Skin Prick Test Reactivity Research Articles

Vergleichsuntersuchung der spezifischen IgE-Messung (Allergenteststreifen Allergodip Mites and More®) mit dem Hautpricktest und der nasalen Provokation bei Hausstaub- und Vorratsmilbenallergikern

There have only been very limited published data dealing with correlations between skin prick test (SPT), in vitro diagnosis (IVD) (Allergen Dipstick) and nasal provocation (NP). We compared SPT with the results of allergen dipstick Allergodip Mites and More® and NP. The following mites were compared: house dust mites (HM): D. pteronyssinus (D. pter.), D. farinae (D. far.) and storage mites (SM): Acarus siro, Lepidoglyphus destructor, Tyrophagus putrescentiae. 108 patients who visited the ENT clinic complaining about chronic rhinitis were investigated. The SPT and IVD results were compared for both HM and SM and comparisons ofNP with SPT and IVD were made only for HM. SPT was classified in reaction 0 (negative), + (very weak positive), ++ (weak positive), +++ (= histamine positive control)/and ++++ (strong/very strong positive). IVD was classified in classes 0, 1, 2, 3, for comparison with NP. SPT: for the comparison of SPT with IVD the following correspondence was obtained: SPT 0/IVD class 0, D. pteronyssinus: 93.3%, D. farinae: 91.3% SM: Acarus siro: 95.2%, Lepidoglyphus destructor and Tyrophagus putrescentiae: 100%. SPT +++/++++/IVD > 1: HM D. pter.: 89.5% and D. far.: 94.2%. For the evaluation of SM, there were not enough patients. NP: correspondence SPT with positive NP, SPT ++++: 58.3% (D. pter.)/48.0% (D. far.), +++; 37.5%/40% ++: 4.2%/12.0% +: 0%/0%. 0:0%/0%. SPT with negative NP, SPT: ++++: 15.4%/13.0%, +++: 23.1%/ 17.4%, ++: 34.6%/30.4%, +: 11.5%/17.4%, 0: 15.4%/21.7%. NP positive, Allergodip class 4: 29.2% (D. pter.)/ 36.0% (D. far.), 3: 45.8%/36.0%, 2: 25.0%/20.0%, 1: 0%/4.0%, 0: 0%/4.0%. NP negative, Allergodip class 4: 0%/0%, 3: 11.5%/8.7%, 2: 7.7%/8.7%, 1: 23.1%/17.4%, 0: 57.7%/65.2%. Conclusion: The stronger the SPT reaction and the higher the classes measured with allergen dipstick the more a positive NP reaction was observed. For a positive NP there, seems to be a cut-off value for SPT of +++/++++ and for IVD of class > 2. The stronger the skin reaction (except SPT 0/IVD 0) the higher is the correspondence with the classes. There is no correlation between the degree of the skin reaction and the level of the classes. Patients with a strong skin reaction (+++/++++) do not necessarily show class 4, they may be lower. The only differentiation can be done in class 0 and ≥ 1. Futhermore, our investigation showed, that D. pter.-allergic patients are also sensitized to D. far. due to cross reactivity between these 2 mites. Some patients were also sensitized to storage mites.

Napins, 2S albumins, are major allergens in oilseed rape and turnip rape

Children with IgE-mediated allergy to foods frequently react to seeds of oilseed rape (Brassica napus ssp. oleifera) and turnip rape (Brassica rapa ssp. oleifera) in skin prick tests (SPTs). Sensitization pathways are not known. We identified possible major allergens in oilseed rape and turnip rape using sera from 72 atopic children (mean age, 3.3 years) with positive SPT responses to oilseed rape and turnip rape. Allergens from oilseed rape and turnip rape seed extracts were purified by using gel filtration and cation exchange chromatography and characterized by means of reversed-phase chromatography, N-terminal amino acid sequencing, and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. IgE binding of sera from 72 children with positive SPT reactions to oilseed rape and turnip rape and 72 age- and sex-matched atopic control subjects with negative SPT responses were analyzed by means of IgE ELISA and immunoblotting. In vivo reactivity of the purified allergens was tested with SPTs in 6 children. In IgE immunoblotting and IgE ELISA major reactivity was to a group of homologous, approximately 9.5- to 14.5-kd proteins. These allergens were identified as 2S albumins, also known as napins, by means of N-terminal amino acid sequencing. In ELISA approximately 80% of the patients had IgE to purified napins from both plants. In SPTs purified napins caused positive reactions in all 6 children tested. This study shows that 2S albumins in oilseed rape and turnip rape are new potential food allergens. Further studies are needed to clarify the routes of exposure and mechanisms of sensitization.

Evaluation of patients with symptomatic dermographism

Dermographism or 'simple' dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal-and-flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life. We aimed to reveal triggering factors and/or associated clinical conditions in patients with SD. Forty patients (28 women and 12 men) with SD whose ages varied between 7 and 65 (30.3 +/- 10.7) participated in the study. Patients having chronic idiopathic urticaria, other types of physical urticaria and cutaneous/systemic mastocytosis were excluded. The diagnosis of SD was confirmed by stroking the skin of the back with a tongue blade. This procedure elicited within minutes a linear weal with a flare and severe itching. In light of the history, physical examination, skin prick test (SPT) with aeroallergens and laboratory results, a possible relationship of certain triggering factors and/or associated diseases (psychic factors, atopy, thyroid diseases, diabetes, menopause, infectious, systemic or malignant diseases, history of scabies, and history of drug reaction) to SD were investigated. The duration of SD varied between 10 days and 10 years (mean: 20.8 months). Psychic factors were found to play the initial triggering role in 12 patients (30%). Five patients (12.50%) were atopic, and they had SPT reactivity to house dust mites. Three female patients (7.50%) defined that their complaints began following drug-induced urticarial rash. Two patients (5%) had hyperthyroidism, and one of the patients with SD of 1-month duration had type-II diabetes mellitus. A female patient defined that her complaints began during the onset of menopausal period. SD was observed with scabies in one patient; and after poststreptococcal glomerulonephritis in a 7-year-old girl. No autoimmune, malignant or other systemic diseases were found in patients with SD. Contrary to commonly held opinion, SD may be associated with some diseases and/or triggered by some conditions. In this study, a close temporal relationship between the appearance of SD and psychic factors, drug reactions and scabies was documented. The relation between SD and atopy, hyperthyroidism, diabetes mellitus, menopause and glomerulonephritis seemed unclear.

062 Traffic-related air pollution assessed using a dispersion model related to allergie and respiratory health in children

Introduction The impact of traffic-related air pollution (TAP) on respiratory and allergie health is still debated. This might hâve been the resuit of inaccurate classification of exposure. Our cross-sectional study was intended to assess the role of TAP modelled using a dispersion model in the prevalence of allergie and respiratory outeomes in children. Methods 6,683 children aged 9-ll years recruited between 1999 and 2000 from 108 schools randomly selected in 6 French cities underwent a clinical examination including skin prick test and exercise-induced bronchial reactivity (EIB). The prevalence of asthma, allergie rhinitis (AR) and eczema were assessed by a stan-dardised questionnaire completed by the parents. A validated 3-D dispersion model, which combines data on traffic conditions, topo-graphy, meteorology and background air pollution, was used to assign outdoor annual mean concentrations of benzene, VOC, SO2, PM10, NO2, NOx, and CO at the 108 schools attended by the children. For each air pollutant, a 2-categories-exposure variable was defined with respect to the median value of the modelled concentrations at school. Results Adjusted odds ratios (OR) for EIB indicated significant positive associations with ail modelled air pollutants (OR =1.7 (95% CI: 1.3-2.1) with SO2, 1.5 (1.2-1.8) with benzene, 1.3 (1.1-1.7) with PM10), except NO2. Asthma was significantly related to benzene (1.3 (1.0-1.6)), SO2 (1.3 (1.0-1.6)) and PM10 (1.3 (1.0-1.6)), AR to PM10 (1.2 (1.0-1.4), eczema to NO2 (1.2 (1.1 -1.4)) and sensitisation to pollen to benzene (1.2 (1.0-1.5)) and PM10 (1.4 (1.1-1.7)). Positive associations of asthma with VOC and CO, of AR with benzene and SO2, of eczema with PM10, and of sensitisation to pollen with VOC reached borderline statistical significance. Sensitivity analyses suggested stronger associations between sensitisation to pollen and TAP in girls than in boys. Positive associations were more pro-nounced among long-term resident children (current address for at least 8 years). Conclusion Accurate modelization of TAP shows an augmented prevalence of respiratory and allergie diseases in areas with high concentrations of air pollutants.

Intraoperative anaphylaxis to bacitracin during pacemaker change and laser lead extraction

Bacitracin is widely used in operating rooms to soak implants, irrigate compound fractures, and apply to surgical incisions. However, bacitracin is a known sensitizer and causes not only allergic contact dermatitis but also anaphylaxis. To describe a 72-year-old woman with anaphylaxis after irrigation and packing of an infected pacemaker pocket with a bacitracin solution. Skin prick testing to bacitracin and latex; serum tryptase, serum histamine, serum IgE to latex, and serial cardiac enzyme measurements; blood cultures, transthoracic echocardiograms, and venograms were performed to characterize the reaction. Six hours after the anaphylactic event, the patient had an elevated serum tryptase level of 49 ng/mL (reference range, 2-10 ng/mL), which normalized the next morning. She had immediate-type skin prick test reactions to full-strength bacitracin ointment (500 U/g) and bacitracin solution (150 U/mL). Serum IgE level to latex was undetectable, and results of skin testing to latex were negative. To our knowledge, this is the first case report of anaphylaxis to bacitracin during pacemaker surgery. This case illustrates that intraoperative anaphylaxis to bacitracin can be life-threatening.

Early Respiratory Infections, Asthma, and Allergy: 10-Year Follow-up of the Oslo Birth Cohort

It has been hypothesized that early infections protect against the development of atopic disease, but there have been few long-term follow-up studies. We estimated the associations between early respiratory infections and doctor-diagnosed asthma, allergic rhinitis, and skin-prick sensitization in children at 10 years of age in the Oslo Birth Cohort, established in 1992-1993. We also considered birth order and attendance at a child care center as proxy measures of increased exposure to infections early in life. A total of 2540 children were followed from birth to the age of 10 years. Experiences of respiratory infections were recorded in follow-up surveys at 6 and 12 months. At age 10, questions were asked about current symptoms of asthma and allergic rhinitis and about having ever received a doctor diagnosis for these diseases. A subsample (n = 1740) of the cohort was tested for skin-prick test reactivity. Current asthma was related to lower respiratory tract infection (adjusted odds ratio [OR]: 2.1; 95% confidence interval: 1.3-3.0) and croup (adjusted OR: 2.3; 95% confidence interval: 1.3-4.2) in the first year. ORs for allergic rhinitis and skin-prick sensitization were smaller but mainly positive. Birth order and child care attendance at age 1 year were not significantly associated with any of the studied outcomes. Early respiratory infections did not protect against the development of asthma, allergic rhinitis, or sensitization to common allergens during the first 10 years of life but increased the risk for asthma symptoms at age 10 in this population.

Serum Alpha- and Gamma-Tocopherol Levels in Atopic Mothers and Their Infants Are Correlated

Background: Vitamin E may have immunomodulatory properties beyond its antioxidant function. The objective here was to assess the α- and γ-tocopherol status and its correlation between atopic mothers and their infants. Methods: Mothers with atopic disease were recruited at the end of gestation and their infants were followed up. Serum samples from mothers and infants were collected at the infants’ age of 1 month. Atopic dermatitis was diagnosed during the 1st year of life and skin prick tests were performed at 1 year. Results: Infants’ serum γ- and α-tocopherol to fat ratios were significantly correlated with maternal serum ratios (r = 0.70, p < 0.0001 and r = 0.52, p = 0.004, respectively). In infants the serum α-tocopherol/fat was higher and the γ-tocopherol/fat ratio lower than in mothers. Serum tocopherol levels were not associated with skin prick test reactions or atopic dermatitis in the infants. Conclusions: Maternal tocopherol status determines that of the infant. Different tocopherol forms may have different serum levels and roles in the regulation of inflammatory diseases.

The usefulness of skin tests to prove drug hypersensitivity

Suspected drug hypersensitivity is common. Only a minority of cutaneous adverse drug reactions (CADRs) are allergic in origin and will reappear after the next exposure. Methods to confirm suspected CADRs are needed and skin testing could serve as one possibility. To analyse the usefulness of skin tests in revealing drug allergy. The relevance of skin test results was evaluated with drug provocation studies. During 1989-2001, 947 patients with a history of suspected CADR were examined with skin tests including patch tests (PTs) (826 patients), skin prick tests (SPTs) (935 patients) and photopatch tests (12 patients). The occurrence of positive and negative test reactions to different drugs was correlated with clinical history. Drug provocation was carried out in 246 patients. Antimicrobial drugs were suspected and tested most often. A positive PT reaction to one or more drug was seen in 89 of 826 (10.8%), most often to beta-lactams, clindamycin and trimethoprim. A positive SPT reaction was seen in 10 of 935 (1.1%) patients. Challenge was carried out in 17 patients with positive skin test results. Thirteen of 16 (81.2%) PT positives developed exanthema, three remained negative and one SPT-positive patient developed urticaria. Among skin test negatives, 207 of 229 (90.4%) challenges were negative and 22 of 229 (9.6%) were positive, 12 with exanthema, three with fixed drug eruptions and seven with urticaria. Skin testing, especially the PT, was a useful screening method to find a cause of CADR if the reaction was exanthema and if antimicrobial, cardiovascular or antiepileptic drugs were suspected. The SPT detected occasional positives with antimicrobials. In cases of fixed drug eruption, PTs performed at the earlier reaction site were useful. When skin tests are negative or dubious, oral challenge should be carried out to confirm the association.

Patch Testing with Egg Represents a Useful Integration to Diagnosis of Egg Allergy in Children with Atopic Dermatitis

Our aim was to investigate atopy patch and skin prick test reactions to egg in 85 children with atopic dermatitis, and to evaluate their relevance by performing repeated open challenges with egg. Thirty-one percent of our patients showed an eczematous response to the challenge. Positive reactions to atopy patch and skin prick tests were recorded in 37% and 19%, respectively. Atopy patch test sensitivity proved significantly higher than that of skin prick test (79.6% vs. 46.2%), whereas specificity was lower (81.4% vs. 93.2%). Our data suggest that combined skin prick and patch testing improves screening for egg allergy in affected children, identifying 92% of those who were challenge positive among our patients.

Isolated hevein-like domains, but not 31-kd endochitinases, are responsible for IgE-mediated in vitro and in vivo reactions in latex-fruit syndrome

Individuals with natural rubber latex allergy often have immediate reactions to plant-derived foods and fresh fruits, such as avocado and banana. IgE of these patients has been shown to bind endochitinases containing an N-terminal hevein-like domain (HLD). However, evidence on 31-kd endochitinase-induced reactions in vivo is lacking. We sought to assess the clinical significance of 31-kd endochitinases and isolated HLDs in latex-fruit syndrome. The 31-kd endochitinases and corresponding HLDs were purified or produced from avocado, banana, latex, and wheat germ. Skin prick test reactivities against purified proteins were examined in 15 patients with natural rubber latex allergy. The binding efficiency of IgE to purified proteins was studied by using an inhibition ELISA. Experimentally resolved or modeled structures of the proteins were compared to clarify the molecular basis of clinical reactions. Eleven (73%) patients had skin prick test reactions to isolated HLDs of avocado and banana, but only 1 (7%) patient reacted to their corresponding 31-kd endochitinases. HLDs from avocado and banana inhibited binding of IgE to prohevein (Hev b 6.01) in 59% and 38% of patients, respectively, whereas corresponding percentages for 31-kd endochitinases were 17% and 20%, respectively. Isolated HLDs of wheat germ agglutinin and 18-kd wheat germ agglutinin did not significantly inhibit IgE binding to hevein. The isolated HLD molecules alone, but not when linked to endochitinases, seem to be responsible for IgE-mediated clinical reactions in latex-fruit syndrome. Careful selection of relevant allergens in their proper molecular form is therefore crucial in forming a reliable diagnosis of latex-fruit syndrome.

Evaluation of the relationship between cockroach sensitivity and house-dust-mite sensitivity in Turkish asthmatic patients

Exposure to cockroach has been identified as an important source of indoor allergens in patients with asthma and allergic rhinitis. We evaluated the relationship between cockroach sensitivity and other allergens in patients with asthma. A total of 114 patients, defined asthma according to GINA, were enrolled in this study. A questionnaire including age, sex, duration of asthma, history of cockroach presence at home, and total IgE, blood eosinophil count, pulmonary function tests, standard skin prick test additional cockroach and shrimp allergen were performed. There were 84 (73.7%) female and 30 (26.3%) male patients with a mean age of 38.1+10.1 years. The average duration of asthma was 7.7+7.2 years. Sixty five (57%) patients were determined atopic and 49 (43%) nonatopic. Pollen allergen was the most common allergen in 59 (51.8%) patients with asthma, and second common allergen was mite allergen in 43 (37.7%) patients. Cockroach sensitivity were detected in 23 (20.2%) of 114 all asthmatics and 23 (35%) of atopic asthmatics. High rates of house-dust-mite allergy (73.9%) was determined in patients with cockroach sensitivity (P<0.05), while we found no relationship with other allergens. There was no difference for cockroach sensitivity between rural and urban population. Cockroach sensitivity was more common in mild bronchial asthmatics and a female predominance was observed. In addition, there was no association between shrimp and cockroach sensitivity. As a result, a high rate of cockroach sensitivity alone or with mite sensitivity was seen in patients with bronchial asthma in Turkish population. Because of cross-reactivity between mites and cockroach, cockroach sensitivity should be investigated in patients with house-dust-mite allergy. In addition, a high rate of cockroach sensitivity, in terms of IgE sensitization, may be important for the development of new sensitizations.

Lack of correlation between regional pollen counts and percutaneous reactivity to tree pollen extracts in patients with seasonal allergic rhinitis

Although seasonal patterns of tree pollination have been reported, it is unknown if aerobiologic data correlate with patterns of in vivo sensitization. To evaluate the relationship between regional tree pollen exposure and patterns of in vivo percutaneous reactivity to specific tree pollen extracts in a local patient population with seasonal allergic rhinitis. Patients with spring seasonal allergic rhinitis and percutaneous sensitivity to 1 or more regional tree pollens were studied. Tree pollen counts were collected at the same urban site from 1997 to 2002 and at a suburban site in 2002. Patients underwent skin prick testing with commercial extracts of 15 indigenous tree species. Serum specific IgE measurements were assayed in a subset of sensitized patients. Of 127 patients who reported symptoms consistent with seasonal allergic rhinitis during the spring pollen season, 93 qualified based on demonstration of at least 1 positive skin prick test result. Mean 5-year pollen counts (1997-2001) and 2002 urban counts were highly correlated (Spearman r = 0.95, P < .001), indicating that year-to-year pollen counts were consistent. No significant correlation was found between mean seasonal pollen counts (urban site, 1997-2001) and frequencies of skin prick test reactivity to specific tree pollen allergens (Spearman r = -0.03, P = .93). No significant relationship was found between 5-year mean tree pollen counts and positive serum specific IgE tests for specific tree pollens (Spearman r = -0.42, P = .30). Eight of 15 species elicited percutaneous reactions in more than 50% of patients (ie, satisfying definition of a major in vivo allergen). However, 6 of the 8 major tree allergens each represented 5% or less of 5-year mean total tree pollen counts. No correlation was found between overall frequencies of in vivo sensitization to tree pollen allergens in a local population and regional pollen exposure data.

Skin Prick Test Reactivity to Supplemental Enzymes in Cystic Fibrosis and Pancreatic Insufficiency

ABSTRACTBackground:Patients with cystic fibrosis and pancreatic insufficiency take supplemental pancreatic enzymes of porcine or plant origin on a daily basis.Objective:The frequency of immediate skin prick hypersensitivity reactions to such enzymes and the correlations to gastrointestinal symptoms and nutritional status were assessed in a single center prospective descriptive study.Methods:Skin prick tests using five different freshly prepared porcine pancreatic enzyme preparations, one enzyme preparation of fungal origin, porcine meat and cat epithelia were performed in patients with cystic fibrosis and pancreatic insufficiency and in healthy control subjects.Results:Positive skin tests in the 48 patients with cystic fibrosis were no more frequent than in 21 control subjects. No correlations with the frequency of gastrointestinal symptoms, nutritional status and lung function were found.Conclusion:Although immediate hypersensitivity reactions to pancreatic enzyme preparations in subjects with cystic fibrosis are not common, individuals with possible allergic reactions to supplemental enzymes should be identified by skin prick tests and in unclear cases by double‐blind placebo‐controlled provocation tests.

Skin Prick Test Reactivity to Supplemental Enzymes in Cystic Fibrosis and Pancreatic Insufficiency

Patients with cystic fibrosis and pancreatic insufficiency take supplemental pancreatic enzymes of porcine or plant origin on a daily basis. The frequency of immediate skin prick hypersensitivity reactions to such enzymes and the correlations to gastrointestinal symptoms and nutritional status were assessed in a single center prospective descriptive study. Skin prick tests using five different freshly prepared porcine pancreatic enzyme preparations, one enzyme preparation of fungal origin, porcine meat and cat epithelia were performed in patients with cystic fibrosis and pancreatic insufficiency and in healthy control subjects. Positive skin tests in the 48 patients with cystic fibrosis were no more frequent than in 21 control subjects. No correlations with the frequency of gastrointestinal symptoms, nutritional status and lung function were found. Although immediate hypersensitivity reactions to pancreatic enzyme preparations in subjects with cystic fibrosis are not common, individuals with possible allergic reactions to supplemental enzymes should be identified by skin prick tests and in unclear cases by double-blind placebo-controlled provocation tests.

Allergen specific induction of proinflammatory cytokines and chemokines in peripheral blood mononuclear cells of latex allergic patients

and Chemokines in Peripheral Blood Mononuclear Cells of Latex Allergic Patients M. Lehto1, K. Palosuo2, A. Kotovuori3, E. Varjonen2, S. Lehtimaki1, M. Majuri1, T. Reunala4, N. Kalkkinen3, T. Palosuo5, H. Alenius1; 1Finnish Institute of Occupational Health, Helsinki, FINLAND, 2Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, FINLAND, 3Institute of Biotechnology, University of Helsinki, Helsinki, FINLAND, 4Tampere University and University Hospital, Tampere, FINLAND, 5National Public Health Institute, Helsinki, FINLAND. RATIONALE: IgE responses and skin reactivity against the two major natural rubber latex (NRL) allergens, Hev b6.01 and Hev b5, have been extensively studied previously. In the present study we examined cellular responses to Hev b6.01 and Hev b5 in NRL-allergic patients and controls. METHODS: Hev b6.01 and Hev b5 were purified under non-denaturating conditions using chromatographic methods. Allergen specific IgE antibodies were measured by ELISA. Peripheral blood mononuclear cells (PBMC) were isolated and their proliferation was examined. Allergen specific cytokine and chemokine mRNA production of PBMC were measured by real-time PCR. RESULTS: More than 70% of the patients had positive skin prick test reactions and IgE antibodies against Hev b6.01, but less than 40% of the patients responded to Hev b5. Proliferation of PBMC against Hev b6.01, but not against Hev b5, was significantly enhanced in NRL-allergic patients compared to controls. There were no significant differences in the levels of Th1 or Th2 cytokines between patients and controls after allergen stimulation. However, stimulation with Hev b6.01 and Hev b5 elicited significantly stronger induction of TNF, IL-12p40 and MIP-1 mRNA in NRL-allergic patients compared to controls. CONCLUSION: Allergen specific induction of proinflammatory cytokines and chemokines in circulating mononuclear cells may play an important role in the pathogenesis of latex allergy. Funding: Finnish Institute of Occupational Health

Relationship between atopic status and nasal interleukin 10 and 11 levels in infants with respiratory syncytial virus bronchiolitis

Interleukin 10 (IL-10) and IL-11 are known to have anti-inflammatory activities, and they have been implicated in the pathogenesis of respiratory syncytial virus (RSV) infection. To determine IL-10, IL-11, and myeloperoxidase levels in nasal secretions of infants with acute RSV bronchiolitis and to investigate whether there are any differences in these levels in patients with vs without atopy. We measured IL-10, IL-11, and myeloperoxidase levels in nasal secretions of 44 infants (20 were atopic) with acute RSV bronchiolitis. The nasal secretion samples were obtained from patients at hospital admission and were stored immediately at -70 degrees C until analysis. Atopy was defined as having at least 1 positive skin prick test reaction to common allergens, a history of atopic dermatitis, or a high serum IgE level compared with age-matched controls. Levels of IL-10, IL-11, and myeloperoxidase increased significantly in samples from infants with acute RSV bronchiolitis. Levels of IL-10 and IL-11 were significantly lower in patients with vs without atopy (P < .05). Myeloperoxidase levels showed no significant difference in patients with vs without atopy (P = .18). Patients with severe symptoms tended to have lower IL-10 levels (P = .09), but no relationship was shown between symptom severity and IL-11 levels. Nasal myeloperoxidase levels were significantly higher in patients with severe symptoms (P < .05). Production of IL-10 and IL-11 was significantly lower in patients with vs without atopy during acute RSV bronchiolitis. The airway inflammation induced by RSV infection may be different in patients with vs without atopy, and this is associated with lower induction of these immunoregulatory cytokines in children with atopy.

Mucosal symptoms elicited by fragrance products in a population‐based sample in relation to atopy and bronchial hyper‐reactivity

Exposure to perfume and fragrance products may, in some individuals, cause symptoms from the eyes and airways. The localization, character and risk factors of such symptoms in the general population are unknown. To investigate both the localization and character of symptoms from the eyes and airways elicited by fragrance products, and the associations between such symptoms and skin prick test reactivity (atopy), methacholine bronchial hyper-reactivity (BHR), allergic rhinitis and asthma. A questionnaire on mucosal symptoms elicited by fragrance products was posted to 1189 persons who had participated in a Danish population-based study of allergic diseases in 1997/1998. The study included measurement of BHR, atopy, forced expiratory volume in 1 s (FEV1), and serum eosinophilic cationic protein (serum ECP). The response rate was 79.6%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. BHR (adjusted odds ratio 2.3, 95% confidence interval 1.5-3.5) was independently associated with symptoms from the eyes and airways elicited by fragrance products. There were no significant associations between these symptoms and atopy, FEV1 or serum ECP. Mucosal symptoms from the eyes and airways were common in this population. BHR was a significant and independent predictor of these symptoms. The lack of association with atopy suggested that IgE-mediated allergic mechanisms do not play a major role in the development of these symptoms.

Recognition of Asthma in Adolescents and Young Adults: Which Objective Measure is Best?

Background. Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability in such studies. Data from a survey of a population sample of adolescents and young adults (n = 609; 288 males), aged 13–23 years, were analyzed to investigate whether AHR, PEF variability, and BR can be used interchangeably as markers of asthma in an epidemiological setting. Methods. Case history, including self-reported and doctor-diagnosed asthma, smoking habits, and use of asthma medication, was obtained by interview and questionnaire. Lung function, airway responsiveness (positive test: PC20 FEV1< 16 mg/mL histamine), PEF variability (positive test: amplitude percentage mean > 20%), BR (positive test: ΔFEV1 [(FEV1max − FEV1min)/FEV1max) 100]> 10%), blood eosinophil count, and skin prick test reactivity were measured by using standard techniques. Results. The prevalence of a positive test was AHR 16.4%, PEFpos 13.3%, and BRpos 7.2%, respectively; 73.5% of the sample had three negative tests. Among the 74 participants with current self-reported asthma (12.2%), 34 subjects (46%) had more than one positive test. Using AHR as the only objective marker of asthma identified 93% of the participants with current asthma, whereas PEF and BR identified 45% and 10%, respectively. Confining the analysis to participants with only one positive test revealed that 61% of the subjects with isolated AHR had current asthma, whereas none of the subjects with isolated BRpos had asthma, and only one participant with isolated PEFpos had current asthma. Degree of histamine responsiveness was closer associated with other asthma-related factors, including self-reported asthma, use of asthma medication, and level of lung function, than PEF variability and bronchodilator responsiveness. Conclusions. Airway responsiveness to histamine, diurnal peak-flow variability, and bronchodilator reversibility cannot be used interchangeably as objective markers of asthma in epidemiologic studies. On the basis of the present findings, airway hyperresponsiveness to a nonspecific bronchoconstrictor is recommended as the objective marker of asthma-related airway lability.

Skin test hypersensitivity for childhood asthma in Istanbul during a period of 16 years

Background For diagnosis of allergic disorders, besides history and physical examination, many in vivo and in vitro laboratory tests are used. Skin prick test (SPT) is an easily performed and valuable test in children. Our aim was to evaluate the SPT results of asthmatic children according to age and gender, in Istanbul and its neighborhood, followed for a period of 16 years. Material and methods Consecutive 5080 asthmatic children, aged 1 to 18 years, admitted to Pediatric Allergy Policlinics of Istanbul University Cerrahpasa Medicine Faculty from 1987 to 2003, were screened retrospectively for 10 frequently exposed allergens. Results 3086 cases (61 %) had SPT reactivity for one and/or for multiple allergens; the SPT reactivity percentages of the exposed allergens was 50% (2554 cases) for house dust mites DP, 49% (2462 cases) for house dust mites DF, 15 % (784 cases) for cat dander, 10 % (525 cases) for dog dander, 4% (228 cases) for lamb wool, 10 % (504 cases) for wheat, 3% (162 cases) for egg white, 6% (345 cases) for hazelnut pollen, 6% (318 cases) for Candida Albicans, 6% (326 cases) for Aspergillus Fumigatus. Conclusion While house dust mites were determined as the predominant allergen for each age groups in this study, allergy against cat dander was the third important allergen in sequence, as cat is a domestic pet which is frequently kept at home in Turkey.

Food hypersensitivity in patients with seasonal rhinitis in Ankara

Background Food hypersensitivity (FH) affects 1-2% of the adult population and is more common in atopic individuals. The aim of this study was to determine the frequency of FH and risk factors for its development in patients with seasonal rhinitis (SR) in our allergy clinic. Methods We performed a retrospective study based on the medical records of 774 patients out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003. Results The mean age of the patients was 29.1 ± 9.29 and 62.7 % were females. The most common major complaints were due to nasal symptoms in 82.3 %. The mean duration of SR was 6.8 ± 6.8 years. Patients were symptomatic for a mean of 3.5 ± 1.7 months per year. Skin prick tests (SPT) with common aeroallergens were positive in 685 patients (90.3 %), and the most common sensitivity was against timothy (85.1 %). The most common accompanying allergic disease was FH in 14%. FH according to history and the results of SPT performed with food allergens were discordant. The most common clinical manifestations of FH were oral allergy (49.1 %) and cutaneous symptoms (38.9 %). Risk factors for the development of FH in patients with SR were dermatological symptoms, rhinitis duration > 5 years, symptom duration > 3 months per year, SPT reactivity to Artemisia vulgaris, tree pollen allergens ( Corylus avellena, Betula verrucosa), and bee allergy. Conclusion FH was the most common (14 %) accompanying allergic disease in patients with SR. SPT with food allergens have limited diagnostic value for food allergy and/or intolerance. Risk factors for developing FH in patients with SR in Turkey were dermatological symptoms, duration of rhinitis > 5 years, duration of rhinitis symptoms > 3 months per year, and SPT reactivity to Corylus avellena.