Results Of Intradermal Testing Research Articles

Accelerated cell‐mediated broncho‐obstructive reaction to inhaled stepronin: a case report

We describe the case of a 20-year-old man who developed an obstructive bronchial reaction accompanied by a maculopapular facial rash 8 h after an aerosol treatment with the mucolytic drug stepronin. The results of intradermal and patch testing with stepronin, together with those of bronchial challenge and histologic findings in patch-tested skin, indicate that the patient's reaction involved an accelerated cell-mediated mechanism of hypersensitivity. Bronchial challenges with methacholine demonstrated a transient increase in nonspecific bronchial hyperreactivity.

Reactivity to intradermal injections of extracts of house dust and housedust mite in healthy dogs and dogs suspected of being atopic

Summary Fifty dogs underwent intradermal allergy testing with housedust mite and house dust extracts, using concentrations recommended by the manufacturer. Twelve dogs (group I) were healthy dogs obtained from a pound; 12 dogs (group II) were healthy, privately owned dogs; 15 dogs (group III) were suspected of being atopic and had had multiple positive reactions to intradermal injections of allergens of specific trees, weeds, grasses, or molds; and 11 dogs (group IV) were suspected of being atopic, but only had had positive reactions to intradermal injections of housedust mite, house dust, and flea antigen extracts. Use of the concentrations of housedust mite and house dust extracts currently recommended for intradermal allergy testing resulted in false-positive reactions in 14 of 24 (58%) and 12 of 24 (50%) healthy dogs tested, respectively. Differences in number of dogs with positive reactions or grade of reaction to housedust mite or house dust allergens were not detected between groups of healthy dogs (groups I vs II), between groups of suspected atopic dogs (groups III vs IV), or between healthy dogs and dogs suspected of being atopic (groups I and II vs III and IV). Therefore, clinical importance of positive results of intradermal allergy testing of house dust or housedust mite allergens was equivocal for dogs suspected of being atopic. Threshold concentrations for intradermal allergy testing were determined in 24 healthy dogs (group I and II) by intradermal administration of 5 dilutions each of housedust mite extract and house dust extract. Positive test results to various concentrations of housedust mite extract were observed in 22 dogs at 1:1,000 wiv, 14 dogs at 1:5,000 wiv, 5 dogs at 1:10,000 ww, 4 dogs at 1:25,000 wv, and 1 dog at 1:50,000 ww. Positive test results to various concentrations of house dust extract were observed in 21 dogs at 500 protein nitrogen units (pnu)/ml, 12 dogs at 100 pnu/ml, and 3 dogs at 50 pnu/ml, but none of the dogs had positive results at 20 and 10 pnu/ml, respectively. Threshold concentrations for housedust mite (1:50,000 w/v) and house dust (20 pnu/ml) extracts were subsequently used for intradermal allergy testing of 9 dogs (group V) that were considered to be atopic and that had had multiple positive test results after intradermal injection of specific allergens. Positive reactions to intradermal injections of threshold concentrations of housedust mite and house dust extracts were observed in 6 of 9 and 7 of 9 atopic dogs, respectively. Analysis of the results was suggestive that house dust and housedust mite extracts can be properly diluted to threshold concentrations for intradermal allergy testing without adversely affecting their diagnostic value. Lower concentrations of housedust mite and house dust extracts than are currently recommended should be used for intradermal allergy testing to avoid false-positive results.

Influence of the histamine control on skin reactivity in skin testing.

We investigated the effect of the histamine control (1 mg/ml) on the results of skin prick and intradermal testing with bee and wasp venom. Skin tests were done on the patients' forearms: on the right arm the histamine control and the bee venom dilutions, on the left arm the wasp venom dilutions only, at distances of 4-5 cm. In intradermal testing 11 (9%) of 122 patients showed a positive wheal and flare reaction to the bee venom solution positioned next to the histamine control. The subsequent solutions in higher concentrations did not produce any skin reactions. The results of intradermal testing with bee venom did not occur in intradermal testing with wasp venom or in skin prick testing with both allergens. Our results show clearly that in skin prick tests a distance of 4-5 cm is sufficient to avoid false positive skin reactions. However, using the same distance in intradermal testing showed that histamine affects the skin reactions produced by adjacent allergen solutions. Therefore false positive results may occur.

Structural correlations with cross-reactivity of beta-lactam antibiotics in delayed type hypersensitivity. Cross-allergenicity in hypersensitivity to cephems with a tetrazolyl group in the C-3 side chain.

Cross-reactivity associated with delayed type hypersensitivity (DTH) arising from cephem antibiotics with a tetrazolyl group in the C-3 side chain was investigated by clinical testing and animal experiments. Clinical cross-reaction testing was performed with the leucocyte migration inhibition test (LMIT) with respect to sixteen patients with hypersensitivity induced by cephems with a tetrazolyl group in the C-3 side chain. The proportion of positive LMIT cross-reactions to cephems with a tetrazolyl group in the C-3 side chain was 78% (25/32), to cephems without a tetrazolyl group, 5% (1/22), and to penams, 0% (0/12). The proportion of positives in tests performed with methyl-tetrazolethiol (MTT) and hydroxyethyl-tetrazolethiol (HTT), which essentially represent the structures of the C-3 side-chains in the allergenic drugs, was 29% (4/14), while the corresponding proportion for 7-aminocephalosporanic acid (7ACA), which represents the skeleton structure of the cephem antibiotics, was 33% (1/3). The animal experiments were performed with guinea pigs, with latamoxef, cefoperazone and MTT as the sensitizing agents and testing for cross-reactivity by means of delayed type intradermal reactions as well as the LMIT. The results of intradermal testing and the LMIT agreed almost completely, thus providing strong support for the clinical results. Latamoxef and cefoperazone displayed the same cross-reactivity, manifesting cross-reactions with MTT, HTT and 7ACA as well as with cephems having a tetrazolyl group in the C-3 side chain. Moreover, DTH induced by MTT displayed cross-reactivity with cephems possessing tetrazolyl groups in the C-3 side chain. The above results indicate that free MTT radicals, as well as the skeleton ring structure represented by 7ACA, are strongly involved in DTH arising from cephem antibiotics with a tetrazolyl group in the C-3 side chain.

Anaphylaxis After Intravenous Methylprednisolone Administration

ALLERGIC type 1 (anaphylactic) reactions to corticosteroid compounds are rare, but a few well-documented case reports of allergic reactions to prednisolone¹and methylprednisolone sodium succinate¹have been reported. We describe a patient who experienced an anaphylactic reaction to systemically administered methylprednisolone. Allergic sensitivity to this compound as well as to hydrocortisone hemisuccinate was documented by results of intradermal and skin prick testing. Furthermore, our patient demonstrated his allergic reaction only to the succinate esters of the parent corticosteroids. This is the first reported case, to our knowledge, of an anaphylactic reaction to only the succinate acid ester of methylprednisolone without reaction to methylprednisolone acetate. <h3>Report of a Case</h3> A 40-year-old man was admitted to the emergency room for an acute asthmatic attack. The patient had a history of childhood asthma that was seasonal in nature, but he had been asymptomatic for the past 30 years. Two days before