[Simple allergen skin test device Multi skit (tentative name)]

We have developed a device tentatively named Multi Skit (Mu), a simple allergen test device, in order to conduct the skin test safely, accurately and conveniently. The utility of this device was evaluated by determining how the results obtained by the intradermal test (In) and Mu were correlated with those obtained by IgE RAST (RA) in 65 AD patients. RA values concerning nine antigens were compared to results obtained by the In and Mu in terms of the positive and negative response coincidence rates, overall coincidence rates, and false-positive and false-negative response rates. The correlation between RA data obtained from the literature and the results of the scratch test (Sc) was also evaluated. The results of In and RAST values showed no correlation regardless of the food antigen used. Mu and RAST values showed correlation with respect to all 4 food antigens except soy-bean, resulting in overall coincidence rates of 66.2 to 87.7%, which were higher than those concerning the Sc. With respect to false-positive responses to environmental antigens, the rate obtained by Mu was higher than that by the Sc, but it was lower than that by the In. However, Mu was the most excellent test with respect to the other indices, i.e., positive and negative response coincidence rates, overall coincidence rates (73.9-89.2%) and false-negative responses. The mechanism of Mu makers it possible to minimize variations from one investigator to another, and the major drawback of all other skin tests. Mu is a safe and convenient screening skin test device which provides accurate and specific test results.

Release of eosinophil granule proteins during IgE-mediated allergic skin reactions

To determine whether the eosinophil (EOS), a prominent component of human allergic skin reactions, releases its potentially pathogenic components in vivo, we appended collection chambers to the bases of unroofed skin blisters and challenged the sites for varying time periods with either pollen antigen (Ag) or buffer (B)-control solutions. In seven sensitive subjects, continuous challenge with pollen Ag consistently induced release of more major basic protein (MBP) and eosinophil-derived neutrophil (EDN) than did B solution. Low levels of both MBP and EDN were observed during the first hour with increased accumulation during the second to fifth hour. Comparison of Ag- versus B-challenged site responses in individual subjects demonstrated significantly higher levels of both MBP and EDN at Ag than at B sites during the second to fifth hour. Levels of both MBP and EDN in the second to fifth hour correlated significantly with histamine release in the same sites in the first hour (r = 0.66 and 0.83, respectively). Imprints of the skin bases of the chambers after 5 hours demonstrated variable numbers of EOS at the Ag-challenged sites and only occasional EOS at the B-challenged sites; most cells on the skin bases were neutrophils. However, immunofluorescence localization of MBP in biopsy specimens of the blister bases revealed striking extra cellular MBP deposition. These findings indicate that EOS components accumulate in vivo in IgE-mediated human skin reactions, even when prominent EOS accumulation is not visualized, possibly because the EOS are degranulated in the allergic-reaction site. Release of EOS components in these reactions may be linked to earlier mast cell activation.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultraviolet-B phototest in patients with atopic dermatitis

To evaluate the possibility of ultraviolet (UV) rays as an aggravating factor of atopic dermatitis (AD), UV-B phototest was performed in patients with AD. Resulting, minimal erythema doses for UV-B were all within normal range and AD lesions were not reproduced by irradiation. UV-B may not be an important factor for skin aggravation in patients with AD.

Positive Multi-Test reactions do not cause false positive reactions at adjacent sites

To answer the question of whether proximity of Multi-Test skin test sites causes false positive reactions, 50 subjects with prior 4+ skin test responses were retested with antigens and ten additional subjects were tested with histamine (1.8 mg/mL). No positive readings occurred at any of the replicate saline control sites adjacent to 3+ or 4+ allergen sites or to 3+ histamine reactions.

Delayed cutaneous hypersensitivity after multiple injury and severe burn

LetHality and overall prognosis after multiple injury and severe burn are determined to a major degree by the incidence and severity of infectious complications. Immunological reactions are influenced by the extent of trauma. Multitest Mérieux is an appropriate and an easily applicable means to delayed hypersensitivity testing (DHT). This study investigates to what extent Multitest Mérieux can help to predict the prognosis of multiply injured and severely burnt patients and whether new therapeutic measures can be recommended. This study encloses 52 patients during 1985: 16 severe burns, 20 multiple injuries with craniocerebral trauma and 16 without. Beginning with the day of injury standard laboratory and cardiopulmonary parameters were recorded every 48 hours. Delayed hypersensitivity testing was performed using Multitest Mérieux. The extent of trauma was determined by help of the ISS. All quantitative laboratory and cardiopulmonary parameters showed no significant changes in correlation to the clinical course during the period under investigation. However, a significant correlation between Multitest reaction at days six and eight and its overall results and the rate of infectious complications was found. Moreover, the extent of trauma measured by ISS shows a positive correlation with the rate of anergic reactions in Multitest. Thus Multitest Mérieux is an easily applicable and reliable means to the assessment of the prognosis after multiple injury and severe burn. Therapeutical recommendations beyond today's intensive care concepts cannot be given.

Release of histamine and tryptase during continuous and interrupted cutaneous challenge with allergen in humans

To help in understanding the patterns of in vivo mediator release in human allergic skin reactions, we have used a skin chamber model to challenge the denuded bases of skin blisters of 11 sensitive subjects with pollen antigens (Ags) and codeine (C), a mast cell degranulator. Challenges were performed either (1) continuously for 6 hours or (2) in an intermittent fashion that is, Ag or C for the first hour, buffer for the next 4 hours, and then Ag or C during the sixth hour. Fluids in the overlying chamber were assayed for levels of the mast cell components, histamine and tryptase. There was peak release of both histamine and tryptase during the first hour of Ag incubation (89 +/- 11 ng/ml and 1428 +/- 260 ng/ml, respectively). At continuous Ag-challenge sites, there was a plateau of histamine levels (8.0 to 9.5 ng/ml) during the next 4 hours, whereas tryptase levels decreased progressively to baseline levels. Challenge of continuous Ag-incubation sites with C, a mast cell activator, led to another peak release of both histamine and tryptase. At interrupted Ag-challenge sites, histamine levels decreased abruptly, and tryptase levels decreased progressively after the first hour. Rechallenge of such sites with Ag during the sixth hour induced a peak release of histamine but no increase in tryptase levels. Continuous challenge with C for up to 5 hours in other sites induced an initial peak histamine release without a subsequent plateau. However, such a plateau of histamine (but not tryptase) release occurred after an initial C challenge if Ag was subsequently incubated in a continuous fashion.(ABSTRACT TRUNCATED AT 250 WORDS)

Direct quantitation of skin elasticity in systemic sclerosis

A simple instrument, the "skin elastometer," was used to evaluate the elastic and plastic properties of volar forearm skin in 24 patients with systemic sclerosis and 24 healthy individuals matched for age, race and sex. Skin elastance in 17 patients with diffuse scleroderma was found to be significantly different from matched controls (p less than 0.001), and was associated with clinical skin scores independently determined by examination (r = 0.89, p less than 0.001). Seven patients with limited scleroderma (the CREST variant) had values for skin elastance which were intermediate between those of the patients with diffuse scleroderma and healthy persons. Plastic deformation of the stretched skin was similar in patients and controls. Quantitative measurement of skin elastance is a simple technique which may prove to be of value in the assessment of patients with systemic sclerosis.

[A study of the immune status in patients before heart surgery using the Imunoskintest Sevac kit]

By means of a Immunoskintest Sevac kit the authors examined 99 patients who were subjected to heart surgery with extracorporeal circulation. In the group of patients with an index of more than 1.0 were 7% postoperative infectious complications, in the group with an index smaller than 1.0 there were 19% and in the group of patients with anergy and relative anergy there were 66% infectious complications after operation. The authors consider as risk patients those where anergy or relative anergy was proved, as well as patients with an index lower than 1.0 and a weak response to 2-3 antigens. In risk patients it is essential to make a detailed immunological examination and to correct in a suitable way their immunodeficiency, e. g. by administration of transfer factors. From the results ensues moreover that the immune response of patients, and thus also the development of postoperative infectious complications, is related to the patient's age and the presence of rheumatic disease.

A comparison of six epicutaneous devices in the performance of immediate hypersensitivity skin testing

Six devices commonly used for immediate hypersensitivity epicutaneous skin testing were compared with regard to precision and diagnostic accuracy. Fifteen subjects were tested on the back to 10 mg/ml of histamine phosphate and 50% glycerosaline by prick technique with a smallpox needle (SN), bifurcated needle (BN), Greer "pen" (GP), and blood lancet, and by puncture with the Morrow-Brown needle (MB) and Multi-Test (MT). Five devices were tested in quintuplicate to histamine and once to glycerosaline in each subject; with MT, five histamine and three glycerosaline sites were used. Analysis of the wheal areas obtained with SN, BN, GP, and MB demonstrated comparable degrees of precision (coefficient of variation). The precision of MT was less than the other devices (p less than 0.05). The blood lancet demonstrated intermediate precision. Twenty-two of 45 (49%) of the glycerosaline skin tests performed with MT were falsely positive, significantly more than the other devices (p = 0.0001). We conclude that MB, BN, GP, and SP are comparable devices for use in immediate hypersensitivity skin testing. The low precision and reliability of MT used for testing on the back would appear to make this device less than adequate for diagnostic or research studies. Its high rate of false positive reactions requires caution in interpretation of results when it is used in the clinical diagnosis of allergy.

[Usefulness of Multitest CMI for the measurement of cell-mediated immunity in patients with bronchial asthma]

Cell-mediated immunity has been measured in vivo in 30 patients with allergic-infectious bronchial asthma with the use of Multitest CMI (Merieux). A decrease in the immunological reactivity has been showed in the asthmatic patients. It was expressed by means of the arithmetic mean value of the positive reactions, and was particularly significant in patients who require long-term corticotherapy. The obtained results suggest that Multitest CMI is a new, valuable device in the diagnosis and monitoring the treatment in asthmatic patients.

Allergen-coated lancets (Phazet) for skin prick testing in children

With a new allergen-coated lancet (Phazet), skin prick tests can be made directly on the skin without separate use of liquid extract (the Phazet dry method), and reactions are recorded as for the ordinary method with liquid allergen extract (Pharmalgen) (the Pharmalgen wet method). 100 children were tested in parallel with the two methods. As a double control each Phazet was used twice (Phazet 1 and 2) in each child, who was tested with nine standard allergens. Good agreement was found between the results obtained with the two methods and also between Phazet 1 and Phazet 2. No general reactions were shown in relation to the numerous skin prick tests with allergen extract of a strength up to 100,000 BU/ml. 66% of the children preferred the Phazet while 22% had no preference.

[The Immunoskintest]

To evaluate the surgical risk before serious operations it is possible to use as one of the criteria a skin test the principle of which is an immunity reaction to a defined antigen injected strictly intradermally. It helps us to assess simply the state of immunological reactivity of the cellular type in a large number of persons of different age and thus to estimate to a certain extent the incidence of postoperative infectious complications. In a selected group of 68 patients who were hospitalized at the Orthopaedic Clinic in Plzen in 1987 the Immunoskintest was performed. The authors compare the incidence of infectious complications in different groups by the character of the disease, i.e. in a) planned operations in coxarthritis, b) in patients with injuries of the proximal part of the femur immediately after injury, c) in patients with injuries of the proximal part of the femur treated conservatively. The incidence of infectious complications is evaluated in conjunction with the results of the Immunoskintest.

Easier patch testing with TRUE Test

TRUE Test, a standardized, ready-to-apply patch test system, is made from polyester covered with a film of allergens incorporated in a hydrophilic polymer. The patches are mounted on nonwoven cellulose tape with acrylic adhesive, covered with siliconized plastic, and packed in an air-tight and light-impermeable envelope. When the test strip is taped on the skin, perspiration hydrates the film and transforms it to a gel, which causes the allergen to be released. The first panel of 12 allergens and allergen mixes is standardized and tested for stability in vitro and in vivo. The accuracy of the test panel has been certified in international multicenter studies by comparing it with present patch test techniques. A second panel of 11 more allergens was completed in 1988. The two test panels include the full standard panel of the North American Contact Dermatitis Group.

Delayed pressure urticaria, objective evaluation of a variable disease using a dermographometer and assessment of treatment using colchicine

A randomized double-blind placebo controlled trial of colchicine in the treatment of 13 patients with delayed pressure urticaria enabled us to assess some of the variables in this disorder. We have modified a previously described method of pressure testing using a calibrated dermographometer and shown a pressure induced papular dose response curve. Assessment of disease activity was based on the number of pressure weals which occurred, the size of delayed pressure induced papules using a dermographometer calibrated at 9.75 x 10(5) pascals for five separate time periods on the back and estimations of erythrocyte sedimentation rate and the acute phase protein levels. We have been unable to show a therapeutic effect using colchicine 0.5 mg bd for I week.

[Use of the Sevac Immunoskintest kit in children]

The Immunoskintest SEVAC is a kit of antigens for skin tests to evaluate the state of cellular immunity. By means of this kit 591 children from birth to 15 years were examined: the children suffered from acute diseases of the CNS, respiratory diseases incl. relapsing ones, a malignant tumour, haematological disease, and there were children who were Mantoux II negative and healthy children from children's homes. The value of the index of the skin test was referred to the child's age and sex; the lowest values were recorded in children with immunosuppressive therapy and the highest values of the skin test were found in healthy children and those with acute disease; boys had higher values than girls. In none of the children undesirable side-reaction were recorded after administration of the antigens.

Comparison between modified skin prick test with standardized allergen extracts and Phazet

Skin prick tests (SPTs) represent one of the most common techniques of skin testing and are of great value, especially when standardized extracts are used. Phazet is a puncture test involving needles coated with standardized allergens. Phazet and SPTs have been compared in 130 subjects tested with six standardized allergen extracts: orchard-grass, olive, and mugwort pollens, cat dander, Dermatophagoides pteronyssinus, and Alternaria. Patients have been carefully selected on the basis of a suggestive clinical history, SPTs, and RAST. For all allergenic species, at least 20 nonsensitive individuals have been tested. The sensitivity (true positive in percent of patients with disease) of Phazet was 99.4%, and its specificity (true negative in percent of patients without disease) was 99.2%. It is concluded that Phazet and SPTs with standardized extracts are equally effective in the diagnosis of immediate-type allergy and that standardized extracts have improved the diagnosis of allergy, especially for previously poorly characterized extracts, such as Alternaria.

Allergy screening including a comparison of prick test results with allergen-coated lancets (Phazet) and liquid extracts

During an allergy screening of families with a history of allergy in one or more subjects, skin prick tests (SPT) were performed in duplicate in 314 adults. The tests were performed with a new type of lancet with a 0.9 mm long point, loaded either with allergen (Phazet) or used together with standardized extracts (10,000 and 100,000 BU/ml). Wheals obtained with both methods were compared, and related to total IgE concentrations and history. A wheal area of 3 and 7 mm2 was used as cut-off limit. Results with Phazet were close to those with Pharmalgen 100,000 BU/ml. With both methods precision was good for allergens, but less for Phazet histamine than for the corresponding wet test. SPT results obtained with Phazet and 100,000 BU/ml correlated better with history than the results with 10,000 BU/ml. Using a wheal size of 7 mm2 as cut-off limit the efficiency for five tested allergens was 91%. "False positive" tests, possibly indicating an unobserved or latent type of allergy, were found more often with higher serum IgE concentrations. The safety of SPT was confirmed and Phazet was well accepted by nurses and tested subjects.

[Use of a new prepared patch in general practice (Epiquick)]

We report on an improved technique of epicutaneous testing. The Finn chambers of the Epiquick system are already loaded with the test material. In a study on 36 patients, the new system was compared with the conventional patch test. The results of both techniques corresponded well for 9 allergens (72.7% at 72 h). Further investigations must settle whether the discrepancies found with some allergens are related to the new system. The simple handling of Epiquick can save considerable time in the patch testing procedure.