Skin Prick Test Reactivity Research Articles

Occupational immediate‐type asthma and rhinitis due to rhodium salts

Whereas platinum salts are well known occupational allergens, rhodium salts have not been identified as inhalative sensitizing substances. A 27-year-old atopic operator of an electroplating plant developed work-related shortness of breath and runny nose with sneezing after exposure to rhodium salts. Quantitative skin prick tests (SPT) and bronchial challenge tests with a dosimeter protocol were performed with quadrupling doses of the sodium chloride salts of rhodium (Na(3)RhCl(6)) and platinum (Na(2)PtCl(6)). The patient showed positive SPT reactions and positive bronchial immediate-type reactions with rhodium and platinum salts. Sensitivity to rhodium salt was much higher than to platinum salt; the molar concentrations differed by a factor of 256 in SPT and a factor of 16 in bronchial challenges. Rhodium salts should be considered as occupational immediate-type allergens.

Two cases of wheat-dependent anaphylaxis induced by aspirin administration but not by exercise

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to enhance the symptoms of wheat-dependent exercise-induced anaphylaxis (WDEIA). In contrast to many reports on WDEIA, there have been only a few reports of wheat-dependent aspirin-induced anaphylaxis not induced by the combination of wheat and exercise. Two patients with wheat-dependent anaphylaxis underwent provocation tests to clarify the cause of their symptoms. Skin-prick testing (SPT) was also performed with and without administration of aspirin. Specific IgE antibody to wheat, gluten, and omega-5 gliadin were examined. In the provocation tests, anaphylactic reactions were not induced by wheat or aspirin alone or by the combination of wheat and exercise, but were induced by the combination of wheat and aspirin. An increase in the blood histamine level was detected after provocation in both patients. Pretreatment with aspirin enhanced the SPT reactions to wheat and gluten in both patients. Specific IgE antibodies to wheat and gluten were expressed in the serum of both patients, and specific omega-5 gliadin IgE antibody was detected in the serum of one patient. We present two cases of specific wheat-dependent anaphylaxis induced by aspirin but not by exercise. We suggest that pretreatment with aspirin under controlled conditions is useful to confirm the diagnosis of food allergy when a challenge test with food alone or with food and exercise fails to induce positive reactions.

In vitro cross-reactivity between tomato and other plant allergens

Cross-reactivity among fruits and different pollen and fruit species has been extensively reported. To investigate the in vitro cross-reactivity between tomato and pollen, fruit, and latex extracts and to identify the proteins involved. A serum pool was prepared from 18 individuals residing on the Spanish Mediterranean coast (9 men and 9 women; mean [SD] age, 27.4 [10.1] years) who had positive skin prick test reactions to tomato peel. Extracts from 10 pollens, 12 fruits, and latex were tested. Levels of specific IgE to each extract were measured. The allergenic profile was evaluated by means of immunoblot. The percentage of inhibition between extracts and tomato peel extract was analyzed by means of CAP inhibition, and the allergens implicated were elucidated by immunoblot inhibition. For pollens, the highest specific IgE values were obtained for grasses. Most pollen extracts showed a capacity of inhibition similar to that of tomato peel extract; high percentages were obtained with Artemisia vulgaris and Poa pratensis. The most strongly inhibited allergens in tomato corresponded to bands of 32 and 45 kDa. For fruits, the highest value of specific IgE was detected for peach. High percentages of inhibition were obtained with peach and hazelnut. No inhibition was detected with latex. Peach, chestnut, and melon inhibited high molecular weight bands (32 and 45 kDa) and a band of approximately 10 kDa. Cross-reactivity between tomato and pollen and fruit extracts has been demonstrated. Allergens with a high molecular weight range seem to be responsible in pollen extracts. A 10-kDa band seems to be responsible in Platanus acerifolia, Salsola kali, peach, chestnut, and melon.

Impact of Maternal Atopy and Probiotic Supplementation During Pregnancy on Infant Sensitization: A Double-Blind Placebo-Controlled Study

Huurre A, Laitinen K, Rautava S, Korkeamäki M, Isolauri E. Clin Exp Allergy. 2008;38(8):1342–1348PURPOSE OF THE STUDY. To explore factors in infant sensitization and the effect of probiotics.STUDY POPULATION. The researchers evaluated 171 mother-infant pairs from an ongoing, placebo-controlled, double-blind study with nutrition modulation through dietary counseling and probiotic supplementation.METHODS. Mothers with no chronic or metabolic disease before or during early pregnancy had dietary counseling and were randomly assigned to receive either probiotics (Lactobacillus rhamnosus strain GG and Bifidobacterium lactis Bb12) or placebo from the first trimester of pregnancy to the end of exclusive breastfeeding. Atopic sensitization of the infants was assessed by skin-prick test to cow's milk, egg white, wheat, rice, gliadin, cod, soya bean, birch, 6 grasses, cat, dog, Dermatophagoides pteronyssinus (dust mite), latex, potato, carrot, and banana at the ages of 6 and 12 months. The mothers were skin tested for these antigens as well as peanut, hazelnut, alder, and mugwort in their third trimester of pregnancy. Infants were examined at 1, 6, and 12 months of age. Breast milk samples were collected immediately after birth and 1 month after delivery. Concentrations of transforming growth factor β2 (TGF-β2) and soluble CD14 were measured in breast milk by using commercial sandwich enzyme-linked immunosorbent assays. The concentrations of interferon γ, tumor necrosis factor α, interleukin (IL)-10, IL-6, IL-4, and IL-2 were measured via flow cytometry. Infant sensitization assessed by skin-prick test at the age of 12 months was the primary variable. The effects of probiotic intervention, allergy status of the mother, and duration of total and exclusive breastfeeding on infant sensitization were analyzed by using the χ2 test. The t test for independent samples was used to compare the probiotic and placebo groups.RESULTS. At the age of 12 months, 30% of the infants showed ≥1 positive reactions on the skin-prick test. Allergic disease and positive skin-prick test results in the mother were likely to be associated with increased risk of sensitization in the child. The total duration of breastfeeding affected the risk of sensitization in the infant according to the allergy status of the mother; the risk of sensitization increased for infants with allergic mothers breastfeeding for >6 months or exclusively breastfeeding for >2.5 months (odds ratio: 4.8; P = .005). Probiotic supplementation had a protective effect against sensitization in infants with mothers with sensitization. The concentration of TGF-β2 tended to be higher in the colostrum of the mothers in the probiotic group, compared with those in the placebo group (probiotic/placebo ratio: 1.5; P = .02). A low level of TGF-β2 in the colostrum seemed to be associated with a positive skin-prick test result in the infant. Probiotic supplementation had a protective effect against sensitization in a subgroup of infants with maternal sensitization: 26% of the infants in the probiotic group versus 50% in the placebo group had positive skin-prick test results. Atopic eczema was diagnosed at the age of 12 months in 9.7% of the infants in the probiotic group and in 17.6% of the infants in the placebo group.CONCLUSIONS. Maternal skin-prick test reactivity accompanied by allergic disease may increase infant vulnerability to sensitization. Breastfeeding by atopic mothers increases the likelihood of sensitization in infants. Probiotics provide protection from sensitization in infants at high risk.REVIEWERS COMMENTS. The authors of this article raise interesting questions about the impact of breast milk in the prevention of atopic disease. They noted a protective benefit of probiotic supplementation in their study population and theorized that the possible mechanism for this protective effect is through an increase in antiinflammatory TGF-β2 in breast milk. The authors noted possible limitations of probiotics, including appropriate selections of antiinflammatory probiotic strains and risk of disease in the infant. This is a fascinating area for future study.

A Pilot Study of Interferon-γ–Induced Specific Oral Tolerance Induction (ISOTI) for Immunoglobulin E–Mediated Anaphylactic Food Allergy

Food-induced anaphylaxis is a life-threatening, IgE-mediated disease. No specific therapeutic recommendations, aside from the avoidance of offending foods, exist at this time. However, specific oral tolerance induction for food allergy has been investigated by several groups. In this study, specific oral tolerance induction was attempted using interferon-gamma (IFN-gamma) as an adjuvant for IgE-mediated anaphylactic food allergies. A total of 25 patients with IgE-mediated anaphylactic food allergy to milk, eggs, or wheat were selected. IFN-gamma-induced specific oral tolerance induction (ISOTI) was conducted on 10 patients, while five patients were only treated with food, five patients received only IFN-gamma therapy, and five patients did not receive any treatment. Tolerance for IgE-mediated anaphylactic food allergy was successfully induced in all patients (10/10) with ISOTI, while no patients acquired tolerance for allergenic foods in the control groups. Food-specific IgE levels were increased, and skin prick test reactions significantly decreased after the completion of ISOTI. IFN-gamma-induced specific oral tolerance induction (ISOTI) is a promisingly effective treatment for IgE-mediated anaphylactic food allergy. IFN-gamma may be an important cytokine in tolerance induction. Simultaneous allergen stimulation with nonspecific immunomodulation of IFN-gamma was essential for specific tolerance induction in IgE-mediated anaphylactic food allergy.

GA2LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe

Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan-European population of patients presenting with suspected allergic disease. Clinical relevance of skin prick tests was recorded with regard to patient history and optional additional tests. A putative correlation between sensitization and allergic disease was assessed using logistic regression analysis. While an overall rate of >or=60% clinically relevant sensitizations was observed in all countries, a differential distribution of clinically relevant sensitizations was demonstrated depending on type of allergen and country where the prick test was performed. Furthermore, a significant correlation between the presence of allergic disease and the number of sensitizations was demonstrated. This study strongly emphasizes the importance of evaluating the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.

Lupin allergy and lupin sensitization among patients with suspected food allergy

Lupin, a legume with good nutritional value, is used in food production today, most often in bakery products. Lupin sensitization is often seen among patients with reactions to legumes, but the number of reports describing lupin anaphylaxis is also increasing. To investigate the occurrence of lupin sensitization, cross-reactivity, and lupin allergy among patients with suspected food allergy in Finland, where lupin is a labeled ingredient in few products. The occurrence of positive skin prick test (SPT) reactions to lupin seed flour was studied among 1522 patients with suspected food allergy from November 1, 2005, through December 31, 2007. Clinical histories and diagnostic SPT results were analyzed among patients with positive SPT results to lupin. For 1 patient, ImmunoSpot and lupin radioallergosorbent test inhibition methods were used. Lupin sensitization was shown in 25 of 1522 patients (1.6%), and probable lupin allergy was diagnosed in 7 of 25 patients, in whom the clinical symptoms varied from anaphylaxis and respiratory symptoms to contact urticaria and itchy mouth. Cross-reactions or concurrent reactions to other legumes were seen in 18 of 25 patients. Clinically relevant lupin allergy often occurs in patients without atopic background or other food allergies, although lupin sensitization most commonly seems to represent cross-reactivity to other legumes. The occurrence of lupin allergy in a country where lupin has not been traditionally used is surprisingly common, suggesting that short-term use of modest amounts of lupin can cause serious allergic reactions.

Skin prick test reactivity to common aeroallergens and ARIA classification of allergic rhinitis in patients of Central Greece

Allergic rhinitis (AR) is prevalent in Mediterranean countries, but there are no epidemiological studies in the Hellenic milieu in accordance with the recent ARIA guidelines. We investigated aetiological aeroallergens in AR patients of Central Greece using the ARIA classification. Between 2002 and 2006, 911 patients with rhinitis symptomatology were interviewed and underwent Skin prick testing and 623 completed the study. Seasonal rhinitis (SAR) represented 37.6%, Perennial rhinitis (PAR) 46.4% and SAR + PAR 16%. Intermittent mild and moderate/severe AR was evident in 9.3 and 24.5%, persistent mild and moderate/severe in 23.2 and 43.0%. Persistent AR appeared in overall 66.2% of patients and was prevalent in PAR and SAR + PAR (p < 0.0001). Severity of AR symptoms did not correlate more with ARIA than with the traditional subgroups. Marked statistical (p < 0.05) differences were evident for seven aeroallergens between the four geographic areas of the study. Pollen allergy was found in 77.8% but all pollens were significantly lower in coastal areas (p < 0.001), besides Parietaria (p < 0.003). Mite sensitivity manifested in 43.2%. Alternaria affected mostly the paediatric population (p < 0.0001). 12.4% (N = 77) was monosensitive, 58.7% (N = 366) oligosensitive, and 28.9% (N = 180) polysensitive. Rhinitis and asthma comorbidity was high (45.3%) and occurrence of asthma was related with PAR (p < 0.007) and SAR + PAR (p < 0.023) but not with the ARIA classification subgroups. This study provides compelling evidence of a typical Mediterranean allergic profile of patients of Central Greece with significant regional variability. Both classifications had approximately equal diagnostic value in our study besides the fact that ARIA subdivision is considered superior in determining treatment.

Detection of specific anti- Alternaria alternata IgE in asthmatic patients

Summary Objective The main purpose of this study was to extract Alternaria alternata antigens for evaluating the skin allergic reactions and specific anti- A. alternata IgE in asthmatic patients. Materials and methods Eighty-eight patients with asthma (46 male, 42 female) and 40 non-atopic individuals were enrolled with sequential trials. Sensitization to A. alternata antigens has been evaluated in asthmatic patients by skin prick test (SPT) and dot-blotting assay. Results Positive SPT reactions were obtained on 70.5% of patients ( P P A. alternata IgE antibody was detected in 46 (52.3%) of patients (strong positive responses) by dot-blotting test, but no specific IgE antibody was detected in control group ( P Conclusion We confirmed that different allergenic components of A. alternata may play an important role in producing signs of asthma in the sensitive patients.

Evaluation of Candida albicans allergens reactive with specific IgE in asthma and atopic eczema patients

Candida albicans (C.albicans) produces important allergenic components which can induce allergic reactions in sensitised patients. The purpose of this study was to extract the C.albicans antigens for evaluating the specific anti-Candida IgE in sera of atopic eczema (AE) and asthmatic patients (AS). 95 AE, 85 AS, and 70 non-atopic cases were selected with sequential trials. Candida albicans antigens were prepared and then skin prick test (SPT), ELISA and IgE-immunoblotting tests were performed for all patients. Positive SPT reactions were obtained on 52.6% of AE and 54.1% of AS patients and 4.3% of healthy controls (P < 0.05). Using ELISA, specific anti-C. albicans IgE antibody was detected in 32.6% and 41.2% of patients with AE and AS, respectively. No specific IgE antibody was detected in healthy controls (P < 0.05). In SDS-PAGE, protein bands with molecular weights between 13 and 135 kDa were detected, and some of them reacted with specific IgE in immunoblotting. In AE patients, the most important allergenic components were 25, 34, and 57 kDa protein bands, whereas in AS, 22, 25, and 34 kDa protein bands were observed as major allergens. Candidaalbicans produces different allergenic components that can induce allergic reactions and may be pathogenetically important in patients with AE and AS.

Discrepancy between sensitization to inhaled allergens and respiratory symptoms in pediatric patients with type 1 diabetes mellitus

According to the 'Th(1)/Th(2) paradigm', children with type 1 diabetes mellitus (T1DM) should have a lower risk of developing allergic sensitization and, because of the involvement of insulin in modulating airway inflammation, different frequency or severity in allergy-related respiratory manifestations. This article aims at evaluating the frequency and type of allergic sensitization and its respiratory manifestation, asthma and/or rhinitis, in a group of pediatric patients with T1DM. Patients (112) with T1DM, 7.8-16.9 yr of age (63 males and 49 females) were evaluated. Skin prick test (SPT) reactivity to the most common classes of aeroallergens were performed and compared with data obtained in 709 school-aged children. The frequency of sensitization was not different in the T1DM and in the control subjects (43.7% and 40.8%, respectively; p = 0.55), with similar proportions of individuals sensitized to one allergen (32.7% and 38.1%, respectively; p = 0.47). In both groups, sensitization to house dust mite allergens was the most frequently detected (69.4% and 65.4%, respectively; p = 0.59), with a higher proportions of individuals sensitized to Graminae (+Cynodon dactylon; p < 0.0001) and a lower, but weakly significant, proportion sensitized to Parietaria (p = 0.03) in the T1DM group, as compared with controls. No differences were found between T1DM and control groups in the proportion of individuals reporting rhinitis (26.8% and 29.2%; p = 0.60). However, comparing separately sensitized and non-sensitized subjects, a lower proportion of rhinitis subjects was detected in the non-sensitized T1DM patients, when compared with the non-sensitized control subjects (p = 0.01). In addition, no differences were detected between T1DM and control groups in frequency of symptoms related to 'lifetime asthma', i.e., asthma episodes during life (14.3% and 16.5%, respectively: p = 0.55), also when sensitized and non-sensitized subjects were evaluated separately (p = 0.12 and p = 1.00, respectively). However, no T1DM patient had 'actual asthma', i.e., asthma episodes in the last year, vs. 5.8% of the individuals in the control group (p = 0.009), the difference being mostly ascribed to sensitized subjects (p = 0.012). Finally, out of the 16 T1DM patients with 'lifetime asthma', 15 had mild intermittent disease and only one mild persistent disease. T1DM does not seem to play a downregulating role on the development of allergic sensitization to aeroallergens, but may lower the frequency or the severity of its clinical manifestations at respiratory level.

Allergy to Carmine Red (E120) Is Not Dependent on Concurrent Mite Allergy

Background: Positive skin prick test (SPT) reactions to carmine red (E120) have been reported to occur concurrently with reactions to mites. The relationships between positive SPT reactions to carmine, carmine allergy and concurrent mite reactions are unknown. The aim of this study was to analyse the prevalence of carmine sensitization and its clinical importance among patients with suspected allergy to food additives. Methods: The occurrence of positive SPT reactions to mites was studied in 6,464 patients: 3,164 were tested with carmine and 2,837 with shrimp. Carmine ingestion-associated symptoms were registered at the time of testing. Patients with positive SPT to carmine received a follow-up questionnaire on their symptoms 1–5 years later. Results: Positive SPT reactions to carmine were seen in 94 patients (3.0%) of whom 74% also had positive SPT reactions to mites and 22% to shrimp. Carmine ingestion-associated symptoms were not dependent on concurrent mite reactivity in 39/94 (42%) patients. Conclusions: Carmine sensitization without sensitization to mites is seen in one fourth of the patients. Allergic reactions to carmine are not dependent on concurrent reactivity to mites.

Specific sublingual immunotherapy with peach LTP (Pru p 3). One year treatment: a case report

AbstractIntroductionFood allergy is an increasing problem with limited therapeutic approaches apart from to the eviction diet.Case presentationA 40-year-old female patient with food allergy symptoms was polysensitized to almost all vegetable food since the age of 36; the onset of symptoms was during pregnancy. The allergological study demonstrated positive skin prick tests (SPT) to nuts, legumes, cereals, spices, several fresh fruits including peach, and other groups of vegetable foods however, it was negative to common aeroallergens. Serum specific IgE levels were negative (&lt;0.35 kU/L) to profilin and carbohydrate determinants, but positive to Pru p 3 (3.5 kU/L). Positive double-blind placebo-controlled food challenge to peach confirmed the allergic disease. She received specific sublingual immunotherapy with native Pru p 3 at a concentration of 40 μg/ml with 5 administrations per week and a cumulative dose of 200 μg of nPru p 3 per month. After an ultra-rush build-up phase concluded in one day she continued therapy during a year with 5 administrations per week. The clinical evolution and laboratory studies demonstrated an early reduction on SPT reactions with no relevant changes on serum specific IgE, IgG, IgG1and IgG4to Pru p 3 during the immunotherapy period. The challenge test was negative 4 months after the beginning of the SLIT. Regarding clinical response she markedly improved after the first month of treatment, and by the 3th month she had no major vegetable dietary restrictions, except for nuts and pepper.ConclusionThese results demonstrate the excellent efficacy and safety of sublingual specific protein immunotherapy developed according to the patient specific sensitivity profile to Pru p3.

Specific sublingual immunotherapy with peach LTP (Pru p 3). One year treatment: a case report.

IntroductionFood allergy is an increasing problem with limited therapeutic approaches apart from to the eviction diet.Case presentationA 40-year-old female patient with food allergy symptoms was polysensitized to almost all vegetable food since the age of 36; the onset of symptoms was during pregnancy. The allergological study demonstrated positive skin prick tests (SPT) to nuts, legumes, cereals, spices, several fresh fruits including peach, and other groups of vegetable foods however, it was negative to common aeroallergens. Serum specific IgE levels were negative (<0.35 kU/L) to profilin and carbohydrate determinants, but positive to Pru p 3 (3.5 kU/L). Positive double-blind placebo-controlled food challenge to peach confirmed the allergic disease. She received specific sublingual immunotherapy with native Pru p 3 at a concentration of 40 μg/ml with 5 administrations per week and a cumulative dose of 200 μg of nPru p 3 per month. After an ultra-rush build-up phase concluded in one day she continued therapy during a year with 5 administrations per week. The clinical evolution and laboratory studies demonstrated an early reduction on SPT reactions with no relevant changes on serum specific IgE, IgG, IgG1 and IgG4 to Pru p 3 during the immunotherapy period. The challenge test was negative 4 months after the beginning of the SLIT. Regarding clinical response she markedly improved after the first month of treatment, and by the 3th month she had no major vegetable dietary restrictions, except for nuts and pepper.ConclusionThese results demonstrate the excellent efficacy and safety of sublingual specific protein immunotherapy developed according to the patient specific sensitivity profile to Pru p3.

Pattern of skin prick test reactivity to aeroallergens in patients with asthma and rhinitis residing in Riyadh, Saudi Arabia. (36.6)

Abstract The aim of this study was to determine the pattern of skin prick test reactivity to aeroallergens in patients with asthma and rhinitis (airway allergy) residing in Riyadh region. During the period between Jan. 2003 and March 2004, allergy skin prick test results of 139 Saudi nationals (53% females and 47% males, mean age 27 + 12 years) with a clinical diagnosis of airway allergy residing in Riyadh region were analyzed in retrospect at King Khalid University Hospital Riyadh. A set of aeroallergens extracts for both indoor and outdoor allergens including fungal spores was used to test the patients. Of the total 75% (105) patients with airway allergy reacted to one or more allergen extracts. Most frequently reacting indoor allergen was house dust mite (77.8%) followed by the cat (33.6%) and cockroach (19.2%) allergens. Among the outdoor allergens Prosopis juliflora tested positive in 72.1%, Bermuda grass in 53.8%, Chenopodium album in 47.1%, Rye grass in 36.5% and Salsola kali in 36.5%. A significant proportion of patients were also found reacting to Moulds (18.2%) and Aspergillus fumigatus (18.2%) extracts. Sensitivity to one or more aeroallergens was common in atopic patients, indicating high level of aeroallergen sensitization in patients with airway allergy residing in Riyadh region.

Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran

BackgroundAllergic rhinitis is the most common allergic disease with negative impacts on patients’ quality of life. The prevalence and pattern of sensitisation vary between different countries and populations. Identifi cation of the most prevalent aeroallergens in each area has a very important role in diagnosis and treatment of allergic rhinitis.Iran is a fairly large country with different geo-climatic conditions and there are no data about the most prevalent aeroallergen in Mashhad City, which is the second largest city in Iran, with a semiarid climate. The aim of this study was to evaluate the prevalence of positive skin test to various common aeroallergens among allergic rhinitis patients in the city of Mashhad. Materials and MethodsSkin prick tests were performed with 27 common regional aeroallergens including grass, weed, tree, mite and mould in 311 patients with allergic rhinitis. ResultsThe overall rate of sensitisation to any allergen was 81 %. 76 % of patients were poly-sensitised and weed and grass were the most prevalent allergens (77 % and 62 % respectively). Salsola Kali and mould were the most and the least prevalent individual allergens (72.5 % and 6.5 % respectively). Mean total IgE in patients with positive skin prick test was signifi cantly higher than in patients without any positive skin prick test (308 vs 128IU/mL, P=0.016). 97 % of atopic patients were sensitised to Salsola kali and or Fraxinus americana. ConclusionsOur work showed the importance of weeds, especially the Amaranthaceae and Chenopodiaceae families. Diagnosis of pollen allergy can be simplifi ed by using a combination of a few common aeroallergens.

Prevalence of positive skin prick test results in children with Down syndrome: a case-control study

Because many of the same otologic and nasal problems experienced by children with Down syndrome are also frequent in children with atopic disease, many children with Down syndrome are referred to an allergist for evaluation. To determine the prevalence of positive skin prick test (SPT) reactions to common aeroallergens in children with Down syndrome. Using a case-control design, we reviewed the medical records of children with Down syndrome who had undergone SPT. Each case was matched by sex and age with a control who had been evaluated by SPT at an initial visit. Thirty-nine cases and controls were identified. Eighteen percent of cases were found to have at least 1 positive SPT result compared with 54% of controls. This closely approximates the percentage of the general population with at least 1 positive SPT result (54.3%) as reported in the Third National Health and Nutrition Examination Survey. Given the low prevalence of positive SPT results in children with Down syndrome, it is unlikely that allergic rhinitis will be identified as the cause of many of the chronic rhinitis symptoms that many of these children are referred to an allergy practice to have evaluated. It may be helpful to the parents and to the patients themselves to avoid involving another specialist and appointment because they frequently are involved with many specialists for medical care. A larger study would be helpful in confirming the prevalence of positive SPT results in children with Down syndrome.

Cow's milk allergic children can present sensitisation to probiotics

To evaluate sensitivity to different probiotics in children with cow's milk allergy. Eighty-five patients (age range: 4 months -12 years) presenting atopic dermatitis (AD) were enrolled. Skin prick test (SPT) responses to three different probiotics preparations (Fiorilac, Dicoflor and Reuterin) were evaluated in addition to relevant food allergens. Thirty-nine patients out of 85 (45.8%) had a positive skin response to prick test for cow's milk (3 with reaction <3 mm). Of the thirty-six patients with a cow's milk weal reaction >3 mm, twenty-eight (77.8%) had a skin response to Fiorilac, four patients (11%) to Dicoflor and four (11%) to Reuterin. The proportion of SPT reaction to all the investigated probiotics preparations was significantly lower than cow's milk (r = 9.406; p = 0.002). A significantly higher sensitization was observed for Fiorilac versus Dicoflor (r = 30.916; p < 0.001) and versus Reuterin (r = 34.133; p < 0.001). Probiotic use in patients with cow's milk allergy has to be limited to products that do not contain milk. This should be clearly reported in the label. In selected patients, it is advisable to perform a screening SPT with the product to evaluate its potential contamination with milk.

Relationship between atopic asthma and the population prevalence rates for asthma or atopy in children: Atopic and nonatopic asthma in epidemiology

Innumerable articles have tried to solve the "continuing enigma of atopic and nonatopic asthma" but notwithstanding the strenuous efforts to substantiate the few well-known clinico-epidemiologic differences between these two forms of asthma most studies have hitherto generated inconclusive statements. In a recent study based on the review of epidemiologic studies conducted worldwide in unselected populations of children, we documented that the prevalence of atopic asthma (AA) was high in the populations with a high prevalence of atopy. We systematically reviewed 36 articles that studied 48 populations of unselected children and reported prevalence rates for asthma and atopy in the total sample and in the subpopulations. No significant difference was found in the prevalence of asthma cases in the quartiles of childhood populations subdivided for the prevalence of atopy. In addition, atopy did not increase significantly in the subgroups of populations subdivided by asthma quartiles. In both subgroups, however, AA increased with increasing atopy or with increasing asthma (p < 0.001). Using a positive skin-prick test reaction to define cases of asthma as cases of AA is misleading because the prevalence of subjects so defined is heavily influenced by the environmentally generated changes in the prevalence of atopy or asthma. Asthma in a child should be labeled as a case of AA only if skin-prick tests yield a positive reaction and the clinical history documents asthma symptoms triggered by allergen exposure.

Intralymphatic allergen administration renders specific immunotherapy faster and safer: A randomized controlled trial

The only causative treatment for IgE-mediated allergies is allergen-specific immunotherapy. However, fewer than 5% of allergy patients receive immunotherapy because of its long duration and risk of allergic side effects. We aimed at enhancing s.c. immunotherapy by direct administration of allergen into s.c. lymph nodes. The objective was to evaluate safety and efficacy compared with conventional s.c. immunotherapy. In a monocentric open-label trial, 165 patients with grass pollen-induced rhinoconjunctivitis were randomized to receive either 54 s.c. injections with pollen extract over 3 years [cumulative allergen dose 4,031,540 standardized quality units (SQ-U)] or 3 intralymphatic injections over 2 months (cumulative allergen dose 3,000 SQ-U). Patients were evaluated after 4 months, 1 year, and 3 years by nasal provocation, skin prick testing, IgE measurements, and symptom scores. Three low-dose intralymphatic allergen administrations increased tolerance to nasal provocation with pollen already within 4 months (P < 0.001). Tolerance was long lasting and equivalent to that achievable after standard s.c. immunotherapy (P = 0.291 after 3 years). Intralymphatic immunotherapy ameliorated hay fever symptoms (P < 0.001), reduced skin prick test reactivity (P < 0.001), decreased specific serum IgE (P < 0.001), caused fewer adverse events than s.c. immunotherapy (P = 0.001), enhanced compliance (P < 0.001), and was less painful than venous puncture (P = 0.018). In conclusion, intralymphatic allergen administration enhanced safety and efficacy of immunotherapy and reduced treatment time from 3 years to 8 weeks.