflammatory changes in six out of the 29 patients, but was normal in all the controls. Numerous anti-IgE positive cells, increasing with the severity of AD, were found in the duodenal mucosa in 25 of the 29 AD patients compared with few sporadic positive cells seen in only two out of 13 controls (P less than 0.001). The total serum IgE level showed a significant positive correlation with the number of anti-IgE stained cells in the mucosa (P less than 0.05). No significant differences were found in the total number of toluidine blue stained cells or cells immunoreactive for histamine between patients and controls. However, AD patients who had high numbers of anti-IgE positive cells often had decreased numbers of histamine immunoreactive cells in the mucosa suggesting mast cell degranulation. These findings provide further evidence that also in adult AD patients the gastrointestinal tract may serve as a portal of entry for allergens which may lead to exacerbation of AD.

UV sunlight and patch test reactions in humans.

No seasonal influence of UV sunlight on patch test reactions in humans over a period of 9 years of clinical practice was found in this retrospective study of almost 8000 patients. Although the mean UV monthly dose varies seasonally, up in the summer and down in the winter, no significant differences could be identified for patch test reactions, either for the mean number of positive test reactions or for the intensity of the skin reaction or for the id-like spread reactions seen in summer or winter. Furthermore, no short-term influences of UV exposure during the weekend preceding patch testing could be demonstrated. Therefore, reliable patch-test results can be expected at any season of the year from a general population, at least in Belgian-type climates.

Photopatch testing: A six-year experience

The results of photopatch testing performed at the Mayo Clinic from 1980 through 1985 were analyzed. During the 6 years, 70 patients underwent photopatch testing. Of the 70 patients, 27 (38.5%) had positive photopatch test reactions and 22 (31%) had ordinary contact reactions. Of the 27 patients with photocontact reactions, 14 had relevant reactions. The most frequent positive reactions were to chlorpromazine (13 patients), musk ambrette (nine patients), and promethazine (eight patients). Photopatch testing is an essential part of the evaluation of patients who are suspected of having photosensitive dermatitis. In some patients with recalcitrant eruptions, testing may help in excluding photosensitivity as a possible contributing factor.