Skin Prick Test Sensitivity Research Articles

실내환경 주요 호흡기 알레르기 항원 감작검사를 위한 피부단자 시험과 혈청 ELISA시험의 상관성에 대한 연구

The indoor environment is an important source of exposure to various aeroallergens and pathogenic microorganism. It has been shown that exposure to aeroallergens enhances the risk of indoor inhabitants developing asthma. Since the skin prick test, a typical clinical method for identification of subjects positive to allergens, can rarely cause fatal or non-fatal reactions in susceptible persons, an in vitro assay such as ELISA using serum has been considered for testing positivity against various allergens. We evaluated the validity of a serum ELISA kit for screening positive subjects to major aeroallergens including Dermatophagoides farinae, Dermatophagoides pteronyssinus, cockroach, Alternaria, Cladosporium, Aspergillus, Penicillium, dog hair, cat fur, mugwort, and ragweed. The ELISA results were compared with the skin prick test results, and sensitivity, specificity, and overall accuracy were calculated to each allergen. Higher sensitivities were obtained from D. farinae, (77.8%) and D. pteronyssinus (69.2%), but sensitivities to Aspergillus, Penicillium, dog hair, cat fur, and ragweed were very low down to 0%. Specificity ranged from 88.7% (cat fur) to 100% (mugwort and ragweed). Overall the accuracy of the serum ELISA kit was relatively high, in that the lowest was 85.1% for cat fur and the highest was 98.6% for Alternaria, Cladosporium, and ragweed. Considering specificity and overall accuracy for the serum ELISA kit, it may be considered reliable. However, when the kit is used for screening purpose, positivity to aeroallergens should be carefully determined since sensitivity for the kit is low.

Sensitivity and specificity of different skin prick tests with latex extracts in pediatric patients with suspected natural rubber latex allergy – A cohort study

Skin prick tests (SPT) with latex extracts are commonly used in the diagnostic approach of natural rubber latex (NRL) allergy. Non-ammoniated latex extracts are commonly utilized for this purpose. There is only one commercially available ammoniated latex extract for both diagnostic and therapeutic purposes. To our knowledge, no direct clinical comparisons have been made so far comparing sensitivity and specificity of different latex extracts in patients with clinically confirmed latex allergy. The objective of this study was to evaluate sensitivity and specificity of non-ammoniated or ammoniated SPT of latex extracts in children with a clinical history suggestive of NRL allergy. Forty-two subjects (age 4-15 yr), referred to our Allergy Clinic Center, with suspected clinical signs of NRL allergy were evaluated. Patients were selected according to the following inclusion criteria: pediatric patients of age above 4 yr with a suspected clinical history of urticaria, rhinoconjunctivitis and/or asthma due to sensitization to NRL. A definitive NRL allergy diagnosis was made on the identification of latex-specific IgE (>0.7 kU/l), positive glove use test and a highly indicative clinical history. NRL allergy was confirmed in 26 (62%) subjects. SPT for latex were performed with three different SPT solutions containing non-ammoniated NRL extracts (product A: Lofarma SpA, Milan, Italy and product B: Stallergenes, Milan, Italy) or an ammoniated extract (product C: ALK-Abellò, Madrid, Spain). A positive result was considered as the appearance of a wheal with a diameter >3 mm. In patients with confirmed NRL allergy, wheal mean (s.d.) diameters were 7.3 (2.1) with product C, and 5.7 (2.3) and 4.4 (1.8) with products B and A respectively (p = 0.004 C vs. B and A). Mean wheal diameters were significantly higher for product C in comparison with product B and A (p < 0.04). Sensitivity according to the different products tested was 65% (product A); 81% (product B) and 96% (product C) (p = 0.0084; C vs. A). No difference between the three products was observed regarding diagnostic specificity (94%, 88% and 94%, product A, B and C, respectively). Our study shows that diagnostic sensitivity of different latex extract for SPT could differ. In this particular clinical setting (i.e., children with NRL allergy) ammoniated latex extract shows a higher sensitivity in comparison with non-ammoniated products. This aspect should be considered in the diagnostic approach in subjects with suspected NRL allergy. In children with clinical confirmed latex allergy, sensitivity and specificity of different commercially available skin prick test could vary. Ammoniated latex extract has shown a higher sensibility in comparison with non-ammoniated products.

Th1–Th2 Interaction: Is More Complex than a See‐saw?

Infections, such as tuberculosis, measles and diphtheria, may decrease the risk of developing atopic allergic disorders. Patients with pulmonary TB having similar allergic skin prick test sensitivity as healthy controls but unable to show vigorous atopic phenotype in their healthy period might be a sign for Th1-Th2 immune interaction.

An analysis of the incidence of adenoid hypertrophy in allergic children

The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explained. Some researches show that in part of children, allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitization. The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.

Diagnosis of Food Allergy by Combined Detection of Short Circuit Current Changes and Histamine Release Induced by Antigen Application during Mucosa-Oxygenation in Human Intestinal Biopsies

Diagnosis of food allergy is hampered by the poor sensitivity and specificity of RAST and skin prick tests. Double-blind placebo-controlled food challenge (DBPCFC), the golden standard, is time and cost consuming. We performed ex vivo tests with intestinal biopsies of two patients with food allergies diagnosed by DBPCFC, and with biopsies of one patient with no known food allergies. Biopsies were mounted in Ussing chambers, serosal surface area was 1.1mm2, both compartments contained 2ml oxygenated Ringer’s solution at 37o C. Short circuit current (Isc) responses to serosally applied food protein extracts (10–250µg/ml) from pork, soybean, wheat, barley, rye, maize and ovalbumin and β-lactoglobulin were analyzed. Serosal and mucosal samples of 100 m l were taken before antigen application and at 2.5, 5.0 and 7.5 minutes thereafter, and were analyzed for histamine content by ELISA. Isc-changes induced by 65 antigen application tests in 24 biopsies ranged from 0–17µA/cm2 and appeared within 1 to 5 minutes. Histamine concentration increments peaked within 5 minutes after antigen application and ranged from 0–0.89 ng/ml (serosal) and from 0–0.49 ng/ml (mucosal). Serosal and mucosal appearance of histamine after antigen application correlated significantly (r=0.68, p<0.0001), and Isc-changes after antigen application correlated significantly to serosal and also to mucosal histamine appearance (r=0.44, p=0.0003 and r=0.29, p=0.02). Isc-changes and histamine release (5.50±0.67µA/cm2, respectively serosal: 0.15±0.04 ng/ml, mucosal: 0.13±0.03 ng/ml; n=30) induced by DBPCFC-positive antigens were significantly higher (p<0.0005) than those by DBPCFC-negative antigens (0.65±0.31µA/cm2, respectively serosal: 0.01±0.01 ng/ml, mucosal: 0.02±0.01 ng/ml; n=17).Detectable Isc-changes and histamine concentration increments were observed in antral, jejunal, ileal, colonic and rectal biopsies after application of relevant food antigens proven positive in the DBPCFC. These results indicate that the combined detection of Isc-changes and of histamine release after application of antigens to living endoscopical biopsies ex vivo may provide a new, sensitive and specific tool in the diagnosis of gastrointestinal food allergy.

Valeur diagnostique des prick-tests, des IgE spécifiques et du test de libération d’histamine pour le diagnostic de routine d’allergie aux hyménoptères

Objectives. – Studies performed to assess the diagnostic value of tests for hymenoptera allergy are usually designed to validate the test whereas very few have evaluated these tests in routine diagnostic situations. In fact, the diagnostic value of such tests, especially skin prick-tests and basophil histamine release, has rarely been studied systematically in patients referred by their physician to an allergist for confirmation of the diagnosis and recommendations for immunotherapy. The aim of the present study was to assess the diagnostic value of skin prick-tests, specific IgE assay and basophil histamine release in patients referred to an allergy unit for suspected hymenoptera venom allergy. Patients and methods. – Diagnostic tests were done prospectively in 25 consecutive patients with allergic reactions to hymenoptera venom defined by clinical history and positive intradermal skin tests, including patients with a localized or a more extensive skin reaction associated with malaise and/or respiratory symptoms, and in 21 control subjects. The hymenoptera studied included yellow jacket (YJ) and honeybee (HB). The sensitivity, specificity, concordance and predictive values of the tests were calculated. Results. – The observed sensitivity, specificity, and positive and negatives predictive values of skin prick-tests with 100 μg/mL HB venom (in percent) 33.3; 100; 100; and 85.7, respectively, and with 100 μg/mL YJ venom 30; 100; 100 and 85, respectively. For skin prick-tests with 300 μg/mL HB venom the values were 75; 100; 100 and 94, respectively and for skin prick-tests with 300 μg/mL YJ venom 57; 100; 100 and 90.3, respectively. For specific IgE assays, the values for HB were 100; 95.2; 84 and 100, respectively and for YJ 100; 76.2; 51.2, and 100, respectively. For basophil histamine release the values for HB were 89; 100; 100 and 97.3 for YJ they were 94; 89, 6 and 98.4, respectively. Conclusions. – Skin prick-tests with venom concentrations under 300 μg/mL are not sensitive enough for an accurate diagnosis of hymenoptera allergy. Basophil histamine release appears to be a good complementary test but it needs better standardization.

Genetic association studies: What are they teaching clinicians?

Genetic association studies: What are they teaching clinicians?

A double-blind, placebo-controlled immunotherapy dose-response study with standardized cat extract

Background: Allergen immunotherapy with doses of cat extract containing approximately 15 μg of the major allergen, Fel d 1, have been proved clinically effective in several double-blind, placebo-controlled studies. However, the maintenance doses used in allergy practice in the United States are often considerably less than this proven dose. Objective: The purpose of this investigation was to determine whether maintenance immunotherapy with cat dander extract containing 0.6 μg or 3.0 μg of Fel d 1 was more effective than placebo and similar in efficacy to treatment with extracts containing 15.0 μg Fel d 1, immunologic parameters being used as the outcome. Methods: Twenty-eight cat-allergic patients were randomly entered, 7 in each group, into a double-blind, placebo-controlled comparison of the immunologic response to treatment with placebo or cat dander extract containing 0.6 μg, 3.0 μg, or 15.0 μg of Fel d 1. Maintenance doses were achieved in 8 visits over a period of 4 weeks through use of a cluster regimen; each subject then received 1 weekly maintenance injection before posttreatment measurements were made. The response to immunotherapy was assessed before immunotherapy and after the first weekly maintenance injection. Studies included responses to titrated skin prick tests to cat extract and an unrelated allergen and serum allergen-specific IgE and IgG4. Titrated nasal challenges were performed with cat extract; measurement of mRNA and secreted cytokines (IL-4, IL-5, and IFN-γ) was done at 6 hours. Serum cytokines (IL-4, IL-5, IFN-γ) were measured, and flow cytometric analysis of intracellular cytokines (IL-4, IL-5, IFN-γ) was performed. Cat allergen–stimulated lymphocyte proliferation was performed with measurement of cytokines in the supernatant (IL-4, IL-5, IFN-γ). Results: All 28 subjects completed the study. Significant and dose-dependent differences were encountered in the titrated skin prick tests (P = .008), the cat-specific IgG4 (P = .01), and the reduction in CD4+/IL-4+ PBMCs on flow cytometry (P = .03). There were no significant differences between placebo and cat dander extract containing Fel d 1 0.6 μg. Both extracts containing 3.0 μg and 15.0 μg produced significant decreases in skin prick test sensitivity (P = .02 and P = .002, respectively). The extracts containing 3.0 μg and 15.0 μg produced significant increases in cat-specific IgG4 (P = .01 and P = .006, respectively). Only the 15.0-μg-per-dose extract produced a significant reduction in the percent of CD4+/IL-4+ PBMCs (P = .003). Conclusion: In this double-blind, placebo-controlled study, a maintenance dose of cat dander extract containing 15.0 μg Fel d 1 produced the most consistent immunologic response. A dose of 3.0 μg reduced skin prick test sensitivity and increased cat-specific IgG4 but did not reduce the circulating CD4+/IL-4+ PBMCs, a change that is likely related to the clinically significant response to allergen immunotherapy. These findings suggest that a maintenance dose of 15.0 μg of Fel d 1 is most apt to be clinically effective for allergen immunotherapy. (J Allergy Clin Immunol 2003;111:155-61.)

Evaluation of the clinical efficacy and safety of grapeseed extract in the treatment of fall seasonal allergic rhinitis: a pilot study

Herbal products are widely used by consumers as alternatives to prescription drugs in treating symptoms of allergic rhinitis. However, there have been few placebo-controlled clinical trials that have examined the efficacy or safety of these products. Although grapeseed extract (GSE) is an herbal that is marketed for treating allergic rhinitis, its efficacy is unproven. The aim of this study was to compare the efficacy and safety of GSE with placebo in the treatment of seasonal allergic rhinitis (SAR). This was a randomized, double-blind, placebo-controlled study of GSE 100 mg, twice daily, versus placebo. Patients with SAR and skin prick test sensitivity to ragweed were randomized to 8 weeks of active treatment or placebo which was begun before the ragweed pollen season. Outcomes included: daily symptom diary scores recorded by patients, rhinitis quality of life scores at baseline and after 4 and 8 weeks of treatment; and requirements for rescue chlorpheniramine. Safety was monitored with routine laboratory studies. Over 8 weeks of treatment, no significant differences were observed between active and placebo groups in rhinitis quality of life assessments, symptom diary scores, or requirements for rescue antihistamine. No significant laboratory abnormalities were detected. This study did not show trends supporting the efficacy of GSE in the treatment of SAR.

Springtime pollinosis and oral allergy syndrome in Sapporo

Objective: The purpose of this present study was to investigate pollinosis in the spring and oral allergy syndrome (OAS) in Sapporo to utilize it for future treatment. Materials and methods: Of the patients referred to our out-patient clinic during April and May in 1999, all those that were suspected to have pollinosis were asked to fill in a questionnaire. A 101 patients (30 males and 71 females) with a mean age of 33 years (range 7–74 years) answered the questionnaire. In all, the patients specific IgE tests were performed. Results: The most common allergen was birch, affecting 54 of 87 patients (62%). In 61% of patients with birch allergy, we observed fruit and vegetable allergy. Among them, apple was the most prevalent allergen (97%), followed by peach (67%), cherry (58%), pear (40%), plum (40%) and melon (33%). The sensitivity of skin prick test with commercial extract to apple was low (11%). Conclusion: Patients with birch pollen allergy had OAS much more frequently than ever reported in Japan, although OAS has not widely been known in Japan. Patients with birch pollen allergy should be informed about the possibility of hypersensitivity to certain fruits.

Studies of the Relationship between Allergen-Specific IgE Antibodies and Skin Test Reactivity in Patients with Asthma in Kuwait

Background: Studies have shown that allergens are important sensitizing agents in asthma. The relationship between various allergy markers has not been documented in Kuwait, although asthma is common. This study was therefore designed to investigate this relationship. Method: One hundred and one adult asthmatics were recruited over a 1-year period for this study. After administering a skin prick test (SPT) for common allergens, blood was taken for measuring specific IgE concentrations. Results: Eighty-two percent of the patients had positive SPT reactions to at least one allergen. Chenopodium sensitization was the most common, occurring in 47% of cases. Specific IgE was positive in fewer cases, which showed a positive reaction to SPT with the same allergen, the highest being observed with cockroach, occurring in 76% of the cases. There was a positive correlation between the wheal diameter of SPT and the concentration of specific IgE in three of the four allergens tested (r = 0.376, p ≤ 0.001 for Bermuda grass; r = 0.255, p ≤ 0.01 for cockroach, and r = 0.254, p ≤ 0.01 for chenopodium). The sensitivity, specificity and diagnostic accuracy of SPT in the allergens tested were below the reported findings in studies from Western countries. Conclusion: This study revealed that SPT had a better predictive value than specific IgE, and there was evidence of increasing sensitization to the cockroach allergen in this environment.

The wheezing schoolchild - an undiagnosed asthmatic: A follow-up of children with parentally reported episodes of wheeze without diagnosed asthma

Objective - To examine children aged 7-15 years with parentally reported episodes of wheeze in order to estimate the proportion of undiagnosed asthmatics in this group. Design - A cross-sectional study with clinical examination of subgroups. Setting - All children (n=832) aged 7-15 years in the municipality of Odda. Subject - Based on completed questionnaires, the children were selected to one of four groups: Children with wheeze but no asthma (wheeze group); children with current asthma (asthma group); children with past asthma (past asthma group); and children with neither asthma nor wheeze (control group). Main outcome measures - Parental reports of episodes of wheeze, assessment of skin prick test sensitivity, measures of lung function and exercise -induced bronchoconstriction (EIB). Results - In the wheeze group, 3 (7.5%) of 40 children were diagnosed with asthma in the 18-month period between the questionnaire survey and the examination, while 4 (10%) other children had EIB. Another 8 children (20%) reported 3 episodes of wheeze or more, and at least 1 episode during the 12-month period before the clinical examination. Classifying these children as asthmatics would give a proportion of 37.5% with undiagnosed asthma in the wheeze group, and the prevalence of current asthma among children aged 7-15 would rise from 2.9% based on a questionnaire survey to 4.9%. Conclusions - Using a wide definition of asthma, this study suggests that a large proportion of Norwegian children with wheeze actually have asthma.

Elevated cord serum IgE increases the risk of aeroallergen sensitization without increasing respiratory allergic symptoms in early childhood.

Increasing prevalence of allergic disorders has focused attention on primary prevention. There is a need to improve the accuracy of early-life predictors of atopy so that the at-risk population can be accurately defined and preventive measures instituted. The predictive capacity of elevated cord IgE, with or without family history of atopy, to allergic symptoms and skin prick test (SPT) sensitization is evaluated in a birth cohort followed up prospectively for 4 years. A birth cohort of 1456 consecutively born children was recruited in 1989. Data were collected on family history of atopy and cord serum total IgE (cord IgE) was measured. Of these, 1218 children were seen in the clinic at 4 years to determine the development of symptoms and signs of allergic disease and 981 were skin tested to a range of common food and aeroallergens. Of 1218 children reviewed at age 4 years, 218 (17.8%) had symptoms of respiratory allergy and, of those skin tested (n = 981), 192 (19.6%) reacted positively. Twice as many children with elevated cord IgE (>/= 0.5 kU/L) at birth became sensitized to aeroallergens by age 4 years (34.8% vs 17.3%, P < 0. 001). Positive predictive value (PPV) of elevated cord IgE for the development of aeroallergen sensitization was better than that of family history of atopy (34.8 vs 22.6%). Combining paternal atopy with elevated cord IgE substantially increased the predictive capacity (PPV 77.8%). Cord IgE levels did not correlate with clinical asthma or rhinitis at age 4 years and PPV for allergic respiratory symptoms remained poor at all cutoffs. Cord IgE is better than family history for predicting atopy as defined by allergen sensitization and this predictive value can be further increased by combining cord IgE with paternal atopy.

Baker’s asthma: Still among the most frequent occupational respiratory disorders

Background: Baker’s asthma and rhinitis are among the most frequent occupational respiratory disorders. Objective: The aim of the study was to evaluate the frequency of work-related symptoms and the clinical relevance of sensitization to allergens in screened and symptomatic bakers. Methods: Eighty-nine bakers participating in a screening study and 104 bakers filing a claim for compensation were examined with regard to occupational and clinical case history, lung function parameters, and sensitization to bakery allergens by skin prick tests, specific IgE analyses, and inhalative challenge tests. Results: A high prevalence of respiratory disorders, abnormal lung function parameters, and sensitization to bakery allergens exists. Most frequently, bakers with workplace-related respiratory symptoms showed sensitization to wheat flour (64%), rye flour (52%), soy bean flour (25%), and α-amylase (21%). The correlation between these sensitizations and asthma case history and inhalative challenge test responses was significant. However, approximately 29% of the bakers with respiratory symptoms showed no sensitization to these bakery allergens, whereas 32% of the sensitized bakers in the screening group had no workplace-related symptoms. Atopic status defined by skin prick test sensitization to common allergens or elevated total IgE levels was found to be a risk factor for the development of sensitization to bakery allergens and respiratory symptoms. On the other hand, there is evidence for an increased frequency of elevated total IgE as the result of occupational allergen exposure because respective findings were observed in bakers without symptoms. Conclusion: Sensitization to bakery allergens seems to be the main cause of baker’s asthma and rhinitis but cannot explain the asthma case history in each case. Further methods are required to objectively assume irritative pathomechanisms. Our findings indicate the necessity for an improved primary prevention of exposure to inhalative noxae in bakeries. (J Allergy Clin Immunol 1998;102:984-97.)

Current allergic asthma and rhinitis: diagnostic efficiency of three commonly used atopic markers (IgE, skin prick tests, and Phadiatop). Results from 8329 randomized adults from the SAPALDIA Study. Swiss Study on Air Pollution and Lung Diseases in Adults.

Total serum IgE, Phadiatop, and the skin prick test (SPT) are commonly used to diagnose atopic diseases. However, no large study has ever been done to test their diagnostic efficiency. We studied the diagnostic value of these three atopic markers in 8329 well-randomized adults from the Swiss Population Registry. The prevalence of current allergic asthma (CAA) was 1.8% and of current allergic rhinitis (CAR) 16.3%. The prevalences of positive Phadiatop, positive SPT (at least, one out of eight SPT to common aeroallergens with a wheal of > or = 3 mm), and positive total IgE (IgE > or = 100 kU/l) were 29, 23, and 23%, respectively. To diagnose CAA and CAR, the sensitivity of Phadiatop was significantly higher than that of SPT (72.5% vs 65.4%, 77.1% vs 68.4% respectively; P < 0.01 and < 0.001) and IgE (72.5% vs 56.9%, 77.1% vs 43.9%, respectively; both P < 0.001). The sensitivity of SPT was significantly higher (68.4% vs 43.9% P < 0.001) than that of IgE to diagnose CAR. When CAA and CAR were excluded, the SPT specificity was significantly higher than that of Phadiatop (77.8% vs 71.9% and 85.9% vs 80.5%, respectively; both P < 0.001): when CAR was excluded, SPT was significantly higher than IgE (85.9 vs 81.4%; P < 0.001). SPT had significantly the best positive predictive value for CAA (5.2% for SPT vs 4.6% for both IgE and Phadiatop; both P < 0.001) and CAR (48.7% for SPT vs 43.5% for Phadiatop and 31.6% for IgE; both P < 0.001). The three markers of atopy had roughly the same negative predictive value (NPV) for CAA, but IgE had a significantly lower NPV for CAR than SPT and Phadiatop (88.1% vs 93.3% and 94.7%, respectively; both P < 0.001). The diagnostic efficiency of SPT was significantly higher than that of Phadiatop (83.1% vs 79.9% and 77.6 vs 71.9%, respectively; both P < 0.001) to diagnose CAR and CAA. IgE and SPT had equal efficiency (77.6%), which was significantly higher than that of Phadiatop, to diagnose CAA (71.9%; both P < 0.001). In conclusion, SPT have the best positive predictive value and the best efficiency to diagnose respiratory atopic diseases. Furthermore, SPT give information on sensitivity to individual allergens and should therefore be used primarily by clinicians to assess respiratory allergic diseases. Moreover, they are cheaper and provide immediate, educational information for both patient and physician.

Incidence of latex sensitization among latex glove users

Background: Although there are several reports of the prevalence of latex sensitization among health care workers, the incidence of sensitization is unknown. Objective: The objective of this study was to estimate the incidence of sensitization among latex glove users at a hospital in Hamilton, Ontario, Canada. Methods: Workers with negative results to the skin test at baseline were followed prospectively over 1 year, some wearing powdered gloves and others using powder-free gloves. They were reevaluated in 1995 with a questionnaire and skin prick test (SPT) sensitivity to latex reagents, three common inhalants, and six foods. A conversion was defined as a (new) latex SPT with wheal diameter at least 4 mm greater than saline control. Glove extracts were assayed for antigenic protein, and air samples were obtained to estimate exposure to airborne latex protein. Results: During powdered glove use, personal exposures ranged from 5 to 616 ng/m 3, whereas during powder-free glove use, all but two results for air samples were below the limit of detection (about 0.1 ng/m 3). During the study period, the protein concentration in the powdered gloves, initially mean 557 μg/gm of sample, declined at a rate of 295 μg/gm per year ( p < 0.0001). Of the 1075 SPT-negative participants at baseline, 479 were working in eligible wards, and of these, 435 (91%) participated in follow-up, 227 using powder-free gloves and 208 using powdered gloves. We identified four conversions, two (1.0%) in the powdered glove group and two (0.9%) in the powder-free group. The two participants using powdered gloves were the only converters who were symptomatic. The significance of skin test conversions identified in the powder-free group, both asymptomatic patients, is unclear. The limitations of the study are discussed, including the limited power, the declines in latex protein concentrations, and the possibility of information (observer) bias. Conclusion: To our knowledge, this represents the first reported estimate (about 1%) of incidence of sensitization in hospital personnel using latex gloves. (J Allergy Clin Immunol 1998;101:171-8.)

Sesame seed and sesame seed oil contain masked allergens of growing importance

Sesame seed and sesame seed oil have been thought of as rare causes of food allergy, representing less than 1% of all food allergy cases. We now report nine cases of IgE-dependent allergy to sesame seed and/or sesame seed oil, six of which were diagnosed in 1995 alone. Our skin test results draw attention to the poor quality of a commercial sesame seed extract and the good sensitivity of skin prick tests made with a freshly prepared sesame seed flour extract. The diagnosis of this food allergy was established by double-blind oral provocation tests, with doses of sesame seed flour ranging from 100 mg to 10 g. Allergy to sesame seed oil was also demonstrated in some cases. The sensitivity of the Pharmacia Phadebas CAP System for the detection of sesame seed-specific IgE was only mediocre. We draw attention to the important use of sesame seed in modern cooking, a fact which may explain the growing frequency of this allergy. We underline the particular risk with sesame seed oil. Sesame seed should also be considered a cause of allergic reactions to drug products and cosmetics.

Skinprick test sensitivity to olive pollen.

Medical Journal of AustraliaVolume 165, Issue 8 p. 460-460 Letter Skinprick test sensitivity to olive pollen Muhdh H Azmi, Muhdh H Azmi Medical Student Flinders University, SASearch for more papers by this authorLoan T Nguyen, Loan T Nguyen Medical Student Flinders University, SASearch for more papers by this authorAnn Kupa, Ann Kupa Senior Lecturer Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this authorRobert J Heddle, Robert J Heddle Senior Visiting Consultant Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this authorPeter J Roberts-Thomson, Peter J Roberts-Thomson Associate Professor Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this author Muhdh H Azmi, Muhdh H Azmi Medical Student Flinders University, SASearch for more papers by this authorLoan T Nguyen, Loan T Nguyen Medical Student Flinders University, SASearch for more papers by this authorAnn Kupa, Ann Kupa Senior Lecturer Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this authorRobert J Heddle, Robert J Heddle Senior Visiting Consultant Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this authorPeter J Roberts-Thomson, Peter J Roberts-Thomson Associate Professor Department of Clinical Immunology, Flinders University, Bedford Park, SA, 5042Search for more papers by this author First published: 01 October 1996 https://doi.org/10.5694/j.1326-5377.1996.tb138603.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume165, Issue8October 1996Pages 460-460 RelatedInformation

Cell cultures as a tool for detection of cytotoxic, mutagenic and carcinogenic activity of airborne particulates

Background: Baker’s asthma and rhinitis are among the most frequent occupational respiratory disorders. Objective: The aim of the study was to evaluate the frequency of work-related symptoms and the clinical relevance of sensitization to allergens in screened and symptomatic bakers. Methods: Eighty-nine bakers participating in a screening study and 104 bakers filing a claim for compensation were examined with regard to occupational and clinical case history, lung function parameters, and sensitization to bakery allergens by skin prick tests, specific IgE analyses, and inhalative challenge tests. Results: A high prevalence of respiratory disorders, abnormal lung function parameters, and sensitization to bakery allergens exists. Most frequently, bakers with workplace-related respiratory symptoms showed sensitization to wheat flour (64%), rye flour (52%), soy bean flour (25%), and α-amylase (21%). The correlation between these sensitizations and asthma case history and inhalative challenge test responses was significant. However, approximately 29% of the bakers with respiratory symptoms showed no sensitization to these bakery allergens, whereas 32% of the sensitized bakers in the screening group had no workplace-related symptoms. Atopic status defined by skin prick test sensitization to common allergens or elevated total IgE levels was found to be a risk factor for the development of sensitization to bakery allergens and respiratory symptoms. On the other hand, there is evidence for an increased frequency of elevated total IgE as the result of occupational allergen exposure because respective findings were observed in bakers without symptoms. Conclusion: Sensitization to bakery allergens seems to be the main cause of baker’s asthma and rhinitis but cannot explain the asthma case history in each case. Further methods are required to objectively assume irritative pathomechanisms. Our findings indicate the necessity for an improved primary prevention of exposure to inhalative noxae in bakeries. (J Allergy Clin Immunol 1998;102:984-97.)

Diagnostic tests in enzyme allergy

Background: Allergies to enzymes occur frequently in enzyme manufacturing plants. In epidemiologic studies the number of exposed subjects with symptoms is considerably higher than the number of sensitizations as assessed by skin tests or RAST. It was the aim of this study to evaluate the sensitivity and specificity of skin prick tests, enzyme allergosorbent test, and immunoprint with enzymes by using the results of bronchial provocation tests as the “gold standard.” Methods: We performed 82 bronchial provocation tests with nine different enzymes in 42 chemical plant workers, all of whom had reported work-related symptoms. All tests with the exception of bronchial provocation tests were also performed in 10 atopic and 10 healthy control subjects. Results: Thirteen workers showed positive results to bronchial provocation tests (50% or greater fall in specific airway conductance) with an enzyme at a maximal concentration of 10 mg/ml. Equivocal test results, that is, tests with a 30% or greater and less than 50% fall in specific airway conductance were seldom. Skin prick tests with nondialyzed aqueous enzyme extracts at a concentration of 10 mg/ml yielded a sensitivity of 100% and a specificity of 93%. Control subjects had no cutaneous reactions to enzymes. Discrepancies between skin tests and bronchial provocation tests occurred in 5 of 82 tests, all with a positive skin test and a negative bronchial provocation test. False-positive skin tests were considered more likely in four subjects and a false-negative bronchial challenge more likely in one case. Enzyme allergosorbent test was 62% sensitive and 96% specific, and atopic control subjects showed positive results in two cases. Results of immunoprint with amylase showed one main band at pH 3.4; this band was also found in exposed subjects without further signs of sensitization, but was not found in control subjects. All but one person with positive results to bronchial provocation tests with enzymes showed bronchial hyperresponsiveness. We identified 13 subjects with bronchial hyperresponsiveness, but without occupational allergy: five of these had sensitizations to nonoccupational allergens and the remainder showed bronchial hyperresponsiveness without any detectable cause. Conclusions: Occupation-related symptoms were not indicative of occupational allergy. Bronchial provocation tests and skin prick tests with nondialyzed aqueous enzyme extracts were appropriate techniques for the diagnosis of enzyme allergy.