Routine Skin Testing Research Articles

Tuberculosis screening in the long-term care setting.

Tuberculosis (TB) skin-testing practices in long-term care facilities (LTCFs) in North Carolina (NC) were assessed from a 56% (148/263) response to a comprehensive TB screening questionnaire. TB skin tests were administered to employees on initial employment by 98% and annually by 97% of the LTCFs, generally (74%) by the Mantoux method. Employee skin tests were read at the appropriate time interval of 48 to 72 hours by 91%, but less than half used diameter of induration when interpreting reactive tests. The booster test was performed on new employees at eight (6%) of the LTCFs. TB skin tests were routinely performed on newly admitted residents by 56% or conditionally required by 18%, generally (73%) by the Mantoux method. Resident skin tests were read at the appropriate time interval of 48 to 72 hours by 92%, but again only half correctly interpreted reactive tests as significant. Residents received routine annual skin tests at 71% of the LTCFs, generally (80%) by the Mantoux method. Eight (6%) facilities routinely performed the booster test on newly admitted residents. TB infection prevalence in new employees during 1983 was 8.1% (47/578) in seven LTCFs and in newly admitted residents was 6.4% (7/110) in three LTCFs supplying this data. The five-year mean TB skin test conversion rate among employees was 1.1% (101/9545) in 12 LTCFs and among residents was 0.9% (46/5216) in nine LTCFs supplying this data. Lack of compliance to established TB skin-testing guidelines in NC LTCF was prevalent. In recognition of described endemic and epidemic spread of TB in LTCFs, residents and employees of LTCFs should be screened for TB utilizing established skin-testing practices.

Routine elective penicillin allergy skin testing in children and adolescents: study of sensitization

This study aims at evaluating the possibility in children and adolescents of (re)sensitization to penicillin that could result from skin test and challenge. Patients (240) with a history of a reaction to penicillin or one of its analogs were skin-tested with penicillin G, commerical benzylpenicilloyl polylysine, and a minor determinant mixture consisting of sodium benzylpenicilloate and sodium benzylpenilloate. The patients were tested when well, in no immediate need for penicillin, and during a routine office visit. Twenty-one (8.7%) patients had one or more positive skin tests. Three (14%) of the positive reactors reacted only to the MDM mixture, with one reacting only to the benzylpenilloate component. Of the patients with negative skin tests, 219 were given a 10-day course of oral penicillin. Three (1.4%) of the patients developed a mild skin exanthem 7 to 10 days after starting the penicillin. All skin test—negative patients were retested 4 wk or more after completion of the oral challenge. Only two patients (<1%) who tolerated an oral challenge of penicillin had a positive skin test upon retesting. We believe that the described penicillin allergy testing procedure in children and adolescents with a history of allergy to penicillin or certain analogs is a safe, highly predictive, nonsensitizing office procedure in the hands of physicians experienced with skin testing. It should be considered for all such individuals labeled as allergic to penicillin when they are well and not in immediate need of penicillin.

An anomalous effect of allergen concentration on weal size elicited by skin testing for immediate hypersensitivity

We report the finding of anomalous responses in the skin of atopic individuals when prick tested with serial dilutions of cocksfoot grass pollen extracts. Each pollen extract was standardized using RAST inhibition activity related to the WHO standard for IgE. 75% of the patients gave a larger weal area with an allergen concentration of 1:10(5) than with the next higher concentration, i.e. 1:10(4). Possible mechanisms whereby a larger skin weal is elicited with a lower concentration of allergen are discussed. This is not a rare finding and can be observed in patients undergoing routine skin testing in the clinic, even where extracts are diluted over a relatively narrow concentration range.

Humoral and cellular immune responses in Aspergillus fumigatus pulmonary disease

This study was designed to evaluate immunologic differences between aspergilloma (A) and allergic bronchopulmonary aspergillosis (ABPA), comparing the results to atopic and nonatopic control subjects. Humoral studies included skin tests with common inhalant antigens and Aspergillus fumigatus. Total and specific IgE and other immunologlobulin levels and serum precipitins were evaluated against A. fumigatus. Cellular immunity was studied with routine skin testing and phytohemaqglutinin-induced lymphocyte blast transformation. Antigen-induced blast transformation was also carried out with the use of serial dilutions of A. fumigatus. All patients with ABPA were atopic and had marked elevations of IgE. None of the A patients were atopic and they had normal IgE levels. Immediate and late skin reactivity to A. fumigatus was generally greater in the ABPA group. Both ABPA and A had serum precipitating antibody against A. fumigatus. The atopic controls had elevated IgE levels and immediate skin test reactivity to A. fumigatus, and one also had weak serum precipitins against A. fumigatus. IgE antibody against A. fumigatus was low in control and A groups but high in 2 patients with ABPA. IgG antibody against A. fumigatus was generally higher in ABPA than A. ABPA and A patients had elevated stimulation indices (SI) to A. fumigatus. No stimulation could be detected with cells from control subjects. This study indicates that both T and B cell sensitization may play a role in the development of or as a response to aspergillus-related pulmonary disease.

Studies on contact hypersensitivity to chromium in the guinea pig. Inhibition of the migration of macrophages by chromium salts.

Macrophage migration inhibition and migration inhibitory factor (MIF) production were investigated in guinea pigs sensitized to potassium dichromate. The migration of peritoneal exudate cells from hypersensitive guinea pigs was inhibited by chromium salts independent of their valency. On the other hand, MIF was produced in the supernatant of lymph node cell cultures only with trivalent but not with hexa- or divalent chromium salts. Peritoneal exudate cells from tolerant animals were not inhibited and lymph node cells from these animals did not produce MIF upon challenge with appropriate hapten. Peritoneal exudate cells from desensitized (skin test-negative) guinea pigs were less inhibited than cells from hypersensitive animals, but significantly more than cells from normal controls. Peritoneal exudate cells from animals which had been submitted to the sensitizing procedure, but did not show apparent skin reactions to epicutaneous tests, gave very variable results in &lt;i&gt;in vitro&lt;/i&gt; tests ranging from normal macrophage migration to complete inhibition. Therefore, the macrophage migration test seems to be more sensitive than the routine epicutaneous skin test.

Allergic reaction to penicillin in milk.

To the Editor:— There are those who advocate routine skin testing for penicillin sensitivity in all patients for whom the use of penicillin is contemplated without regard to prior history of allergy. We disagree with this view. Wicher ( 208 :143, 1969) described a woman with known sensitivity to penicillin who had a systemic allergic reaction to the small amounts of penicillin in milk. In this patient, a generalized reaction to skin testing had developed previously with less than 1 unit of penicillin. The history in this case is not unique. In a partial listing of published reports of reactions from penicillin skin testing ( some of them anaphylactic. involving 24 patients ), most gave histories of penicillin allergy ( Milit Med 133 :557, 1968). The number of such reactions to skin testing which go unreported is unknown. When a random sample of patients for whom penicillin is contemplated is questioned with regard to

Onchocerciasis: some new epidemiologic and clinical findings. Results of an epidemiologic study in the Republic of Chad.

Some poorly recognized features of onchocerciasis were defined in the Republic of Chad in Central Africa in two hitherto unrecognized holoendemic foci. One of these was Ouli Bangala, situated at 7° 50′N latitude and 15° 50′E longitude, the other Masidjango at 10° 10′N latitude and 19° 25′E longitude, on the southern shore of Lake Iro near Boum Khebir. A study of the village of Ouli Bangala (population, 398) revealed the following: the recovery of microfilariae of Onchocerca volvulus in urine specimens from an unexpectedly high percentage of the population (11%); the diagnostic value of routine chest roentgenograms in onchocerciasis; the suppression of delayed hypersensitivity reactions as observed in routine tuberculin skin tests in persons with onchocercoma or skin atrophy or both; and the finding that patients with onchocercal microfilaruria generally have lower serum antibody titers to indirect hemagglutination tests with Dirofilaria immitis. The finding of a high rate of onchocercal microfilaruria was attributed both to the technique employed, that of triple concentration of complete urine specimens (settling overnight plus two centrifugations) and to the severity of infection. The presence of microfilariae in urine samples was closely associated with the intensity of skin infection, with a higher risk of exposure to bites of Simulium damnosum, and with the presence of other well-known manifestations of onchocerciasis.

Insect allergens: Their interrelationship and differences: A comparison of skin reactivity and a proposal for routine skin testing with insect allergens

Insect allergens: Their interrelationship and differences: A comparison of skin reactivity and a proposal for routine skin testing with insect allergens

Hypogammaglobulinemia with respiratory allergy

Hypogammaglobulinemia is characterized by susceptibility to recurrent infection, low gamma globulin, absence of circulating antibodies and isohemagglutinins, and immunologic unresponsiveness to antigenic stimulation. There are two main types, the congenital, a sex-linked recessive trait expressed in male children, and the acquired, occurring in either sex at any age. A case of acquired hypogammaglobulinemia is described in a 51-year-old man with respiratory allergy and keratitis. The absence of skin sensitizing antibodies in the hypogammaglobulinemic patient was demonstrated by P-K passive transfer studies. The capacity to develop delayed-type allergy was demonstrated by delayed-type skin reactions, not only to tuberculin but to such common antigens as molds, epidermals, inhalants, and certain foods, but none to pollens. The relationship between delayed type of hypersensitivity in the hypogammaglobulinemic patient and clinical allergy is discussed. The possible significance of delayed type of reactions in routine skin testing is emphasized.

Geotrichum in blood stream of an infant.

Geotrichosis, an infection rarely mentioned in the United States, is probably commoner than realized. Europe and certain South American countries have been aware of the fungus Geotrichum for many years and have reported its varying types of pathogenesis. There is increasing evidence that it will be found oftener in the United States when clinicians and laboratories become aware of its characteristics. In France, Brumpt, 1 in an excellent summary of Geotrichum infections, listed 20 species reported by various writers. Reeves, 2 in the southern United States, reported 79 cases of bronchomycoses, two of which were geotrichosis. He stated that in geotrichosis the chest roentgenogram resembles that of chronic tuberculosis, with heavy studding along the bronchi and frequent cavitation. Kunstadter and Milzer 3 consider Geotrichum of sufficient importance to include Geotrichum extract with routine skin tests for detection of mycotic infections. One of the most detailed discussions of this disease is

Skin testing methods: Multiple single sitting vs. serial small group tests

No evidence has been found in the literature to support the statements that routine multiple skin testing is more dangerous than a few tests at one sitting. Evidence is offered that numerous simultaneous average positive skin tests do not cause systemic reactions by their cumulative effects. On the contrary, systemic reactions seem to be associated with one reaction, or a few huge, rapidly developing local reactions, indicative of extreme hypersensitiveness to one or perhaps to a few allergens. Only two of 2,018 patients, tested with from 80 to 150 allergens at one sitting, had constitutional reactions. Neither of the reactions was alarming. In all, over 200,000 tests were done. It must be emphasized that one precaution has to be taken before doing multiple skin tests at one sitting. That precaution is a preliminary scratch test with allergens which commonly produce strong skin reactions or to which the history suggests the patient might be strongly sensitive.

Histamine-like effects on gastric acidity due to cold: Horton, B. T., and Brown, G. E. Proc. Staff Meetings Mayo Clinic 7: 367, 1932

1.1. Routine skin and eye tests with the whole sand fly extract in 192 cases of allergy have revealed 14 patients with positive reactions. The 4 positive cases in which the passive transfer test was done, elicited the presence of sand fly reagin in their blood sera.2.2. The comparative frequency of sand fly hypersensitiveness warrants its use as a routine test in all patients with allergic conditions, particularly those patients living near lakes, rivers, and ponds. In this way, I feel that many of our patients, especially those with summer hay fever and asthma, will more often be successfully diagnosed and treated.

The sand fly (caddis fly) as an exciting cause of allergic coryza and asthma: II. Its relative frequency

1. 1. Routine skin and eye tests with the whole sand fly extract in 192 cases of allergy have revealed 14 patients with positive reactions. The 4 positive cases in which the passive transfer test was done, elicited the presence of sand fly reagin in their blood sera. 2. 2. The comparative frequency of sand fly hypersensitiveness warrants its use as a routine test in all patients with allergic conditions, particularly those patients living near lakes, rivers, and ponds. In this way, I feel that many of our patients, especially those with summer hay fever and asthma, will more often be successfully diagnosed and treated.