Routine Allergy Testing Research Articles

Serum GFAP- pediatric reference interval in a cohort of Danish children.

Glial fibrillary acidic protein (GFAP) in blood is an emerging biomarker of brain injury and neurological disease. Its clinical use in children is limited by the lack of a reference interval (RI). Thus, the aim of the present study was to establish an age-dependent continuous RI for serum GFAP in children. Excess serum from routine allergy testing of 391 children, 0.4-17.9 years of age, was measured by a single-molecule array (Simoa) assay. A continuous RI was modelled using non-parametric quantile regression and presented both graphically and tabulated as discrete one-year RIs based on point estimates from the model. Serum GFAP showed a strong age-dependency with declining levels and variability from infants to adolescents. The estimated median level decreased 66 % from four months to five years of age and another 65 % from five years to 17.9 years of age. No gender difference was observed. The study establishes an age-dependent RI for serum GFAP in children showing high levels and variability in the first years of life.

Pathomorphological changes in the organs of the peripheral immune system in mycobacteriosis of cattle

Conducting routine allergy tests of cattle with a simultaneous sample in TB-prone farms is necessary to confirm the stage of the epizootic process. The purpose of the research – to explore the pathomorphological changes in cows upon detection of para allergic reactions during diagnostic testing for tuberculosis. The diagnosis of tuberculosis in animals was performed comprehensively using all methods for tuberculosis control provided for in the guidelines – epidemiological, clinical, allergic, pathological, histomorphological, bacteriological and biological. It allowed establishing that the reactions to tuberculin in cows were of a paraallergic nature, caused by nontuberculous mycobacteria or so-called atypical mycobacteria. It was determined that cows that reacted positively to tuberculin and an atypical mycobacterial allergen and were sent for slaughter for diagnostic purposes did not demonstrate pathological changes characteristic of tuberculosis. However, pathological changes (granulomatous foci, atrophy of lymphoid and epithelioid tissue, hyperplasia of varying intensity and nature, dotted haemorrhages in the cortical zone) were observed in many lymph nodes, including mediastinal, mesenteric, pharyngeal and mandibular lymph nodes, indicating an active infectious process in the body of animals caused by nontuberculous mycobacteria. Therewith, several changes were observed in the lymph nodes during histomorphological examination: development of primary nodules of lymphocytes and reticular tissue in reactive centres, degradation and necrosis of lymphocytes, the establishment of cellular detritus in the centre of the nodules and capsules of epithelioid elements around the nodules, etc., which can be used to confirm the patterns of pathology development and, indirectly, the mechanism of sensitisation of the cow’s body, and therefore the nature of paraallergic reactions in animals. The obtained results are important for the timely detection and identification at the histomorphological level of a complex of changes in the organs and tissues of cows due to the penetration of nontuberculous mycobacteria, which is the key to the successful diagnosis of primary foci of mycobacteriosis and their effective prevention

Clinical implication of detecting sensitization to iodinated radiocontrast media in the basophil activation test by flow cytometry.

The use of iodinated radiocontrast media is necessary for visualization. A number of patients have adverse effects of various nature and severity when these drugs are administered. Routine allergy tests do not provide adequate diagnosis of reactions to drugs in this group. The aim of this work is to assess the capabilities of the basophil activation test to confirm sensitization to non-ionic iodinated radiocontrast media, as well as to select a safe alternative drug in patients with a burdened history. Basophil activation test by flow cytometry was performed in 184 patients The Nikiforov Russian Centre of Emergency and Radiation Medicine» EMERCOM of Russia and 32 volunteers using ultravist, omnipack, and optiray. The presence of sensitization was assessed based on the basophil activation index, as well as spontaneous and anti-IgE antibody-induced activation of basophils and the population of T-lymphocytes type 2 immune response. The volunteers showed no sensitization to iodinated radiocontrast media. In patients with a medium degree of hypersensitivity reaction in vivo, in vitro sensitization to drugs was detected 4 times more often than in patients with a mild degree (51% versus 13.5%). In patients with systemic reactions to the administration of a known drug, in vitro sensitization was confirmed in 86% of cases, while the frequency of detection of sensitization to drugs did not differ. Spontaneous activation of basophils in patients and type 2 T-lymphocytes were 2 times higher than in volunteers. Patients were more likely to have low (less than 30%) activation of basophils for anti-IgE antibodies. The specificity of the basophil activation test with iodinated radiocontrast media was 100% with a sensitivity of 94.1%. Most patients were able to select a non-sensitizing contrast. Inclusion in the algorithm of spontaneous and anti-IgE antibody-induced activation of basophils and a population of T-lymphocytes type 2 immune response will allow the doctor to carry out a personalized approach to the management of patients with a burdened history.

Recent developments and highlights in food allergy

The achievement of long-lasting, safe treatments for food allergy is dependent on the understanding of the immunological basis of food allergy. Accurate diagnosis is essential for management. In recent years, data from oral food challenges have revealed that routine allergy testing is poor at predicting clinical allergy for tree nuts, almonds in particular. More advanced antigen-based tests including component-resolved diagnostics and epitope reactivity may lead to more accurate diagnosis and selection of therapeutic intervention. Additional diagnostic accuracy may come from cellular tests such as the basophil activation test or mast cell approaches. In the context of clinical trials, cellular tests have revealed specific T-cell and B-cell populations that are more abundant in food-allergic individuals with distinct mechanistic features. Awareness of clinical markers, such as the ability to eat baked forms of milk and egg, continues to inform the understanding of natural tolerance development. Mouse models have allowed for investigation into multiple mechanisms of food allergy including modification of epithelial metabolism, and the induction of regulatory cell subsets and the microbiome. Increasing numbers of children who underwent food immunotherapy enlarged the body of evidence on mechanisms and predictors of treatment success. Experimental immunological markers in conjunction with clinical determinants such as lower age and lower initial specific IgE appear to be of benefit. More research on the optimal dose, preparation, and route of application integrating a high-level safety and efficacy is demanded. Alternatively, biologics blocking TSLP, IL-33, IL-4 and IL-13, or IgE may help to achieve that.

Evaluating children with suspected allergic reactions to vaccines for infectious diseases.

Vaccines often contain potentially allergenic material in addition to pathogen-specific immunogens that may induce allergic reactions. Parents and physicians often suspect that adverse reactions to vaccines are allergic in etiology. The concern that some of the substances contained in vaccines may trigger an anaphylactic reaction may lead to a low vaccination adherence with emergence of infectious disease epidemics. To provide practical suggestions for managing children suspected to have an allergic reaction to a vaccine. Information was obtained from a search of guidelines and relevant studies on allergic reactions to vaccines for infectious diseases. True allergic reactions elicited by a vaccine are rare. Skin testing to the vaccine and to its components may identify the triggering agent. Graded dosing desensitization is helpful in children sensitized to the offending vaccine. All children with a suspected allergic reaction to a vaccine should be carefully evaluated by routine allergy tests. When it is necessary, further immunization should be given under strict medical surveillance, which ensures that every child can safely complete the vaccination schedule.

Aminopenicillin-associated exanthem: lymphocyte transformation testing revisited.

The lymphocyte transformation test (LTT) has been promoted as in-vitro test for diagnosis of drug hypersensitivity. For determination of statistical LTT sensitivity, series of patients with clinically uniform reactions followed by complete drug hypersensitivity work-up are mandatory. Assessment of LTT specificity requires control patients who tolerated exposure to the drug studied. To prospectively determine the diagnostic value of the LTT in a clinically and diagnostically well-defined series of patients. Patients with exanthematous skin eruptions after ampicillin (AMP) intake were included in this study. After exclusion or confirmation of delayed-onset allergic AMP hypersensitivity by skin and provocation testing, two independent LTTs were performed: one standard LTT and a modified LTT with additional anti-CD3/anti-CD28 monoclonal antibody stimulation. By testing, delayed-onset allergic AMP hypersensitivity was diagnosed in 11 patients and definitely ruled out in 26. The standard LTT reached a diagnostic sensitivity of 54.5% while the modified LTT yielded 72.7%. However, the methodical test modification resulted in a decline of specificity from 92.3% (standard LTT) to 76.9%. In cases of AMP-associated exanthems, the diagnostic value of the LTT compared with routine allergy testing is limited. When evaluating such exanthems, provocation testing remains the gold standard. Delayed reading of intradermal skin tests remains most useful to avoid positive provocation reactions.

Nonallergic Rhinitis: Diagnosis and Management

Program Description: Patients with nonallergic rhinitis (NAR) are commonly seen in an otolaryngologist’s practice. These patients may have no allergic triggers, may be negative to routine allergy testing, and are therefore diagnosed with NAR. Recent workgroups both in the United States and internationally have attempted to better classify the pathophysiology and phenotype of patients with NAR, with the goal of facilitating more accurate diagnosis and improved treatment. This panel will review, through brief didactic discussions and case presentations, recent knowledge and current understanding of NAR and will highlight methods to improve the management of these frequently challenging patients. Educational Objectives: (1) Discuss the various pathophysiologies and presentations that are grouped under the diagnostic category of nonallergic rhinitis. (2) Review important elements of the diagnostic workup in evaluating the patient with nonallergic rhinitis. (3) Implement treatment strategies for patients diagnosed with nonallergic rhinitis.

Incrimination of Blomia tropicalis as a Potent Allergen in House Dust and its Role in Allergic Asthma in Kolkata Metropolis, India

Background Theincreasing trend in allergic diseases has become obvious in the present day, especially in developing countries like India, because of many factors such as change in ambient air quality, increased air pollution, metamorphic change in living habits and lifestyle, and climate 1. Mites present in house dust represent a major source of allergens, resulting in different allergic manifestations all over the world, and hypersensitivity to these dust mites may play a pivotal role in pathogenesis of several allergic complaints including bronchial asthma. The present study evaluated the sensitization toward house dust and house dust mites among patients residing in Kolkata metropolis, India, who are suffering from allergic asthma.Methods The skin prick test was performed on a total of 1079 patients (585 males and 494 females) between the age group 5-50 years and 50 healthy controls using a variety of 16 common aero-allergenic extracts including 4 allergens of interest, viz. Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis and total house dust allergens. Total serum IgE level was measured by using the EIA technique and specific IgE levels against aforesaid allergens were detected with the Pharmacia ImmunoCAP 100 System. The influence of age and sex, if any, on allergen sensitivity was also investigated. All statistical analyses were performed using SPSS 10.0 for Windows and Zar 2.Results The responses among patients with asthma to house dust and house dust mite allergen tests were as follows: house dust (96.22%), D. pteronyssinus (75.06%), B. tropicalis (72%), and D. farinae (63.72%). The frequency of positive skin response was found to be independent of age and sex. The total serum IgE levels in patients varied between 7.3 and 4040 IU/ml (mean 369 ± 26.51 IU/ml). Specific IgE antibody test proved that 83% patients showed sensitivity toward at least 1 of the allergens tested.Discussion The results indicate that patients are highly sensitive to house dust and 3 other allergenic mites, namely, D. pteronyssinus, D. farinae, and B. tropicalis, as evidenced by the skin prick test, quantification of total serum IgE, and detection of allergen-specific IgE antibodies among patients of Kolkata. Although mites belonging to the genus Dermatophagoides have already been incriminated as a major source of allergen in house dust in India, this is the first time the role of B. tropicalis mites causing allergic asthma has been reported from an Indian population. Thus, the importance of B. tropicalis mite as an aetiopathological agent in causing various allergic manifestations among the Kolkata population should not be undermined and the allergen should be included in routine allergy testing.

Prevalence of allergic sensitization to indoor fungi in West Virginia

Exposure to indoor fungi is of growing concern in residential and occupational environments in the United States. The purpose of this study was to determine the prevalence of sensitization to common indoor fungal species in an atopic population. We evaluated 102 patients (73 female and 29 male patients) for immunoglobulin E (IgE) reactivity to a panel of skin-prick test (SPT) reagents used for routine allergy testing. Patients also were tested for six additional fungi that are common indoor contaminants. All patients had symptoms consistent with allergic rhinitis or asthma. The presence of specific IgE against the fungal species was determined using immunoblotting. Of the 102 eligible patients, 68% had at least one positive skin test. The most prevalent positive SPTs were to dust mites, cats, vernal grass, and short ragweed. Overall, 21/102 (21%) patients with asthma or allergic rhinitis were skin test positive to at least one fungal extract. Of the patients with a positive SPT to fungi, 12/21 (58%) showed sensitivity to one or more of the newly tested species; most notably Trichoderma viride (8%), Chaetomium globosum (7%), Paecilomyces variotii (7%), and Acremonium strictum (6%). Immunoblotting revealed specific IgE against a number of protein bands belonging to these fungal species. The prevalence of fungal sensitization was common, particularly for indoor fungal contaminants that are not routinely included in SPT panels. Cross-reactivity with other fungi may partially explain our results; however, skin testing for these indoor fungi may provide useful diagnostic information.

Toleranzinduktion bei bekannter Penicillinunverträglichkeit

Background: In some diseases, penicillin G is still a treatment of choice like in sclerosing diseases of the connective tissue or in persistent scleredema of Buschke. But, suspected allergy to penicillin may limit this helpful therapy option and even leed to the exclusion of other antibiotics like cephalosporins that possibly may crossreact. Skin testing and in vitro diagnostic to detect specific sensitization to penicillin and its derivates have always to be performed but must not be conclusive. In some cases an exposition test is necessary. In single cases of medical demand a tolerance induction is needed to perform penicillin therapy for a period of time. Patients and methods: We present two patients with sclerosing diseases of the connective tissue like circumscribed sclerosis and one patient with persistent scleredema of Buschke with a positive history for penicillin. Although routine allergy testing including intracoutaneous skin testing and in vitro tests were negative, they were treated as allergic to penicillin. Penicillin was decided to be the treatment of choice so that tolerance induction with penicillin was necessary. The administration of pencillin G was achieved by performing a new scheme of tolerance induction. We started with oral doses of penicillin V and finished off with high doses of intravenously applied penicillin G. Results: In each case penicillin G was well-tolerated until the high dose of 3 × 10 7 IU/day, administered over a period of 3 weeks. In all demonstrated cases substantial clinical improvement was achieved without any complication. Conclusions: Suspected allergy to penicillin is widespread and leads to tendency to avoid all penicillin derivatives and cephalosporins as a possible way of treatment. In certain cases there is only a positive history for penicillin allergy and the diagnostic procedure remains negative. Nevertheless, these patients are suspected to be allergic to penicillin. In cases where penicillin seems to be a treatment of choice it might be necessary to perform a tolerance induction with penicillin. Here, we present a new scheme how to treat initially with penicillin V and to continue with penicillin G, and to switch from an oral to an intravenious way to manage a high-dose penicillin therapy.

Routine Allergy Testing Urged for Asthma Patients

Routine Allergy Testing Urged for Asthma Patients

Influence of sensitization to inhalative allergens on adenotonsillar disease.

We sought to determine the influence of IgE-mediated sensitization on adenotonsillar disease in children. We compared follow-up after tonsillectomy/adenoidectomy of atopic and nonatopic children.Study design and setting A prospective study of 293 children consecutively undergoing tonsillectomy/adenoidectomy was conducted at a university hospital center. Preoperative and postoperative (1-year follow-up) allergy-related symptom scores were obtained by parents. Intraoperative total serum IgE, the screening test sx1 (Pharmacia), and, if positive, serum specific IgE to inhalative allergens were carried out. Sixty-seven children (22.9%) showed positive RAST results to inhalative allergens (class 1 to 6). In both sensitized and nonsensitized groups, the general health was improved in more than 89% at 1 year postoperatively. No significant difference of postoperative nasal symptoms between the atopic and nonatopic groups was found. Both atopic and nonatopic children with adenotonsillar disease improve health after adenoidectomy or adenotonsillectomy. In our opinion, routine allergy tests before adenotonsillectomy or adenoidectomy are not justified. Only if allergy is suspected due to clinical findings or family history should an allergy test be carried out.

Influence of sensitization to inhalative allergens on adenotonsillar disease

We sought to determine the influence of IgE-mediated sensitization on adenotonsillar disease in children. We compared follow-up after tonsillectomy/adenoidectomy of atopic and nonatopic children.Study design and setting A prospective study of 293 children consecutively undergoing tonsillectomy/adenoidectomy was conducted at a university hospital center. Preoperative and postoperative (1-year follow-up) allergy-related symptom scores were obtained by parents. Intraoperative total serum IgE, the screening test sx1 (Pharmacia), and, if positive, serum specific IgE to inhalative allergens were carried out. Sixty-seven children (22.9%) showed positive RAST results to inhalative allergens (class 1 to 6). In both sensitized and nonsensitized groups, the general health was improved in more than 89% at 1 year postoperatively. No significant difference of postoperative nasal symptoms between the atopic and nonatopic groups was found. Both atopic and nonatopic children with adenotonsillar disease improve health after adenoidectomy or adenotonsillectomy. In our opinion, routine allergy tests before adenotonsillectomy or adenoidectomy are not justified. Only if allergy is suspected due to clinical findings or family history should an allergy test be carried out.