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Millán Martínez R, Sorcia Ramírez G, Muñoz-Pérez MJ. Sensitization to Aeroallergens in a Mexican Cohort with Allergic Conjunctivitis: A Cross-sectional Retrospective Study Conducted in Ángeles Puebla Hospital. Ocul Immunol Inflamm 2024; 32:11-18. [PMID: 36508712 DOI: 10.1080/09273948.2022.2145487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
Abstract
This study aims to evaluate the sensitization distribution of aeroallergens in patients with allergic conjunctivitis (AC) living in a temperate subhumid region and to describe the prevalence in a Mexican cohort. A total of 761 patient records were revisited, including the results of the skin prick test (SPT) for 45 aeroallergens. We found 292 patients with AC and a positive SPT in a 5-year period. The most frequent aeroallergens include dust mites (69.2% for Dermatophagoides pteronyssinus and 47.6% for Dermatophagoides farinae), trees (36% for cypress and 22.6% for ash), animals (33.9% for dogs and 26.7% for cats), and grasses (21.2% for Paspalum notalum and 19.9% for Poa pratensis). Among the studied population, a prevalence of 38.4% for the disease was calculated. House dust mites were responsible for most sensitizations found in the studied population. There is a high prevalence of AC in the selected cohort during the period studied.
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Affiliation(s)
| | | | - María J Muñoz-Pérez
- Department of Investigation, Universidad Anáhuac Puebla, San Andrés Cholula, Mexico
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Chiaranairungroj M, Chatchatee P, Srituravanich W. The effect of applied force and device design on skin prick test performance. Ann Allergy Asthma Immunol 2023; 130:312-316. [PMID: 36436784 DOI: 10.1016/j.anai.2022.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin prick tests (SPTs) are difficult to standardize, and SPT performance mainly relies on the clinician's expertise. So far, the effect of various factors such as device types, shape, variety of material type, and applied force on the performance of SPT has not been extensively investigated. OBJECTIVE To investigate the effect of various factors, including type or shape of devices, material type, and applied force, on the performance of SPT. METHODS Four SPT devices with different shapes and materials were applied on 12 subjects under 3 different applied forces (30, 45, and 60 g). The results were compared with standard method using an ALK lancet pricked by an experienced clinician. RESULTS A total of 480 pricks were conducted on 12 subjects. The wheal sizes and sensitivities of all devices increased with higher applied forces. The thinner lancets with a long sharp tip had relatively higher analytical sensitivities and provided 100% sensitivity at applied forces of 45 g and above. The pain scores of all devices at applied forces of 30 to 60 g ranged from 1.00 to 1.81 with minimal incidences of bleeding (0%-4.17%), whereas the pain score of the standard method by the ALK lancet was 2.08 with much higher incidences of bleeding at 27.08%. CONCLUSION The type/shape of the SPT device and applied force are the essential factors affecting the performance of SPT. The study result could pave the way toward higher performance and standardized SPT. TRIAL REGISTRATION The Thai Clinical Trials Registry identification number: TCTR20220627004 (https://www.thaiclinicaltrials.org/show/TCTR20220627004).
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Affiliation(s)
- Muthita Chiaranairungroj
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Pantipa Chatchatee
- HAUS IAQ Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Werayut Srituravanich
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
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White KM. Skin prick testing technique: Under pressure to improve? Ann Allergy Asthma Immunol 2023; 130:263-264. [PMID: 36868720 DOI: 10.1016/j.anai.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 03/05/2023]
Affiliation(s)
- Kevin M White
- Allergy and Immunology Clinic, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas.
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Testera-Montes A, Jurado R, Salas M, Eguiluz-Gracia I, Mayorga C. Diagnostic Tools in Allergic Rhinitis. FRONTIERS IN ALLERGY 2021; 2:721851. [PMID: 35386974 PMCID: PMC8974728 DOI: 10.3389/falgy.2021.721851] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Allergic mechanisms account for most cases of chronic rhinitis. This condition is associated with significant impairment of quality of life and high indirect costs. The identification of the allergic triggers of rhinitis has been historically based on the performance of atopy test [skin prick test (SPT) and serum allergen-specific (s)IgE]. Nevertheless, these tests only denote sensitization, and atopy and allergy represent two different phenomena. It is now clear that allergic phenotypes of rhinitis can exist in both atopic (allergic rhinitis, AR) and non-atopic (local allergic rhinitis, LAR) individuals. Moreover, both allergic phenotypes can coexist in the same rhinitis patient (dual allergic rhinitis, DAR). Therefore, a diagnostic approach merely based on atopy tests is associated with a significant rate of misdiagnosis. The confirmation of the allergic etiology of rhinitis requires the performance of in vivo test like the nasal allergen challenge (NAC). NAC is mandatory for the diagnosis of LAR and DAR, and helps decide the best management approach in difficult cases of AR. Nevertheless, NAC is a laborious technique requiring human and technical resources. The basophil activation test (BAT) is a patient-friendly technique that has shown promising results for LAR and DAR diagnosis. In this review, the diagnostic usefulness for chronic rhinitis of SPT, NAC, olfactory tests, serum sIgE, BAT and the quantification of inflammatory mediators in nasal samples will be discussed. The accurate performance of an etiologic diagnosis of rhinitis patients will favor the prescription of specific therapies with disease-modifying potential like allergen immunotherapy.
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Affiliation(s)
| | - Raquel Jurado
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Maria Salas
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- *Correspondence: Cristobalina Mayorga
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Amirneni A, Tversky J. High Histamine Control Concentration Leads to False Negative Allergy Skin Testing. Am J Rhinol Allergy 2021; 35:854-860. [PMID: 33827292 DOI: 10.1177/19458924211008685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Allergy skin test reliability depends on the reagents and controls selected. Histamine is used at 1 mg/ml and 6 mg/ml concentration but few studies address the rationale for selecting one versus the other and how this may impact diagnostic accuracy. OBJECTIVE To determine the rate of false negative allergen skin tests responses between UniTest PC (using the 1 mg/mL histamine) and Quintip devices (using 6 mg/mL) for 4 common aeroallergens. METHODS Subjects aged 18-65 with symptoms of allergy to cat and/or ragweed received skin testing with 4 aeroallergens (dust mite mix, timothy grass, ragweed, cat), histamine and control diluent. Those individuals who tested positive to cat or ragweed with one skin prick test (SPT) device but not the other then proceeded to nasal allergen challenge (NAC). The primary outcomes were the aeroallergen false negative rates and sensitivities of the skin test devices followed by nasal allergen (NAC). RESULTS Twenty-five individuals were recruited and underwent a total of 300 SPTs. SPT to allergens (ragweed, dust mite, cat, and timothy grass) resulted in a statistically significant difference in wheal size among the two skin testing devices (p value <0.0001, 0.0001, 0.0006, and 0.0053 respectively). Six NAC procedures were performed to cat/ragweed and 5 of 6 (83% were positive). The overall allergen sensitivity rate for UniTest and Quintip were 97% and 78% respectively with most false negatives due to the use of 6 mg/ml histamine control reagent. CONCLUSION Our study shows that 6 mg/ml concentration of histamine control reagent may contribute to a false interpretation of aeroallergen skin prick test results.
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Affiliation(s)
- Amulya Amirneni
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jody Tversky
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Watts-Oquendo ET, Coppola-Fasick G, Arroyo-Flores E, Soto-Salgado M, Nazario S. Effect of topical pramoxine hydrochloride on discomfort, wheal and flare associated with epicutaneous allergy test. Ann Allergy Asthma Immunol 2019; 122:652-653. [PMID: 30928414 DOI: 10.1016/j.anai.2019.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Erika T Watts-Oquendo
- Department of Internal Medicine, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Giannina Coppola-Fasick
- Allergy and Immunology Section, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Erving Arroyo-Flores
- Allergy and Immunology Section, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Marievelisse Soto-Salgado
- Department of Biochemistry, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Sylvette Nazario
- Allergy and Immunology Section, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
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Reliability of allergy skin testing. Ann Allergy Asthma Immunol 2019; 120:80-83. [PMID: 29273134 DOI: 10.1016/j.anai.2017.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/15/2017] [Accepted: 10/12/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Percutaneous allergen skin testing remains an established benchmark for diagnosing atopic disease. The reliability of skin testing depends greatly on the performance of allergen extracts used, methods used, and the presence of antihistamine medications. OBJECTIVE To determine the differential effect of cetirizine on 2 different concentrations of histamine control solution and 5 common allergens used for percutaneous skin testing. METHODS Twelve individuals underwent skin testing with histamine (1 and 6 mg/mL), control diluent, and 5 common aeroallergens. Wheal and flare measurements were measured in a masked fashion by a single operator. Cetirizine was administered for 4 consecutive days to determine the effect on both histamine and allergen wheal and flare responses. RESULTS A total of 384 skin tests were performed on 12 volunteers. Cetirizine began to suppress wheal and flare responses at 1 hour (P < .05), with maximum suppression at day 5 (P < .05). Wheal and flare responses returned to greater than 90% baseline within 4 days of not taking cetirizine. Suppression was more apparent with 1 vs 6 mg/mL of histamine (62% vs 33%). Four of the 12 individuals taking cetirizine had a positive skin test result using 6 mg/mL of histamine control when the 1-mg/mL histamine test result was negative. Importantly, twice as many individuals had false-negative allergen responses using 6 mg/mL of histamine vs the 1 mg/mL as a positive control, although this finding did not reach statistical significance. CONCLUSION The use of a 6-mg/mL histamine control for some percutaneous skin test devices may result in more false-negative allergen responses because of the inability to detect the presence of antihistamines.
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Kowalski ML, Ansotegui I, Aberer W, Al-Ahmad M, Akdis M, Ballmer-Weber BK, Beyer K, Blanca M, Brown S, Bunnag C, Hulett AC, Castells M, Chng HH, De Blay F, Ebisawa M, Fineman S, Golden DBK, Haahtela T, Kaliner M, Katelaris C, Lee BW, Makowska J, Muller U, Mullol J, Oppenheimer J, Park HS, Parkerson J, Passalacqua G, Pawankar R, Renz H, Rueff F, Sanchez-Borges M, Sastre J, Scadding G, Sicherer S, Tantilipikorn P, Tracy J, van Kempen V, Bohle B, Canonica GW, Caraballo L, Gomez M, Ito K, Jensen-Jarolim E, Larche M, Melioli G, Poulsen LK, Valenta R, Zuberbier T. Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement. World Allergy Organ J 2016; 9:33. [PMID: 27777642 PMCID: PMC5062928 DOI: 10.1186/s40413-016-0122-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/19/2016] [Indexed: 01/14/2023] Open
Abstract
One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation. Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures. Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended. This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.
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Affiliation(s)
- Marek L. Kowalski
- Department of Immunology, Rheumatology & Allergy, Medical University of Lodz, 251 Pomorska Str, 92-213 Lodz, Poland
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao, Spain
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mubeccel Akdis
- Swiss institute of Allergy & Asthma research, Davos, Switzerland
| | - Barbara K. Ballmer-Weber
- Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich, Switzerland
| | - Kirsten Beyer
- Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin, Germany
| | - Miguel Blanca
- Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga, Spain
| | - Simon Brown
- Royal Perth Hospital, Department of Emergency Medicine, Perth, WA Australia
| | - Chaweewan Bunnag
- Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Mariana Castells
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hiok Hee Chng
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Frederic De Blay
- Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg, France
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Stanley Fineman
- Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, Georgia
| | | | - Tari Haahtela
- Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Makowska
- CSK, Department of Allergy & Clinical Immunology, Lodz, Poland
| | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona, Spain
| | - John Oppenheimer
- UMDNJ – Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey, USA
| | - Hae-Sim Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, South Korea
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa, Italy
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Harald Renz
- Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg, Germany
| | - Franziska Rueff
- Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen, Germany
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas, Venezuela
| | - Joaquin Sastre
- Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain
| | | | - Scott Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | | | - Vera van Kempen
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - Barbara Bohle
- Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - G Walter Canonica
- Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa, Italy
| | - Luis Caraballo
- Immunology Department, Universidad De Cartagena, Cartagena, Colombia
| | | | - Komei Ito
- Department of Allergy, Aichi Children’s Health and Medical Center, Aichi, Japan
| | - Erika Jensen-Jarolim
- Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria
| | - Mark Larche
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | | | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | | | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
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Andersen HH, Lundgaard AC, Petersen AS, Hauberg LE, Sharma N, Hansen SD, Elberling J, Arendt-Nielsen L. The Lancet Weight Determines Wheal Diameter in Response to Skin Prick Testing with Histamine. PLoS One 2016; 11:e0156211. [PMID: 27213613 PMCID: PMC4877047 DOI: 10.1371/journal.pone.0156211] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 05/03/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Skin prick test (SPT) is a common test for diagnosing immunoglobulin E-mediated allergies. In clinical routine, technicalities, human errors or patient-related biases, occasionally results in suboptimal diagnosis of sensitization. OBJECTIVE Although not previously assessed qualitatively, lancet weight is hypothesized to be important when performing SPT to minimize the frequency of false positives, false negatives, and unwanted discomfort. METHODS Accurate weight-controlled SPT was performed on the volar forearms and backs of 20 healthy subjects. Four predetermined lancet weights were applied (25 g, 85 g, 135 g and 265 g) using two positive control histamine solutions (1 mg/mL and 10 mg/mL) and one negative control (saline). A total of 400 SPTs were conducted. The outcome parameters were: wheal size, neurogenic inflammation (measured by superficial blood perfusion), frequency of bleeding, and the lancet provoked pain response. RESULTS The mean wheal diameter increased significantly as higher weights were applied to the SPT lancet, e.g. from 3.2 ± 0.28 mm at 25 g to 5.4 ± 1.7 mm at 265 g (p<0.01). Similarly, the frequency of bleeding, the provoked pain, and the neurogenic inflammatory response increased significantly. At 265 g saline evoked two wheal responses (/160 pricks) below 3 mm. CONCLUSION AND CLINICAL RELEVANCE The applied weight of the lancet during the SPT-procedure is an important factor. Higher lancet weights precipitate significantly larger wheal reactions with potential diagnostic implications. This warrants additional research of the optimal lancet weight in relation to SPT-guidelines to improve the specificity and sensitivity of the procedure.
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Affiliation(s)
- Hjalte H. Andersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anna Charlotte Lundgaard
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anne S. Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise E. Hauberg
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Neha Sharma
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Sofie D. Hansen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Elberling
- The Allergy Clinic, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Oppenheimer J. Skin testing versus in vitro testing in the evaluation of aeroallergy: The great debate. Am J Rhinol Allergy 2015; 29:362-4. [PMID: 26358347 DOI: 10.2500/ajra.2015.29.4211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When one examines reviews regarding diagnostic allergy testing, it generally is noted that the advantage of skin testing is that it uses testing to an end organ, is less expensive, is more sensitive, and provides immediate results, which are easily visualized by the patient. In the case of in vitro testing, it is thought to be more helpful for patients with dermographia or widespread dermatitis, is not affected by H1 or H2 antagonists, and is thought to be safer than skin testing. This may not be entirely correct because studies actually demonstrated phlebotomy to be associated with more morbidity than skin-prick testing. Other concerns regarding both tests include allergen quality, the need from proficiency testing, and the fact that these tests should be used for corroborating a diagnosis as opposed to a screening test for allergy.
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Affiliation(s)
- John Oppenheimer
- Pulmonary and Allergy Associates, Summit, New Jersey and Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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Klimek L, Werfel T, Vogelberg C, Jung K. Authorised allergen products for intracutaneous testing may no longer be available in Germany: Allergy textbooks have to be re-written. ALLERGO JOURNAL INTERNATIONAL 2015; 24:84-93. [PMID: 26120551 PMCID: PMC4479459 DOI: 10.1007/s40629-015-0051-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Beside the skin prick test, the intracutaneous test represents the most important skin test method for detecting type-1 allergies. With the incorporation of European directives into national law, test allergens used for allergy diagnosis are deemed medicinal products within the meaning of the German Medicinal Products Act (Arzneimittelgesetz) and therefore require marketing authorisation for distribution in Germany. The high costs of acquiring and maintaining these authorisations have lead to no new finished intracutaneous test products being authorized in Germany for more than 20 years. Instead, most manufacturers have voluntarily withdrawn their existing marketing authorisations for intracutaneous test extracts. The last manufacturer to offer approved finished allergen products for intracutaneous tests recently announced that it would now cease production and distribution of these solutions. METHODS Research on the current European and German legislation; selective literature search in Medline, including national and international guidelines and Cochrane meta-analyses; licensing information on the Paul-Ehrlich-Institute homepage (www.pei.de) as well as in the Bundesanzeiger (Federal Gazette). RESULTS According to information on www.pei.de, marketing authorisations still existed as of 31.01.2015 for intracutaneous test solutions of six grass/cereal/herbal pollens, seven tree pollens, ten food allergens, twelve moulds and yeasts as well as two fungal mixtures, five house dust and storage mites and five animal epithelia/danders, all held by only one company in Germany. These marketing authorisations were granted between 16th March 1987 and 17th January 1992; more recent marketing authorisations do not exist. CONCLUSIONS European legislation and the associated increase in production and licensing costs have already lead to numerous suppliers withdrawing their marketing authorisation for diagnostic test allergens - marketing authorisations for 443 diagnostic allergens were voluntarily withdrawn by manufacturers in 2013 alone. If the announced restrictions on the allergen portfolio go ahead, considerable problems in the management of allergy patients in Germany due to the discontinuation of the intracutaneous test are likely to be encountered. Moreover, the fact that a diagnostic procedure that has been established for decades seems set to disappear quite simply because all the requisite substances vanish from the market in one fell swoop may well be without parallel in modern medicine. The situation for skin prick test allergens is less dramatic, although, here again, the available range is becoming increasingly limited.
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Affiliation(s)
- Ludger Klimek
- />Centre for Rhinology and Allergology, An den Quellen 10, 65183 Wiesbaden, Germany
- />Medical Association of German Allergologists (Ärzteverband Deutscher Allergologen, AeDA), Dreieich, Germany
| | - Thomas Werfel
- />Dept of Dermatology, Allergology and Venereology, Division of Immunodermatology and Experimental Allergology, Hannover Medical University, Hannover, Germany
- />German Society for Allergology and Clinical Immunology (Deutsche Gesellschaft für Allergologie und Klinische Immunologie, DGAKI), Aystetten, Germany
| | - Christian Vogelberg
- />Department of Pediatrics and Adolescent Medicine, Dresden University Allergy Centre (UAC), Dresden, Germany
- />German Society for Pediatric Allergology (Deutsche Gesellschaft für Pädiatrische Allergologie, GPA), Aachen, Germany
| | - Kirsten Jung
- />Group Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
- />Medical Association of German Allergologists (Ärzteverband Deutscher Allergologen, AeDA), Dreieich, Germany
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Möller C. Histamine and Its Relation to Allergens in the Skin Prick Test. Int Arch Allergy Immunol 2015; 166:241-2. [PMID: 25968299 DOI: 10.1159/000381878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Klimek L, Werfel T, Vogelberg C, Jung K. Zugelassene Fertigallergenlösungen zur Intrakutantestung werden in Deutschland bald nicht mehr verfügbar sein. ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Hong X, Hao K, Ladd-Acosta C, Hansen KD, Tsai HJ, Liu X, Xu X, Thornton TA, Caruso D, Keet CA, Sun Y, Wang G, Luo W, Kumar R, Fuleihan R, Singh AM, Kim JS, Story RE, Gupta RS, Gao P, Chen Z, Walker SO, Bartell TR, Beaty TH, Fallin MD, Schleimer R, Holt PG, Nadeau KC, Wood RA, Pongracic JA, Weeks DE, Wang X. Genome-wide association study identifies peanut allergy-specific loci and evidence of epigenetic mediation in US children. Nat Commun 2015; 6:6304. [PMID: 25710614 PMCID: PMC4340086 DOI: 10.1038/ncomms7304] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/16/2015] [Indexed: 12/17/2022] Open
Abstract
Food allergy (FA) affects 2–10% of U.S. children and is a growing clinical and public health problem. Here we conduct the first genome-wide association study of well-defined FA, including specific subtypes (peanut, milk, and egg) in 2,759 U.S. participants (1,315 children; 1,444 parents) from the Chicago Food Allergy Study; and identify peanut allergy (PA)-specific loci in the HLA-DR and -DQ gene region at 6p21.32, tagged by rs7192 (p=5.5×10−8) and rs9275596 (p=6.8×10−10), in 2,197 participants of European ancestry. We replicate these associations in an independent sample of European ancestry. These associations are further supported by meta-analyses across the discovery and replication samples. Both single-nucleotide polymorphisms (SNPs) are associated with differential DNA methylation levels at multiple CpG sites (p<5×10−8); and differential DNA methylation of the HLA-DQB1 and HLA-DRB1 genes partially mediate the identified SNP-PA associations. This study suggests that the HLA-DR and -DQ gene region likely poses significant genetic risk for PA.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
| | - Kasper D Hansen
- 1] Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health Baltimore, Baltimore, Maryland 21205, USA [2] McKusick-Nathans Insitute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Hui-Ju Tsai
- 1] Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA [2] Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan 35053, Taiwan [3] Department of Public Health, China Medical University, Taichung 40402, Taiwan
| | - Xin Liu
- 1] Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA [2] Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Xin Xu
- Guangdong Provincial Institute of Nephrology, Southern Medical University, Guangzhou 510515, China
| | - Timothy A Thornton
- Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Deanna Caruso
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA
| | - Corinne A Keet
- 1] Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA [2] Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Yifei Sun
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health Baltimore, Baltimore, Maryland 21205, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA
| | - Wei Luo
- 1] Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA [2] College of Computer Science and Technology, Huaqiao University, Xiamen 361021, China
| | - Rajesh Kumar
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA
| | - Ramsay Fuleihan
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA
| | - Anne Marie Singh
- Department of Pediatrics and Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois 61611, USA
| | - Jennifer S Kim
- 1] Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA [2] NorthShore University HealthSystem, Evanston, Illinois 60201, USA
| | - Rachel E Story
- 1] Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA [2] NorthShore University Health Systems, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Ruchi S Gupta
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA
| | - Peisong Gao
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
| | - Zhu Chen
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA
| | - Sheila O Walker
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA
| | - Tami R Bartell
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
| | - M Daniele Fallin
- Department of Mental Health, Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Robert Schleimer
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia; Perth and Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland 4029, Australia
| | - Kari Christine Nadeau
- Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Robert A Wood
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Jacqueline A Pongracic
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA
| | - Daniel E Weeks
- Departments of Human Genetics and Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
| | - Xiaobin Wang
- 1] Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, E4132, Baltimore, Maryland 21205, USA [2] Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Fatteh S, Rekkerth DJ, Hadley JA. Skin prick/puncture testing in North America: a call for standards and consistency. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2014; 10:44. [PMID: 25221603 PMCID: PMC4162909 DOI: 10.1186/1710-1492-10-44] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Skin prick/puncture testing (SPT) is widely accepted as a safe, dependable, convenient, and cost-effective procedure to detect allergen-specific IgE sensitivity. It is, however, prone to influence by a variety of factors that may significantly alter test outcomes, affect the accuracy of diagnosis, and the effectiveness of subsequent immunotherapy regimens. Proficiency in SPT administration is a key variable that can be routinely measured and documented to improve the predictive value of allergy skin testing. METHODS Literature surveys were conducted to determine the adherence to repeated calls for development and implementation of proficiency testing standards in the 1990's, the mid-2000's and the 2008 allergy diagnostics practice parameters. RESULTS Authors publishing clinical research in peer-reviewed journals and conducting workshops at annual scientific meetings have recommended proficiency testing based primarily on its potential to reduce variability, minimize confounding test results, and promote more effective immunotherapeutic treatments. Very few publications of clinical studies, however, appear to report proficiency testing data for SPT performance. Allergen immunotherapy recommendations are updated periodically by the Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI). CONCLUSIONS Despite consensus that all staff who perform SPT should meet basic quality assurance standards that demonstrate their SPT proficiency, the gap between recommendations and daily practice persists. By embracing standards, the accuracy of SPT and allergy diagnosis can be optimized, ultimately benefiting patients with allergic disease.
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Affiliation(s)
- Shahnaz Fatteh
- />Allergy, Asthma Care Center of Florida, 33324 Plantation, FL USA
| | | | - James A Hadley
- />Physicians Regional Medical Center, 34119 Naples, FL USA
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Imai T, Yanagida N, Ogata M, Komata T, Tomikawa M, Ebisawa M. The skin prick test is not useful in the diagnosis of the immediate type food allergy tolerance acquisition. Allergol Int 2014; 63:205-10. [PMID: 24561767 DOI: 10.2332/allergolint.12-oa-0513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/10/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Some studies have been reported about positioning of SPT in the diagnosis of food allergy. On the other hand, it is not yet clear about the positioning of SPT in the diagnosis of tolerance acquisition of the immediate type food allergy. METHODS The retrospective study had been conducted for 236 egg allergic children (51.3 months in mean), 127 milk allergic children (53.4 months), and 96 wheat allergic children (42.6 months). The retrospective analysis of serum nonspecific and antigen-specific IgE levels, SPT, and OFC had been conducted for each allergic patient. All OFC had been conducted to verify the acquisition of tolerance against eliminated food. RESULTS The OFC was positive in 61 (25.8%) hen's egg allergies, 34 (26.8%) milk allergies and 33 (34.4%) wheat allergies. The greatest AUC for each allergen is as following; hen's egg for egg white specific IgE at 0.745, milk/histamine (wheal) index at 0.718, and wheat for wheal size at 0.597. For the predictive decision points, the highest accuracy rate was at 25.8% for an egg white wheal of 9.5mm, at 26.8% for a milk wheal of 9.5mm, and at 34.4% for a wheal of 6.5mm. CONCLUSIONS As a result of this analysis, the diagnostic accuracy of SPT had not been satisfactory to judge the acquisition of tolerance in allergic children for eggs, milk and wheat. Therefore, this is not a strong evidence to testify the tolerance of the immediate type food allergy.
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Affiliation(s)
- Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan; Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Mika Ogata
- Department of Pediatrics, National Hospital Organization, National Kumamoto Medical Center, Kumamoto, Japan
| | - Takatsugu Komata
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Morimitsu Tomikawa
- Department of Pediatrics, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, National Sagamihara Hospital, Kanagawa, Japan
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Buyuktiryaki B, Sahiner UM, Karabulut E, Cavkaytar O, Tuncer A, Sekerel BE. Optimizing the use of a skin prick test device on children. Int Arch Allergy Immunol 2013; 162:65-70. [PMID: 23816800 DOI: 10.1159/000350788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 03/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies comparing skin prick test (SPT) devices have revealed varying results in performance and there is little known about their use on children. METHODS We performed 2 complementary studies to test the sensitivity, reproducibility and acceptability of commercially available SPT devices (Stallerpoint, Antony, France) using different application techniques. In the first part, histamine/saline was put on as a drop by use of a vial (V), and in the second part it was transferred from a well with the aid of the test device (W). The techniques were as follows: apply vertical pressure (Stallerpoint-VP or Stallerpoint-WP), apply vertical pressure with 90° clockwise rotation (Stallerpoint-VC or Stallerpoint-WC) and apply vertical pressure with 90° clockwise and counter-clockwise rotations (Stallerpoint-VCC or Stallerpoint-WCC). For comparison, ALK Lancet was used with a technique of 'drop and apply vertical pressure'. RESULTS In the first part, sensitivities of the Stallerpoint-VC (96.6%), Stallerpoint-VCC (95.5%) and ALK Lancet (93.2%) techniques were superior (p < 0.001) to the other Stallerpoint-VP and Stallerpoint-WP techniques (76.1 and 46.6%). Intrapatient coefficient of variation (CV) values were 15.0, 18.9, 15.4, 22.4 and 48.5%, respectively. Interpatient CV ranged between 22.8 and 55.1%. In the second part, the Stallerpoint-WC (98.8%), WCC (97.5%) and ALK Lancet (98.8%) techniques yielded high sensitivities, whereas the sensitivity of Stallerpoint-WP (28.7%) was very low. There were false-positive reactions in the Stallerpoint-VCC and WCC techniques. CONCLUSION In children, the SPT technique was found to be as important as the testing device. Stallerpoint-VC and WC techniques are reliable, tolerable and comparable with the ALK Lancet technique.
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Affiliation(s)
- Betul Buyuktiryaki
- Department of Pediatrics, Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
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Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, Canonica GW, Carlsen KH, Cox L, Haahtela T, Lodrup Carlsen KC, Price D, Samolinski B, Simons FER, Wickman M, Annesi-Maesano I, Baena-Cagnani CE, Bergmann KC, Bindslev-Jensen C, Casale TB, Chiriac A, Cruz AA, Dubakiene R, Durham SR, Fokkens WJ, Gerth-van-Wijk R, Kalayci O, Kowalski ML, Mari A, Mullol J, Nazamova-Baranova L, O'Hehir RE, Ohta K, Panzner P, Passalacqua G, Ring J, Rogala B, Romano A, Ryan D, Schmid-Grendelmeier P, Todo-Bom A, Valenta R, Woehrl S, Yusuf OM, Zuberbier T, Demoly P. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012; 67:18-24. [PMID: 22050279 DOI: 10.1111/j.1398-9995.2011.02728.x] [Citation(s) in RCA: 363] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This pocket guide is the result of a consensus reached between members of the Global Allergy and Asthma European Network (GA(2) LEN) and Allergic Rhinitis and its Impact on Asthma (ARIA). The aim of the current pocket guide is to offer a comprehensive set of recommendations on the use of skin prick tests in allergic rhinitis-conjunctivitis and asthma in daily practice. This pocket guide is meant to give simple answers to the most frequent questions raised by practitioners in Europe, including 'practicing allergists', general practitioners and any other physicians with special interest in the management of allergic diseases. It is not a long or detailed scientific review of the topic. However, the recommendations in this pocket guide were compiled following an in-depth review of existing guidelines and publications, including the 1993 European Academy of Allergy and Clinical Immunology position paper, the 2001 ARIA document and the ARIA update 2008 (prepared in collaboration with GA(2) LEN). The recommendations cover skin test methodology and interpretation, allergen extracts to be used, as well as indications in a variety of settings including paediatrics and developing countries.
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Affiliation(s)
- J Bousquet
- Department of Respiratory Diseases, University Hospital, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Weeks JA, Harper RA, Simon RA, Burdick JD. Assessment of sensitization risk of a laundry pre-spotter containing protease. Cutan Ocul Toxicol 2011; 30:272-9. [DOI: 10.3109/15569527.2011.565010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Masse MS, Granger Vallée A, Chiriac A, Dhivert-Donnadieu H, Bousquet-Rouanet L, Bousquet PJ, Demoly P. Comparison of five techniques of skin prick tests used routinely in Europe. Allergy 2011; 66:1415-9. [PMID: 21797883 DOI: 10.1111/j.1398-9995.2011.02679.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin prick tests represent indispensable tools in allergy, even more than 30 years after their introduction in clinical practice. OBJECTIVES Few recent European studies have focused on this topic and we thus wanted to compare the instruments most often used today. METHODS Four instruments were investigated: the 23G intravenous (IV) needle, the ALK Lancet, the Stallergenes (STG) Prick Lancet and the Stallerpoint(®) (using two different methods). Sensitivity, reproducibility, and acceptability were evaluated. In 22 subjects, we calculated the sensitivity and reproducibility (both intra- and interpatient) of these methods by testing the positive control five times. In 50 subjects, we tested the single-blind acceptability of these same five techniques. RESULTS In terms of sensitivity, the IV needle (100%) and metal lancets (96% for the ALK Lancet and 98% for the STG Prick Lancet) were superior (P < 0.01) to the two Stallerpoint(®) methods (20% and 57%). Intrapatient reproducibility was 16.2%, 14.6%, 15.0%, 97.1% and 18.1%, respectively. The instruments that were best tolerated by the patients were the IV needle and the two metal lancets. CONCLUSION Metal needles and/or lancets are the tools of choice for skin prick testing.
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Affiliation(s)
- M S Masse
- Département de Pneumologie, Unité d'Exploration des allergies et INSERM U, Hôpital Arnaud de Villeneuve, Montpellier, France
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Scadding G, Hellings P, Alobid I, Bachert C, Fokkens W, van Wijk RG, Gevaert P, Guilemany J, Kalogjera L, Lund V, Mullol J, Passalacqua G, Toskala E, van Drunen C. Diagnostic tools in Rhinology EAACI position paper. Clin Transl Allergy 2011; 1:2. [PMID: 22410181 PMCID: PMC3294630 DOI: 10.1186/2045-7022-1-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/10/2011] [Indexed: 01/10/2023] Open
Abstract
This EAACI Task Force document aims at providing the readers with a comprehensive and complete overview of the currently available tools for diagnosis of nasal and sino-nasal disease. We have tried to logically order the different important issues related to history taking, clinical examination and additional investigative tools for evaluation of the severity of sinonasal disease into a consensus document. A panel of European experts in the field of Rhinology has contributed to this consensus document on Diagnostic Tools in Rhinology.
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Weinmayr G, Genuneit J, Nagel G, Björkstén B, van Hage M, Priftanji A, Cooper P, Rijkjärv MA, von Mutius E, Tsanakas J, Forastiere F, Doekes G, Garrido JB, Suarez-Varela MM, Bråbäck L, Strachan DP. International variations in associations of allergic markers and diseases in children: ISAAC Phase Two. Allergy 2010; 65:766-75. [PMID: 20028376 DOI: 10.1111/j.1398-9995.2009.02283.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Circulating allergen-specific IgE (sIgE) and skin prick tests (SPT) are used to define atopy. Downregulation of local inflammatory responsiveness has been proposed to explain a low prevalence of positive SPTs in less affluent countries. We analysed the association between SPTs, total and allergen-specific IgE and their relationships to allergic symptoms in centres with diverse living conditions. METHODS Cross-sectional studies of stratified random samples of 8 to 12-year-old children (n = 7461) used the standardized methodology of Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC). Symptoms of asthma, rhinitis and eczema were ascertained by parental questionnaires. Skin examination, hypertonic saline bronchial challenge, six aeroallergen SPTs and measurements of serum total IgE and sIgE were performed. RESULTS In nonaffluent countries, a higher proportion of children with positive SPT had no detectable sIgE (range 37-61%) than in affluent countries (0-37%). Total serum IgE was associated with all disease outcomes among children with both positive SPT and sIgE (P < 0.001), but only with self-reported eczema in children with negative SPTs and negative sIgE. CONCLUSIONS The international pattern of discordance between SPT and sIgE results did not support the downregulation hypothesis. Among children with no evidence of sensitization to common aeroallergens, increased total IgE contributes little to the risk of wheeze and rhinitis in the general population but may play a role in eczema.
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Affiliation(s)
- G Weinmayr
- Institute of Epidemiology, Ulm University, Helmholtzstrasse 22, Ulm, Germany.
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Abstract
Food allergy and atopic dermatitis often occur in the same patients. Food-induced eczema may be perceived as a controversial topic because the immunologic mechanisms have yet to be fully elucidated. Nevertheless, published clinical studies have clearly demonstrated that foods can induce symptoms in a subset of patients with atopic dermatitis. Those at greatest risk are young children in whom eczematous lesions are severe or recalcitrant to therapy. Allergy testing can be helpful but must be applied judiciously. A medical history obtained by a skilled and knowledgeable health care provider is of paramount importance to interpret test results appropriately. Finally, the implementation of proper dietary avoidance can improve symptoms and provide safety from potentially fatal anaphylaxis. However, if inappropriate prescribed, elimination diets can have significant negative nutritional and social consequences.
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Affiliation(s)
- Jennifer S Kim
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Kim JS, Ouyang F, Pongracic JA, Fang Y, Wang B, Liu X, Xing H, Caruso D, Liu X, Zhang S, Xu X, Wang X. Dissociation between the prevalence of atopy and allergic disease in rural China among children and adults. J Allergy Clin Immunol 2008; 122:929-935.e4. [PMID: 18805578 DOI: 10.1016/j.jaci.2008.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 07/16/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of allergic diseases is increasing worldwide, but the reasons are not well understood. Previous studies suggest that this trend might be associated with lifestyle and urbanization. OBJECTIVE We sought to describe patterns of sensitization and allergic disease in an unselected agricultural Chinese population. METHODS The data were derived from a community-based twin study in Anqing, China. Skin prick tests were performed to foods and aeroallergens. Atopy was defined as sensitization to 1 or more allergens. Allergic disease was ascertained by means of self-report. The analysis was stratified by sex and age (children [11-17 years] and adults [>or=18 years]) and included 1059 same-sex twin pairs. RESULTS Of 2118 subjects, 57.6% were male (n = 1220). Ages ranged from 11 to 71 years, and 43.3% were children (n = 918). Atopy was observed in 47.2% (n = 999) of participants. The most common sensitizing foods were shellfish (16.7%) and peanut (12.3%). The most common sensitizing aeroallergens were dust mite (30.6%) and cockroach (25.2%). Birth order and zygosity had no effect on sensitization rates. Multivariate logistic regression models revealed that risk factors for sensitization include age for foods and sex for aeroallergens. The rates of food allergy and asthma were estimated to be less than 1%. CONCLUSIONS Atopic sensitization was common in this rural farming Chinese population, particularly to shellfish, peanut, dust mite, and cockroach. The prevalence of allergic disease, in contrast, was quite low.
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Affiliation(s)
- Jennifer S Kim
- Division of Allergy and Immunology, Children's Memorial Hospital, Chicago, IL, USA.
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25
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Abstract
Primary care providers are advised to refer to an allergist those children in whom they suspect a food allergic reaction. Approximately 6% of U.S. children have food allergy, although many more parents will present with concerns of a food-induced condition. At higher risk are young children with atopic dermatitis. Generally, the stronger the test response (wheal size or sIgE concentration), the more likely there is to be clinical allergy. However, testing must be applied judiciously. Most importantly, the medical history must be considered in order to interpret test results appropriately. Avoidance of the offending food allergen is currently the only way to prevent reactions. Because exposures and reactions can occur unexpectedly, patients and their families must be prepared to treat symptoms quickly with intramuscular epinephrine in the lateral thigh. Hopefully, additional treatment options will become available in the near future to ease the anxiety and fearfulness that parents and patients face on a daily basis. Until then, healthcare providers are urged to demonstrate the correct administration of autoinjectable epinephrine using a placebo device and review the technique with families on an ongoing basis.
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Affiliation(s)
- Jennifer S Kim
- Northwestern University Feinberg School of Medicine, USA.
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Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DBK, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1-148. [PMID: 18431959 DOI: 10.1016/s1081-1206(10)60305-5] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3031] [Impact Index Per Article: 189.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Dykewicz MS, Lemmon JK, Keaney DL. Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices. Ann Allergy Asthma Immunol 2007; 98:559-62. [PMID: 17601269 DOI: 10.1016/s1081-1206(10)60735-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Different devices for percutaneous allergy skin testing have demonstrated statistically and clinically significant differences in performance characteristics. OBJECTIVE To compare 2 Food and Drug Administration-approved multihead allergy skin testing devices: Multi-Test II (Lincoln Diagnostics) and Skintestor Omni (Greer Laboratories). METHODS Skin tests with glycerinated histamine (6-mg/mL base) and glycerinated saline were applied to 31 adults using Multi-Test II on the volar surface of one forearm and Skintestor Omni on the opposite forearm. RESULTS Data were accumulated from 155 histamine sites and 93 negative control sites for each device. Using cutoff wheal sizes of 5 vs 3 mm inclusive to define a positive result, Multi-Test II sensitivity remained at 100%, but specificity increased from 74% to 97%, whereas Skintestor Omni sensitivity decreased from 94% to 87%, and specificity increased from 58% to 88%. For Multi-Test II vs Skintestor Omni, histamine mean (SD) wheal sizes were 9.23 (1.37) vs 7.74 (2.83) mm (P < .001), mean coefficients of variance were 14.8% vs 36.6%, and pooled estimates of variance were 0.642 vs 6.974. Multi-Test II produced similar histamine wheal sizes regardless of test head position used, whereas Skintestor Omni produced statistically significantly smaller wheals at certain test head positions. CONCLUSIONS Multi-Test II had higher sensitivity and specificity than Skintestor Omni and produced reproducible wheal sizes from all test head positions. Because some Skintestor Omni test head positions produced significantly smaller histamine wheal sizes, skin testing using this device might result in underdiagnosis of allergy.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Clinical Immunology, Division of Immunobiology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA.
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Seshul M, Pillsbury H, Eby T. Use of intradermal dilutional testing and skin prick testing: clinical relevance and cost efficiency. Laryngoscope 2006; 116:1530-8. [PMID: 16954975 DOI: 10.1097/01.mlg.0000234916.43285.f8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to determine the agreement of the positive results from a multiple skin prick test (SPT) device with the ability to determine a definable endpoint through intradermal dilutional testing (IDT) to compare semiquantitatively the degree of positivity of SPT results with quantitative results from IDT and to analyze the cost of immunotherapy based on SPT compared with IDT guided by SPT. STUDY DESIGN Retrospective review of clinical data (random accrual). METHODS One hundred thirty-four patients underwent allergy screening using a multiple SPT device. Antigens testing positive by skin prick device were tested using IDT on a separate day. Antigens testing negative by SPT were not evaluated by IDT. Regional allergy testing practice patterns were determined, and a cost analysis using Medicare rates was performed RESULTS There was good agreement between an antigen testing positive by SPT and the determination of a definable endpoint (93.33%, n = 1,334 antigens). The degree of positivity from the SPT correlated poorly with the final endpoint concentration (r = 0.40, P < .0001). Blended testing techniques were similar in cost when compared with several commonly used allergy testing protocols. CONCLUSIONS Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.
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Affiliation(s)
- Merritt Seshul
- Carolina Ear, Nose and Throat Head and Neck Surgery Center, Hickory, North Carolina, USA
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Abstract
OBJECTIVE To provide the reader with a relevant review of the literature regarding skin testing in the allergist's office. DATA SOURCES A PubMed search for the years 1970 through 2005 was performed using the following keywords: allergy skin testing, skin prick testing, and intradermal skin testing. STUDY SELECTION Articles that highlighted aspects of sentinel to clinical allergists' use of skin testing in the office, such as methods of skin testing, intradermal vs skin prick testing, skin test devices, and methods of expressing skin test results, were selected for further review. RESULTS Skin testing remains the central test to confirm an allergic response. It is minimally invasive and when performed correctly has good reproducibility. Results are easily quantifiable and correlate well with end organ challenge. It is imperative however that technicians who perform the skin tests and the clinicians who order or interpret these tests understand the characteristics of the specific tests they are administering. It is also important that the clinician express skin test results in a manner that allows easy interpretation by another physician. CONCLUSIONS Allergists must consider controllable variables that affect skin test results and their interpretation. When not considered, they may be responsible for some of the inaccuracies associated with allergy skin testing.
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Affiliation(s)
- John Oppenheimer
- Department of Internal Medicine, Section of Allergy and Immunology, Morristown Memorial Hospital, Morristown, New Jersey, USA
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Abstract
BACKGROUND In the allergist's office, skin testing remains the central way to confirm allergic response. Although anecdotal data suggest widely varying practices in skin testing by allergists, the diversity and relative frequency of these practices have not been documented. OBJECTIVE To determine the extent of the diversity in skin testing practices among allergists. METHODS A questionnaire was sent via the Internet to all physician members and fellows of the American College of Allergy, Asthma and Immunology who practice in the United States. This survey explored choice of extract concentrations, skin test device, number and type of tests, method for interpretation and documentation of skin test results, and quality assurance procedures used. RESULTS Overall, a significant degree of variability was reported with regard to number of skin tests performed, extract concentrations, skin test devices, interpretation and documentation of results, and quality assurance procedures. The average number of skin prick tests performed ranged from 5.09 (grasses) to 10.9 (trees), whereas the average number of intradermal tests performed ranged from 2.03 (grasses) to 5.6 (perennial). The allergen extract concentrations used for intradermal testing varied widely. Expressed as a dilution of the concentrated extracts, 20.8% use 1:100 dilutions, 10.3% use 1:500 dilutions, and 59.4% use 1:1,000 dilutions. Significant variability also occurred regarding devices and the technique with which the devices were used. Most clinicians (92.1%) used the most concentrated extract available for skin prick testing. For reporting the results of skin testing, 53.8% used a 0 to 4+ scale, and only 28.3% measured orthogonal diameters. Of those using a 0 to 4+ scale, two thirds related the results to the size of the histamine control. Quality assurance testing was reportedly performed by 61.2% of responders. However, less than 10% of responders used an objective test protocol for this purpose. CONCLUSIONS This survey highlights some of the areas that allergists can improve on in the use and reporting of skin tests.
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Affiliation(s)
- John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA.
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Zarei M, Remer CF, Kaplan MS, Staveren AM, Lin CKE, Razo E, Goldberg B. Optimal skin prick wheal size for diagnosis of cat allergy. Ann Allergy Asthma Immunol 2004; 92:604-10. [PMID: 15237761 DOI: 10.1016/s1081-1206(10)61425-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The skin prick test is the diagnostic procedure of choice for determination of immediate hypersensitivity. A wheal diameter of 3 mm or larger is generally accepted as the cutoff for a positive test result, although the validity of this assumption has not been rigorously demonstrated. OBJECTIVE To determine the skin prick wheal size that best identifies clinical allergy to cat. METHODS Forty-five patients referred for evaluation of rhinoconjunctivitis underwent determination of atopic status by skin testing using the Greer Dermapik device and a combination of other modalities, including history, in vitro determination of specific IgE level, and nasal challenge with standardized cat pelt extract. Parameters evaluated before and after nasal challenge included symptom score and nasal lavage tryptase and prostaglandin D (PGD2) levels. RESULTS The widely accepted 3-mm wheal for a positive skin test result to cat is highly sensitive but only moderately specific for diagnosis of cat allergy as evaluated by history, specific IgE level, postchallenge symptom score, and tryptase and PGD2 levels. Optimal cutoffs for a positive skin test result to cat based on receiver operating characteristic analysis and 95% positive predictive value were 5.5 mm or greater for each of these parameters. When a true-positive result for cat allergy was defined as a combination of positive history, specific IgE level, postchallenge symptom score, and tryptase and PGD2 levels and a true-negative result as all of these parameters being negative, a 6-mm cutoff was able to distinguish cat allergic from cat nonallergic individuals. CONCLUSION In a potentially allergic population undergoing skin prick testing with the Greer Dermapik using standardized extracts, a 3-mm skin prick wheal will overestimate the presence of cat allergy. A 6-mm wheal appears to distinguish those individuals who are cat allergic from those who are not.
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Affiliation(s)
- Maryam Zarei
- Department of Allergy, Center for Medical Education, Kaiser Permanente Medical Center, Los Angeles, California, USA
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Boyd EL. Cutaneous testing for allergy diagnosis: comparison of methods in common use. Otolaryngol Clin North Am 2004; 36:869-77, vii. [PMID: 14743778 DOI: 10.1016/s0030-6665(03)00063-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Practitioners who treat allergic patients must be familiar with the tests that are available to assist them in establishing the diagnosis. They must also understand the strengths and weaknesses of each of the techniques, devices, and grading systems at their disposal and that there is no criterion standard skin test. This article discusses the various techniques used in skin testing for allergy, their grading systems, and their advantages and disadvantages.
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Affiliation(s)
- Edwyn L Boyd
- Hoover Ear, Nose, and Throat Associates, 2116 Data Park, Hoover, AL 35244, USA
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Abstract
Testing for food and chemical sensitivities usually becomes necessary as part of the evaluation of otolaryngology patients who have chronic illness. The more complex the patient, and the more recalcitrant the problem is to treatment, the more likely it is that allergies, and especially food or chemical sensitivities, are involved in the pathogenesis of the illness. Failure to consider all major allergen contacts, including foods and chemicals, can lead to inadequate therapy. Similarly, failure to understand total allergic and oxidant load and the effects of chemical toxicity can lead to inappropriate or ineffective treatment. Clinically, food allergies occur in two different types: immediate, anaphylactic, fixed reactions and delayed, chronic, cyclic reactions. Different test methods have been developed for the two types. Fixed food allergies can be safely and efficiently detected by in vitro specific IgE or histamine release tests. Cyclic food allergies are best detected by either oral food challenges or by the IPDFT test. Choosing the best test for a particular patient requires a clear understanding of the two food allergy types and how their clinical presentations differ. Other tests for food allergies are compared and contrasted with these primary tests. Chemical sensitivity also occurs in two different clinical types: allergic, and toxic. True allergy to chemical haptens, either type I, IgE-mediated, or type IV, delayed hypersensitivity, occurs with significant frequency but is often unsuspected. Chemical toxicity can be caused by the aftereffects of an acute exposure or as a result of chronic, low-level exposure, but is even more frequently unsuspected and will not be diagnosed without a high index of suspicion. Both types of chemical sensitivity need to be addressed in any patients who have either a high allergen or chemical exposure load [105]. Either in vitro or in vivo tests can be used for chemical allergy detection; the advantages of each are outlined. Chemical toxicity screening tests are available and useful but do not detect all possible toxicants. Definitive toxic chemical tests usually require specialized laboratory facilities and expert consultation, for which possible sources are specified. The most important point in testing for food or chemical sensitivity is to be aware that food or chemical sensitivity can be contributing to a specific patient's clinical problems. Only then can appropriate investigations be undertaken to understand and then, perhaps, to intervene successfully in that illness.
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Affiliation(s)
- Bruce R Gordon
- Department of Otology and Laryngology, Harvard University, Cambridge, MA, USA
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Zeiss CR, Gomaa A, Murphy FM, Weissman DN, Hodgson M, Foster D, Dejativongse S, Colella K, Kestenberg K, Kurup VP, Bush RK, Chiu AM, Kelly KJ, Fink JN. Latex hypersensitivity in Department of Veterans Affairs health care workers: glove use, symptoms, and sensitization. Ann Allergy Asthma Immunol 2004; 91:539-45. [PMID: 14700437 DOI: 10.1016/s1081-1206(10)61531-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This report of the prevalence of latex glove allergy in 3 Department of Veterans Affairs (VA) medical centers was a collaboration of the VA, the Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health. OBJECTIVE To enroll and evaluate personnel from across the entire hospital workforce for latex hypersensitivity and to determine the type and extent of latex glove use. METHODS A questionnaire was administered that covered demographics, job category, latex glove use, and current latex glove allergic symptoms. Skin testing to aeroallergens was performed to evaluate the presence of atopy. Blood was drawn for analyses of serum antilatex IgE antibody by CAP assay. RESULTS Of 1,959 subjects, 158 (8.1%) had latex glove-allergic symptoms, a positive latex CAP assay result, or both. In 1,003 subjects who reported latex glove use, 915 (91.4%) used nonpowdered gloves. A total of 133 subjects reported latex glove allergic symptoms, and 36 subjects had positive CAP assay results. Latex sensitization was correlated with atopy, race, and latex glove exposure. Latex symptoms were correlated with atopy, a positive CAP assay result, and latex glove exposure. Of the 133 subjects with latex glove allergic symptoms, only 11 had positive CAP assay results, giving a prevalence of confirmed latex glove allergy of 0.6%. CONCLUSIONS Symptoms attributed to latex gloves and/or latex sensitization occurred in 8.1% of the employee population, with exposure, race, and atopy being the major risk factors. Few symptomatic individuals were sensitized to latex (0.6%). This low rate of confirmed latex glove allergy may have been related to nonpowdered glove use.
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Affiliation(s)
- C Raymond Zeiss
- VA Chicago Health Care System/Lakeside Division, Chicago, Illinois 60611, USA.
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Gungor A, Houser SM, Aquino BF, Akbar I, Moinuddin R, Mamikoglu B, Corey JP. A Comparison of Skin Endpoint Titration and Skin-Prick Testing in the Diagnosis of Allergic Rhinitis. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300118] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among the many methods of allergy diagnosis are intradermal testing (IDT) and skin-prick testing (SPT). The usefulness of IDT has been called into question by some authors, while others believe that studies demonstrating that SPT was superior might have been subject to bias. We conducted a study to compare the validity of SPT and IDT—specifically, the skin endpoint titration (SET) type of IDT—in diagnosing allergic rhinitis. We performed nasal provocation testing on 62 patients to establish an unbiased screening criterion for study entry. Acoustic rhinometric measurements of the nasal responses revealed that 34 patients tested positive and 28 negative. All patients were subsequently tested by SET and SPT. We found that SPT was more sensitive (85.3 vs 79.4%) and more specific (78.6 vs 67.9%) than SET as a screening procedure. The positive predictive value of SPT was greater than that of SET (82.9 vs 75.0%), as was the negative predictive value (81.5 vs 73.0%). None of these differences was statistically significant; because of the relatively small sample size, our study was powered to show only equivalency. The results of our study suggest that the information obtained by the SET method of IDT is comparable to that obtained by SPT in terms of sensitivity, specificity, and overall performance and that both SET and SPT correlate well with nasal provocation testing for ragweed. Therefore, the decision as to which to use can be based on other factors, such as the practitioner's training, the desire for quantitative results, the desire for rapid results, and the type of treatment (i.e., immunotherapy or pharmacotherapy) that is likely to be chosen on the basis of test results.
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Affiliation(s)
- Anil Gungor
- Department of Surgery, Pritzker School of Medicine, University of Chicago
| | - Steven M. Houser
- Department of Surgery, Pritzker School of Medicine, University of Chicago
| | - Benjamin F. Aquino
- Department of Surgery, Pritzker School of Medicine, University of Chicago
| | - Imran Akbar
- Department of Surgery, Pritzker School of Medicine, University of Chicago
| | - Rizwan Moinuddin
- Department of Surgery, Pritzker School of Medicine, University of Chicago
| | - Bulent Mamikoglu
- Department of Surgery, Pritzker School of Medicine, University of Chicago
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Gispert J, Antonijoan R, Barbanoj M, Gich I, Garcia E, Esbrí R, Luria X. Efficacy of ebastine, cetirizine, and loratadine in histamine cutaneous challenges. Ann Allergy Asthma Immunol 2002; 89:259-64. [PMID: 12269645 DOI: 10.1016/s1081-1206(10)61952-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have compared the antihistaminic effect of ebastine at 20 mg/day (maximal recommended daily dose) with the effect found for other antihistamines in human pharmacologic models. OBJECTIVE To compare the inhibition of the histamine-induced skin reaction produced by ebastine (20 mg/day) with that produced by cetirizine (10 mg/day), loratadine (10 mg/day), or placebo in a double-blind, randomized, crossover, placebo-controlled clinical trial. METHODS Twenty volunteers (10 men and 10 women) received the four treatments once daily for 7 days, with a mean 7-day washout period between treatments. Three intradermal histamine challenges (0.05 mL of a 100 microg/mL histamine solution at 4, 8, and 24 hours after drug administration) were performed at baseline, day 1 (single dose), and day 7 (multiple doses). Wheal and flare areas were measured after 15 minutes. RESULTS All treatments yielded significant reductions of histamine-induced wheal in comparison to placebo (P < 0.001). Analysis of covariance revealed significant differences between treatments (P < 0.05). Ebastine had a significantly greater antihistaminic effect than did cetirizine or loratadine, except at 4 hours after a single dose versus cetirizine. Further, the effect of cetirizine was similar with single or multiple doses after both 4 and 24 hours, whereas the effect of ebastine showed significant increases in wheal reduction with multiple doses (P < 0.05). No serious adverse events or withdrawals occurred during the study. CONCLUSION This study shows that ebastine in a 20-mg dose is an effective once-daily antihistamine. Superior efficacy was found in comparison to cetirizine (10 mg) or loratadine (10 mg) on the overall skin wheal response after single and multiple doses.
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McCann WA, Ownby DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Allergy Asthma Immunol 2002; 89:368-71. [PMID: 12392380 DOI: 10.1016/s1081-1206(10)62037-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergy skin testing is a cornerstone in the evaluation of the allergic patient. This seemingly simple test is subject to multiple variables that can affect the result. OBJECTIVE To evaluate the degree of variability among board-certified/board-eligible allergists in the scoring and interpretation of allergen skin tests. MATERIALS AND METHODS A series of allergen prick skin tests were digitally photographed and a questionnaire generated. Approximately 70 board-certified/board-eligible allergists were asked to grade each test item and to interpret them as positive, negative, or indeterminate or if they desired a followup intradermal test. RESULTS Thirty-three interpretable responses were obtained. The majority of respondents (24) used a grading scale of 0 to 4. Agreement among physicians using a 0 to 4+ scale ranged from a standard deviation of 0.26 to 1.35, with greatest agreement on items with median/mode scores of 4+. The largest standard deviations were found on test items with median/mode scores of 1+ to 2+. Interpretation of the test items also showed greatest variation for those items with median/mode scores of 1+ to 2+. The number of intradermal tests requested ranged from 0 to 11 (of 22 test items). CONCLUSIONS The results demonstrate interphysician variation in the scoring and interpretation of epicutaneous skin tests. A questionnaire such as the one used here may serve a useful quality control instrument to ensure reproducible scoring of skin tests. In addition, the results highlight the need for greater study on the clinical utility of intradermal skin testing when epicutaneous tests are negative or equivocal.
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Affiliation(s)
- William A McCann
- Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA.
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Rhodius R, Wickens K, Cheng S, Crane J. A comparison of two skin test methodologies and allergens from two different manufacturers. Ann Allergy Asthma Immunol 2002; 88:374-9. [PMID: 11991555 DOI: 10.1016/s1081-1206(10)62367-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Skin prick tests (SPTs) are a frequently used method for evaluation of atopy. A variety of standard allergen preparations are available, together with a number of different methods of application. OBJECTIVE The objective of this study was to compare SPT reactivity 1) using Soluprick SQ allergens (ALK Allergologisk Laboratorium A/S, Hørsholm, Denmark) and Bayer allergens [Bayer Corporation, West Haven, CT], and 2) using two common methods of application, a standard prick lancet and a Quintest, both produced by Bayer. METHODS SPTs were undertaken on 22 adult volunteers (mean age 40 years, 17 female, 5 male). Wheal size was recorded as mean diameters (mm) and area (mm2). RESULTS Bayer allergens produced larger mean diameters and areas to dust mites than ALK allergens, with the differences significant when allergens were applied with the lancet. There was a tendency for the ALK cat allergen to produce larger reactions than the Bayer product. The method of application also influenced the wheal size, with the lancet producing significantly larger mean diameters than the Quintest for the histamine and allergens from both manufacturers, except the ALK cat allergen. There were similar differences between methods of application for reactions measured as an area. CONCLUSIONS SPTs that use different allergens or different methods of application will not provide comparable assessments of atopy.
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Affiliation(s)
- Robert Rhodius
- Faculty of Medicine, University of Groningen, The Netherlands
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Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001; 108:S147-334. [PMID: 11707753 DOI: 10.1067/mai.2001.118891] [Citation(s) in RCA: 2094] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
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Ronchetti R, Pia Villa M, Ciofetta G, Barreto M, Falasca C, Martella S. Changes over 13 years in skin reactivity to histamine in cohorts of children aged 9-13 years. Allergy 2001; 56:436-41. [PMID: 11350308 DOI: 10.1034/j.1398-9995.2001.056005436.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies report substantial differences in the prevalence of skin test reactivity to allergens in children from adjacent geographic areas; others report an increased prevalence over time. To find out whether these differences depend on variations in skin reactivity to histamine, we determined the time trend of histamine wheal sizes in successive cohorts of unselected children living in the same area (Viterbo, Italy). METHODS We conducted three epidemiologic surveys, each including children aged 9 and 13 years. The 1983-7 study investigated 170 children (150 were tested twice); the 1992 study, 158 children; and the 1996 study, 208 children. RESULTS In both age groups, the mean diameter of the wheal induced by histamine skin prick tests (10 mg/ml) increased significantly over time (9-year-olds: 3.25 mm in 1983, 4.68 in 1992, and 5.89 in 1996; 13-year-olds: 3.89 mm in 1987, 5.18 in 1992, and 6.50 in 1996) (P < 0.001 between subsequent studies). The distribution of the wheal diameters for both ages showed a trend to a right shift in the three successive studies (P < 0.001). The dose-response curves for three histamine concentrations (0.2, 1, and 10 mg/ml) had significantly steeper slopes in 1996 than in 1983-7 (P < 0.001). CONCLUSION The marked time-related increase in the size of the histamine wheals could help to explain the trend toward an increased prevalence of positive allergen skin test reactions reported during the past years. The causes of increased skin reactivity to histamine remain conjectural.
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Affiliation(s)
- R Ronchetti
- II Pediatric Clinic, University of Rome La Sapienza , Rome, Italy
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Zacharisen MC. RHINITIS IN CHILDREN, ADOLESCENTS, THE ELDERLY, AND PREGNANT WOMEN. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zacharisen MC. RHINITIS IN CHILDREN, ADOLESCENTS, THE ELDERLY, AND PREGNANT WOMEN. Immunol Allergy Clin North Am 2000. [DOI: 10.1016/s0889-8561(05)70156-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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