Skin Test Results Research Articles

Autologous Whole Blood Therapy in Chronic Spontaneous Urticaria: A Comparative Study Between Autologous Serum Skin Test Positive and Negative Patients

Introduction: Chronic Spontaneous Urticaria (CSU) is frequently encountered in our day to day practice. Patients are often reluctant to take medicines for prolonged durations and seek interventions for rapid and prolonged remission. Autologous Whole Blood Therapy (AWBT) has been used with varied results in CSU and Autologous Serum Skin Test (ASST) reactivity has shown to influence the therapeutic response in some studies. Aim: To compare the efficacy of AWBT in ASST positive versus negative CSU. Materials and Methods: The present prospective, interventional, parallel group study was conducted in the Department of Dermatology, Command Hospital Air Force (tertiary care centre), Bangalore, India, from January 2014 to December 2015. Eight weekly injections of AWB (5 mL) were administered to 30 ASST positive and 30 age and sex matched ASST negative patients of CSU and followed-up for four weeks. Modified Urticaria Severity Score (MUSS) was recorded at baseline, 4th, 8th and 12th weeks to assess objective response to AWBT. Subjective response was documented as poor, satisfactory, good and excellent based on patient’s feedback at the end of 12 weeks. Independent two-sample t-test, Chi-square (χ2 ) test and cross tabulations were used to analyse the data through Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of <0.05 was considered statistically significant. Results: A total of 102 consenting patients were subjected to ASST, out of which 38 patients were ASST positive. After excluding those who were lost to follow-up, data from 30 ASST positive patients and corresponding age and sex matched ASST negative controls were analysed. Baseline MUSS of ASST positive group was significantly higher, indicating more severe nature of CSU. With AWBT, improvement in MUSS of ASST positive group (68.49±10.32%) was significantly higher than the ASST negative group (p-value <0.001) and ASST positive group required significantly lesser doses of rescue antihistamines (p-value <0.001) at the end of 12 weeks. Subjective response to AWBT was either good or excellent in both groups. Conclusion: Although AWBT resulted in significant reduction of MUSS in ASST positive patients, it benefited patients in both groups irrespective of their ASST reactivity status. AWBT can be used as an effective adjuvant in the treatment of CSU.

TREC И KREC – ПЕРСПЕКТИВНЫЕ МАРКЕРЫ АКТИВНОСТИ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ

Scientists around the Globe are making deliberate attempts to develop the new methods for predicting and diagnosing tuberculosis, but these measures are not enough to end its epidemic. The purpose of the study was to evaluate the excisional rings of the T-cell receptor (TREC) and K-deletion element of B-cells (KREC) in infants and preschool children at high risk of tuberculosis as a promising prognostic marker for tuberculosis infection activity. A cross-sectional study was conducted in Jan. - Sept. 2022. The observation group consisted of 87 children aged 1 to 7 [6 (5‒7)] y/o, of which 13 (14.9%) aged 1 to 3 y/o and 74 aged 4 to 7 y/o; 53 (60.9%) boys/34 (39.1%) girls. The three groups were formed: G1 (n=27) with an established diagnosis of tuberculosis (TB), G2 (n=34) with TB infection diagnosis made based on the results of tuberculin diagnosis and without signs of a local specific process, and [control] G3 (n=26) without signs of TB infection according to the results of specific skin tests and without signs of TB, i.e., conditionally healthy. All children, in addition to methods to confirm or exclude TB and methods of specific immunodiagnostics, have undergone a molecular genetic study: DNA extraction from a dry blood spot and quantitative determination of TREC and KREC by real-time PCR in values of TREC and KREC copies per 105 cells. In order to build the reference values of TREC and KREC quantitative indicators in dry blood spots, the results obtained in G3 were analyzed as well. Results: the reference values of TREC and KREC were established for children of early and preschool ages when extracting DNA from a dry blood spot. When assessing tuberculosis infection in children of early and preschool ages, statistically significant criteria were determined, such as: anti-tuberculosis therapy (F=42.001; p<0.001), positive or negative reaction to the recombinant tuberculosis allergen during an intradermal test (F=39.394; p<0.001), high blood TREC level (F=12.707; p<0.001), tuberculin reaction (F=10.625; p<0.001), and KREC level (F=3.182; p=0.039). Conclusion: high level of TREC can be considered as a marker for the activity or a personalized predictor for the risk of progression of TB infection in children of early and preschool ages with high risk of TB.

Latent tuberculosis in adult hematopoietic stem cell transplantation recipients: Clinical experience from a previously endemic population.

Hematopoietic stem cell transplantation (HSCT) recipients may be at an elevated risk of developing active tuberculosis infection due to suppression in the cellular immune system. Herein, we aimed to evaluate the prevalence of latent tuberculosis and active tuberculosis in patients with allogeneic and autologous HSCT. In this cohort, data were obtained retrospectively from patients' records. The patients who were followed up in the bone marrow transplantation unit of the University of Health Sciences Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital between January 2016 and December 2019 were screened for the study. And the HSCT recipients who had tuberculin skin test and/or QuantiFERON-TB gold (QFT-GIT) test results were included in the study. A total of 361 patients were included in the study, 227 patients had autologous HSCT, and 134 patients had allogeneic HSCT. QFT-GIT was performed in 10 patients with allogeneic HSCT, and it was found positive in only 1 patient. Tuberculin skin test ≥5 mm was accepted as positive and was accepted to have latent tuberculosis, and it was positive in 18.2% (41) of the patients with autologous HSCT and was positive in 21.6% (29) of the patients with allogeneic HSCT. There was no significant difference between the 2 groups (P = .429). Isoniazid (INH) prophylaxis was started in 16.7% of patients with autologous HSCT and 22.4% of patients with allogeneic HSCT. During follow-up, active tuberculosis did not develop in any patients in both groups. There was no statistically significant difference found between allogeneic and autologous HSCT recipients regarding the prevalence of latent tuberculosis. Active tuberculosis infection did not develop in any of the patients who started INH prophylaxis. INH prophylaxis seems to be very efficient in preventing the reactivation of latent tuberculosis in patients going through allogeneic HSCT and/or autologous HSCT.

Subsequent AS01-adjuvanted vaccinations induce similar transcriptional responses in populations with different disease statuses.

Transcriptional responses to adjuvanted vaccines can vary substantially among populations. Interindividual diversity in levels of pathogen exposure, and thus of cell-mediated immunological memory at baseline, may be an important determinant of population differences in vaccine responses. Adjuvant System AS01 is used in licensed or candidate vaccines for several diseases and populations, yet the impact of pre-existing immunity on its adjuvanticity remains to be elucidated. In this exploratory post-hoc analysis of clinical trial samples (clinicalTrials.gov: NCT01424501), we compared gene expression patterns elicited by two immunizations with the candidate tuberculosis (TB) vaccine M72/AS01, between three groups of individuals with different levels of memory responses to TB antigens before vaccination. Analyzed were one group of TB-disease-treated individuals, and two groups of TB-disease-naïve individuals who were (based on purified protein derivative [PPD] skin-test results) stratified into PPD-positive and PPD-negative groups. Although TB-disease-treated individuals displayed slightly stronger transcriptional responses after each vaccine dose, functional gene signatures were overall not distinctly different between groups. Considering the similarities with the signatures found previously for other AS01-adjuvanted vaccines, many features of the response appeared to be adjuvant-driven. Across groups, cell proliferation-related signals at 7 days post-dose 1 were associated with increased anti-M72 antibody response magnitudes. These early signals were stronger in the TB-disease-treated group as compared to both TB-disease-naïve groups. Interindividual homogeneity in gene expression levels was also higher for TB-disease-treated individuals post-dose 1, but increased in all groups post-dose 2 to attain similar levels between the three groups. Altogether, strong cell-mediated memory responses at baseline accelerated and amplified transcriptional responses to a single dose of this AS01-adjuvanted vaccine, resulting in more homogenous gene expression levels among the highly-primed individuals as compared to the disease-naïve individuals. However, after a second vaccination, response heterogeneity decreased and was similar across groups, irrespective of the degree of immune memory acquired at baseline. This information can support the design and analysis of future clinical trials evaluating AS01-adjuvanted vaccines.

UTILIZATION OF A HOSPITALIST DRIVEN PENICILLIN SKIN TESTING PROTOCOL TO PROMOTE ANTIBIOTIC STEWARDSHIP

<h3>Introduction</h3> Antibiotic resistance is an increasing problem throughout the world. Inappropriate labeling of penicillin allergies results in suboptimal antibiotic selection for patients. Penicillin skin testing is a valuable tool for facilitating a switch to beta-lactam antibiotics. <h3>Methods</h3> A retrospective analysis of all patients with a documented history of penicillin allergy were included in the study from March 2017 to May 2019; a total of 128 patients were included. Analysis involved nature of penicillin allergy and results of penicillin skin test. Benzylpenicilloyl polylysine (PRE-PEN®) tested major determinant, and diluted penicillin G tested minor determinant. The primary outcome of the study is the rate of antibiotic deescalation, and secondary outcome is a comparison of the duration of non beta-lactam therapy in appropriately re-labeled versus non re-labeled subjects (student t-test). <h3>Results</h3> 12 of 128 patients (9.4%) had a negative histamine test and were labeled indeterminate. Of the remaining 116 patients, 111 had a negative test (95.7%) and 5 (4.3%) had a positive test to PRE-PEN ® or dilute penicillin G. 78 of the 111 negative (70.3%) were switched to a narrower spectrum-based antibiotic, and subsequently did not experience allergic reaction. There was a significantly decreased use of vancomycin, aztreonam, carbapenem, fluoroquinolone and clindamycin. There was no significant difference in duration of non beta-lactam therapy in appropriately re-labeled versus non re-labeled subjects (3.6 days vs. 4.25 days; p=0.35). <h3>Conclusion</h3> Our protocol has demonstrated that a penicillin skin testing protocol can substantially reduce broad spectrum antibiotic use and increase antibiotic stewardship.

Diagnostic value of a medical algorithm for investigation of perioperative hypersensitivity reactions.

Evaluation of perioperative hypersensitivity (POH) is challenging, and accurate screening tools are needed to optimize the diagnostic process. We aimed to assess and validate the diagnostic value of a published algorithm (using tryptase and clinical presentation) to identify appropriate individuals for further testing for IgE-mediated POH. We analysed the clinical presentation (tryptase elevation, cardiovascular, respiratory, skin involvement) of patients proceeding to testing for possible IgE-mediated POH at a single tertiary referral centre, relative to subsequent skin testing and specific IgE results. Clinical presentations by drug class were also determined. In 293 consecutive patients, the use of a published algorithm based on one or more of; (i) defined increase in serum tryptase, (ii) involvement of at least two-organ systems, or (iii) presentation with new urticaria and/or angioedema; was highly sensitive [98.8% (CI95: 95.7-99.9%)] but less specific [34.6% (CI95: 25.7-44.4%)] in identifying patients testing positive on skin testing and/or specific IgE. Presentation with cardiovascular symptoms was also sensitive [89.8%(CI95: 84.2-94.0%)], while the combination of respiratory symptoms and increased tryptase was most specific [85.9%(CI95:76.6-92.5%)]. Respiratory involvement was more common in neuromuscular blocking agent allergy, while urticaria/angioedema was more common in antibiotic allergy. The published algorithm (of tryptase rise, two-organ involvement or new urticaria/angioedema) is highly sensitive, and appropriate as a screening tool to identify patients suitable for testing for IgE-mediated POH.

Clinical significance of sensitization to house dust mite allergens using flow cytometry-based basophil activation test

Respiratory allergy takes a significant place among allergic diseases. Similar clinical manifestations occur in sensitized patients in response to various airborne allergens. Accordingly, the allergen testing by means of in vivo and in vitro techniques is necessary to identify a causally significant allergen. The main laboratory assay to estimate sensitization to the airborne allergens is based on detection of specific immunoglobulin E (sIgE). However, clinical manifestations cannot be always confirmed by this test. The aim of this work was to evaluate the potential of basophil activation test (BAT) using flow cytometry, in order to confirm sensitization to house dust mite allergens. The BAT was carried out with allergens from Dermatofagoides in 34 volunteers, 130 patients were examined at the Russian Centre of Emergency and Radiation Medicine (33 people with household and 97 people with polysensitization), and 10 patients with allergy to house dust mites confirmed by skin testing. The sensitization was assessed using two laboratory kits (Allergenicity and BD FastImmune). The total IgE and sIgE to house dust mites, as well as concentrations of eosinophilic cationic protein, were determined. Specificity of the BAT with Allergenicity kit for the house dust mites was 94%. The sensitivity was 88% in the patients with household sensitization, thus being comparable with skin testing results available from the literature. An absolute correlation was found between positive results of skin testing and the BAT. In patients with household sensitization, sIgE levels &gt; 0.35 UA/mL were detected in 39% of cases. A positive correlation was shown between the indices of basophil activation in response to testing allergens, and total immunoglobulin E and sIgE concentrations. High degree of correlation was found between the results of Dermatofagoides sensitization testing with both BAT kits. It was shown that the use of H1 histamine receptor blockers had no effect on BAT results. A decrease in sensitivity assay for airborne allergens was revealed upon therapy with glucocorticosteroids. Due to the proven clinical significance of the basophil activation test for diagnosing sensitization to inhaled allergens, one may require to supplement the range of approved assays in Russian Clinical Guidelines with BAT testing to prove sensitization in patients with allergic rhinitis and bronchial asthma, thus contributing to better diagnosis of causally significant allergens and, accordingly, administration of proper therapy.

Immunoglobulin E-mediated allergies among children with type 1 diabetes mellitus

Background Type 1 diabetes mellitus (T1DM) and immunoglobulin E (IgE)-mediated allergy belong to the most common diseases in the pediatric population, in which they are caused by multifactorial causes. Growing evidence proposes that there is a change in Th1/Th2 balance, and subsequently their associated cytokine response, which is essential during the pathogenesis of autoimmune disorders such as T1DM. Aim To assess clinical characteristics and subsequently risk factors potentiating the IgE-mediated allergy among Egyptian children with T1DM and also to assess serum level of interleukin 5 (IL5) among them. Patients and methods An interviewer-administrated questionnaire was designed to take history of allergy in diabetic children who come to the outpatient clinic fulfilling inclusion criteria and used to collect data. The age range was 5–17 years, with at least 2 years duration of T1DM. Skin prick testing was performed for all diabetic children with history of allergy. Patients were divided into allergic diabetic group (45 patients) and nonallergic diabetic group (45 patients). Laboratory assessment of serum total IgE, IL5, and eosinophils% was carried out. Results Among the 45 allergic diabetic group, 82% were asthmatic cases, 40% of them have allergic rhinitis, and 30% of them have skin allergy. Skin test results showed that allergy to house dust mite showed the highest percentage among the diabetic allergic group (51.1%). The allergic diabetic group showed significantly higher levels of IL5, total IgE, and eosinophils than nonallergic diabetic group (Z=8.13, P&lt;0.001; Z=7.18, P&lt;0.001; and Z=8.02, P&lt;0.001). Conclusion Bronchial asthma is considered the most common type of IgE-mediated allergy that may occur in children with T1DM. Developing IgE allergy in T1DM is dependent on the increased levels of IL5. IL5 was an independent predictor of developing asthma, allergic rhinitis, and skin allergy among our studied cases.

The user safety assessment of a selenized yeast feed additive

Purpose: Of the several selenized yeasts authorised for use as feed additives in the EU, Saccharomyces cerevisiae CNCM I-3060 inactivated’ (Sel-Plex®), was the first to be approved for use, in 2006. The additive has a concentration of selenium between 2000 and 2400 mg/kg and a selenomethionine content greater than 63%. Previous toxicological and safety studies have shown Sel-Plex® to be safe for use for target animal species, consumers, users and the environment. A new formulation of Sel-Plex® was recently developed however, with a minimum selenium content of 3000 mg/kg. The increase in selenium in this product, Sel-Plex® 3000, presented the need to assess the risk for workers and users and to establish if there would be any eye and/or skin irritancy and skin sensitisation effects associated with the product. The purpose of this paper is to present the methodology and results of the user safety skin and eye studies performed on Sel-Plex® 3000. Materials & Methods: In vitro skin and eye models were used to assess skin and eye irritancy, while skin sensitisation was examined using an in vivo method. The acute eye irritation was evaluated using a Reconstructed human Cornea-like Epithelium (RhCE) model, which followed the OECD guideline 492. The skin irritation was assessed based on its ability to induce cell death in a commercial reconstructed human epidermis (RhE) model (EPISKIN™) according to the OECD Guideline No. 439. The skin sensitising potential was evaluated in the Guinea pig in line with OECD Guideline 406, and measured the extent and degree of skin reaction to a challenge exposure following previous topical exposure of a substance on the skin. Results: The skin and eye irritation test results showed that Sel-Plex® 3000 was a non-irritant in both cases. The skin sensitisation study showed that the additive did not generate a sensitisation response in the guinea pig and should not be considered a skin sensitiser. Conclusion: These results indicate that Sel-Plex® 3000 is safe to use for workers in an industrial setting when handling the product and the studies may be further used to support regulatory compliance in respective markets.

Amoxicillin hypersensitivity: Patient outcomes in a seven-year retrospective study

BackgroundThe beta-lactam antibiotic amoxicillin and the beta-lactamase inhibitor clavulanic acid in combination with amoxicillin are known to cause both immediate- and nonimmediate-type hypersensitivity. ObjectiveTo characterize a large cohort of patients with a history of amoxicillin or amoxicillin-clavulanic acid hypersensitivity. MethodsA retrospective analysis was conducted of the demographics, presentation, investigation, and management of 331 patients presenting to 1 allergy center with a history of hypersensitivity to amoxicillin or amoxicillin-clavulanic acid. ResultsHypersensitivity was confirmed in 37 of 221 patients (17%) who took amoxicillin and 47 of 110 patients (43%) who took amoxicillin-clavulanic acid as the index drug.In immediate hypersensitivity, skin test results confirmed the diagnosis in 66 of 139 patients (47%). Penicillin cross-reactivity was observed in 16 of 36 patients (44%). Of the 16 patients who were cross-reactive, 13 (81%) reacted to amoxicillin-clavulanic acid as the index drug. All patients who had negative skin test results (73/139) underwent drug provocation. The negative predictive value of skin tests was 89%.In nonimmediate hypersensitivity, delayed intradermal tests confirmed diagnosis in 12 of 170 patients (7%). Of the 12 patients whose skin test results were positive, 8 (67%) presented with drug reaction with eosinophilia and systemic symptoms. All patients with a negative skin test result (158/170) underwent drug provocation. The negative predictive value of skin tests was 95%. Penicillin cross-reactivity was observed in 3 of 12 patients (25%).Ten patients were diagnosed with hypersensitivity to clavulanic acid. ConclusionThe negative predictive value of skin tests in both immediate and nonimmediate hypersensitivity reactions is excellent and excludes severe allergy. Nonimmediate hypersensitivity is rare. Confirmed hypersensitivity is more likely if amoxicillin-clavulanic acid is the index drug. Cross-reactivity was more common in patients presenting with immediate hypersensitivity, typically involving benzylpenicillin. A minority of patients were allergic to clavulanic acid.

Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies.

BackgroundAllergies against Hymenoptera venoms are a major cause of severe anaphylaxis. Risk assessment for subjects with suspected allergy is difficult because there are currently no biomarkers that predict the likelihood of high-grade anaphylaxis other than several associated comorbidities.ObjectiveWe investigated the relationship between the severity of anaphylaxis and the results of intracutaneous skin tests (ICTs) together with serum levels of tryptase, total IgE, and venom-specific IgE, IgG, and IgG4.MethodsWe performed a retrospective evaluation of 194 patients who presented to a single medical center with allergies to bee venoms (Apis mellifera, Bombus spp.; n=24, 12.4%), vespid venoms (Vespula spp., Vespa spp., Polistes spp.; n=169, 87.1%), or both (n=1, 0.5%).ResultsIndex bee stings occurred earlier in the year than vespid stings, although the latter were reported more frequently overall. On average, subjects who previously experienced grade IV anaphylaxis required higher dosages of venom to yield positive ICTs than those who exhibited lower grade responses. Patients diagnosed with grade IV anaphylaxis exhibited significantly lower levels of venom-specific IgE and IgG and trended toward elevated levels of tryptase. No significant differences in average levels of venom-specific IgG4 and total IgE were observed.ConclusionOur findings reveal that intracutaneous skin testing and levels of venom-specific IgE do not predict the degree of anaphylaxis that develops in patients with venom allergy. Furthermore, the month of the index sting is not a reliable means to differentiate bee from vespid stings in patients presenting with an uncertain history.

The Interrelationship Between Persistent Asthma and Atopy in Children

Background: Childhood asthma is mainly developed by an interplay between genetic and environmental factors. Atopic asthma has been regarded as the most common form of asthma in the pediatric age group. Therefore, we aimed to evaluate the role of atopy in inducing uncontrolled asthma in children. Materials and Methods: Seventy-five children between 1 to 14 years of age, referred to The Asthma and allergy clinics of Azad University hospitals for a period of one year because of wheezing and or chronic cough with a diagnosis of asthma were enrolled in this cross-sectional study. After scrutinizing the children’s medical history relevant to their asthmatic manifestations, they were evaluated with a skin prick test (SPT) for common aero and food allergens. Results: Thirty-five asthmatic children had positive SPTs with their mean age higher than those with negative skin test results (P≤0.0001). In those with positive SPTs, the symptoms recurred if the medications were discontinued within a month of symptom improvement (P=0.001). The same results were true considering the history of previous atopic disorders in response to the discontinuation of therapy (P&lt;0.0001). Conclusion: To conclude, in most patients with negative skin tests, symptoms of asthma improved in less than a month from the initiation of appropriate therapies. However, in those with positive SPTs and a history of atopy, the symptoms recurred if the medications were discontinued within less than a month of symptom improvement (P=0.001 and P&lt;0.0001, respectively).

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Pleural tuberculosis: experiences from two centers in Brazil

ObjectiveThis study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. MethodsPatients aged < 18 years were evaluated retrospectively. The patients’ medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. ResultsNinety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. ConclusionsTuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.

Oral Swab Specimens Tested With Xpert MTB/RIF Ultra Assay for Diagnosis of Pulmonary Tuberculosis in Children: A Diagnostic Accuracy Study.

Microbiologic diagnosis of childhood tuberculosis may be difficult. Oral swab specimens are a potential noninvasive alternative to sputum specimens for diagnosis. This was a prospective diagnostic accuracy study of oral swab specimens (buccal and tongue) for pulmonary tuberculosis diagnosis in children (aged ≤ 15 years) in 2 South African hospital sites. Children with cough of any duration as well as a positive tuberculin skin test result, tuberculosis contact, loss of weight, or chest radiograph suggestive of pulmonary tuberculosis were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Xpert MTB/RIF Ultra) assay and liquid culture. Oral swab specimens were obtained before sputum specimens, frozen, and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed tuberculosis, unconfirmed tuberculosis (receipt of tuberculosis treatment), or unlikely tuberculosis according to National Institutes of Health consensus definitions based on sputum microbiologic results. Among 291 participants (median age [interquartile range], 32 [14-73] months), 57 (20%) had human immunodeficiency virus (HIV), and 87 (30%) were malnourished; 90 (31%) had confirmed pulmonary tuberculosis (rifampicin resistant in 6 [7%] ), 157 (54%), unconfirmed pulmonary tuberculosis, and 44 (15%), unlikely tuberculosis. A single oral swab specimen was obtained from 126 (43%) of the participants (tongue in 96 and buccal in 30) and 2 swab specimens from 165 (57%) (tongue in 110 and buccal in 55). Sensitivity was low (22% [95% confidence interval, 15%-32%]) for all swab specimens combined (with confirmed pulmonary tuberculosis as reference), but specificity was high (100% [91%-100%]). The highest sensitivity was 33% (95% confidence interval, 15%-58%) among participants with HIV. The overall yield was 6.9% with 1 oral swab specimen and 7.2% with 2. Use of the Xpert MTB/RIF Ultra assay with oral swab specimens provides poor yield for microbiologic pulmonary tuberculosis confirmation in children.

Allergy clinic patients' drug hypersensitivity.

Drug hypersensitivity reaction (DHR) is a common reason for an allergology con- sultation, during which it is not only necessary to gather a thorough medical history, but also to propose and perform diagnostic tests. The aim of the study was to retrospectively assess the patients with a profile of preliminary drug hypersensitivity diagnosis, the usefulness of NSAID hypersensitivity classifica- tion in outpatient practice, and to analyze the results of skin, provocation, and drug tolerance tests performed in Immunology and Allergy Clinic patients. Around 501 medical records of patients referred to the academic allergy outpatient clinic from 2011 to 2019, and had a preliminary drug hypersensitivity diagnosis were analyzed. The diagnostic and drug tolerance tests results carried out in 269 patients of the Clinic from 2009 to 2019 were then evaluated. Among the patients referred due to suspected drug hypersensitivity, the majority (n=338, 67.5%) were believed to be hypersensitive to NSAIDs and antibiotics (n=272, 54.3%). In patients with hypersensitivity to NSAIDs, the mixed pattern was the most prevalent (n=73, 21.6%), followed by NECD (n=64, 18.9%) and NIUA (n=55, 16.3%). The second most common drug causing DHR were the antibiotics, mainly β-lactams (n=160, 58.8%), followed by macrolides (n=35, 12.9%). In hypersensitivity caused due to β-lactams, the delayed form was predominant (n=24, 15%) with manifested skin symptoms (n=74, 46.3%). Non-steroidal anti-inflammatory drugs (n=21, 42.9%), followed by antibiotics (n=11, 22.5%) were the commonest causes of ana- phylaxis, as reported by 49 patients. The study shows that a majority of patients with suspected drug hypersensitivity can be classified under the hypersensitivity umbrella based on their medical history, which is the basis for further diagnostic process.

Frequency of Latent Tuberculosis Infection in Patients with Type 2 Diabetes referred to Shahid Rahimi Hospital in Khorramabad City with Tuberculin Skin Test in 2018-2020

Introduction: Tuberculosis is the leading cause of death from infectious diseases worldwide. Diabetes has been suggested as an important risk factor for tuberculosis. To date, few studies have examined the association between diabetes and tuberculosis. In this study, the prevalence of latent tuberculosis in diabetic patients was investigated.&#x0D; Methods: In this study, 195 patients with type 2 diabetes were studied in a cross-sectional study to diagnose latent tuberculosis infection with a tuberculin skin test. Individuals with symptoms of active tuberculosis were excluded from the study, and individuals with a positive tuberculin test were evaluated for active tuberculosis by chest x-ray. For analyzing the data, SPSS software version 16 was run, a t-test was used to analyze quantitative variables, and for qualitative variables, Chi-square was applied. The significance level of 0.05 was considered for all the results.&#x0D; Results: Out of 195 diabetic patients, 115 patients were referred for tuberculin test results. 43 out of 115 patients (37.39%) had an induration diameter greater than or equal to 5 mm, 29 patients (25.21%) had an induration diameter greater than or equal to 8 mm, and 3 patients (2.61%) had an induration diameter greater than or equal to 10 mm (Positive tuberculin test) (p&gt;0.05).&#x0D; Conclusion: False tuberculin skin test results can hide the true prevalence of latent tuberculosis infection. The sensitivity of the tuberculin test decreases in immunocompromised patients and leads to limitations in assessing the prevalence of latent tuberculosis infection. Although not enough information was available in this study to establish a significant association between diabetes and latent tuberculosis infection, further studies will help to investigate this association.

Acute urticaria alone after CoronaVac COVID-19 vaccination should not be a contraindication for revaccination.

SummaryPatients who develop an immediate allergic reaction within the first 4 h of COVID‐19 vaccine injection are recommended not to receive the same vaccine again. This recommendation mainly focuses on the mRNA and adenoviral vector COVID‐19 vaccines, but data for whole virus vaccines are unknown. We report seven patients who developed an immediate reaction within 4 h (six had generalized urticaria, one had localized urticaria) after the first vaccination with CoronaVac, the inactivated SARS‐CoV‐2 vaccine. The results of skin tests and basophil activation tests suggested that spike peptides play a role in exacerbating urticaria in some patients. However, all subjects who developed urticaria within 4 h after CoronaVac vaccination were successfully revaccinated without graded challenge, although recurrent urticaria was common. This preliminary result indicates that acute urticaria alone should not be a contraindication for the second dose of CoronaVac if the supply of alternative vaccines is limited.

Results of penicillin skin testing in patients with suspected penicillin allergy - the Qatar experience.

Background: Unverified penicillin allergy has been linked to adverse patient events and increased healthcare expenditure owing to the usage of broad-spectrum, expensive antibiotics. Penicillin allergy test is the gold standard to diagnose penicillin allergy; and in this study, we present data from Qatar which have not been published before.Methods: Patients with a history of penicillin allergy who underwent penicillin allergy testing between January 2015 and December 2020 at the Allergy Division of the Hamad General Hospital were retrospectively reviewed from the division registry. Benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM) kit DAP-penicillin (0.04 mg +0.5 mg)/vial) (penicillin G, amoxicillin (20 mg/vial), and lately clavulanic acid (20 mg/vial) (DAP, Diater, Madrid, Spain) were used for skin and intradermal testing according to published guidelines. Patients with negative skin tests were administered direct oral challenge with amoxicillin/clavulanate (500/125 mg) and observed for 2 hours.Results: Of the 189 charts reviewed, 183 patients had a complete data set for analysis. Patients were predominantly women (n = 132, 72%) with an average age of 42 years. Of these patients, 149 (81.4%) had a history of an immediate allergic reaction to penicillin, 10 had a history of delayed reactions, and 24 had other or undefined reactions. A total of 39 (21.3%) patients were diagnosed with penicillin allergy (30 patients with positive skin test results and 9 using a direct oral challenge).Of the 30 patients with positive skin testing, 5 reacted to PPL, 8 to MDM, 13 to amoxicillin, and 4 to clavulanic acid.Conclusion: Previous studies indicate that 90% patients with a history of penicillin allergy were able to tolerate the drug (10% were truly allergic). Our data showed that 21% were truly allergic to penicillin. This high positive rate can be attributed to the high pretest probability based on the detailed history obtained before the test, which led to the exclusion of patients with symptoms incompatible with penicillin allergy from the test.

Correlation between skin test results and historical manifestations in patients with suspected lidocaine hypersensitivity.

Background: Adverse reactions to local anesthetics (LA) are relatively common; however, true IgE-mediated allergy is extremely rare, estimated to occur in less than 1%. Investigating patients with suspected allergy to LA should begin with a detailed history to exclude other more common operation theater related culprit medications, followed by skin testing. The subcutaneous challenge is considered the gold standard for confirming true IgE-mediated allergy to LA. In this study, we have described the skin prick test results of patients with suspected lidocaine allergy who had historical reaction symptoms typical to IgE-mediated allergic reactions.Methods: The data were retrieved from the allergy procedure log registry for patients who were referred to the allergy clinic with a suspected allergic reaction to lidocaine at the Hamad Medical Corporation between 2016 and 2020. These patients’ symptoms of historical reactions to lidocaine were compared to their skin test results.Result: A total of 7 patients were identified. The skin test result for lidocaine was positive in only 1 patient; his historical reaction was anaphylaxis (urticaria/angioedema and shortness of breath). The remaining 6 patients had a negative result for skin and challenge tests. Of these 6 patients with negative results, 4 had only urticaria/angioedema as historical reactions; 1 had systematic manifestation (tachycardia) along with urticaria/angioedema, and 1 experienced systemic symptoms (shortness of breath, chest pain, and palpitation) with no skin or mucous membrane involvement (Table 1).Conclusion: Negative skin test and subcutaneous challenge with a history of generalized cutaneous symptoms and/or systemic symptoms during the reaction to LA can be attributed to many causes, such as an IgE-mediated reaction against a component other than lidocaine (e.g., latex), medication side effects (adrenaline in combined preparations), and/or symptoms of primary disease (chronic spontaneous urticaria/angioedema).