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Rosada T, Lis K, Bartuzi Z, Grześk-Kaczyńska M, Ukleja-Sokołowska N. Diagnostics of Allergy to Furry Animals-Possibilities in 2024. J Clin Med 2024; 13:3239. [PMID: 38892951 PMCID: PMC11172995 DOI: 10.3390/jcm13113239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diagnosing allergies is not always easy. Sometimes the symptoms reported by the patient do not match the results of diagnostic tests. Diagnostics of IgE-dependent allergy, including allergy to furry animals, can be based on two basic strategies, "BOTTOM-UP" and "TOP-DOWN", and almost all available allergy tests can be used ranging from skin tests, through specific IgE, to molecular panels and challenge tests. Currently, most information regarding the diagnosis and incidence of allergies to furry animals focuses almost exclusively on the two most common pets-dogs and cats. This is certainly due to the fact that allergy to cats and/or dogs is a common phenomenon, has a huge impact on quality of life, and is a challenge for doctors of many specialties. However, the growing number of owners of other pet species means that diagnostic methods must keep up with the changing needs of patients. Further research in these groups will certainly provide new facts and facilitate clinical decision-making when working with allergic patients.
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Affiliation(s)
- Tomasz Rosada
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Kinga Lis
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Zbigniew Bartuzi
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Magdalena Grześk-Kaczyńska
- Clinic of Allergology, Clinical Immunology and Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz, 75 Ujejskiego St., 85-168 Bydgoszcz, Poland;
| | - Natalia Ukleja-Sokołowska
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
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Cichocka-Jarosz E, Brzyski P, Jedynak-Wąsowicz U, Mól N, Klasa B, Mazurek-Durlak Z, Lis G, Nowak-Węgrzyn A. Skin prick tests are not useful for the qualification for venom immunotherapy in children. World Allergy Organ J 2023; 16:100775. [PMID: 37351272 PMCID: PMC10282561 DOI: 10.1016/j.waojou.2023.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 06/24/2023] Open
Abstract
Background The basis for qualification for venom immunotherapy (VIT) is the fulfilment of both the clinical and immunological criteria. Diagnostic tests that confirm the immunological criterion of an IgE-mediated sensitization include skin prick tests (SPT), intradermal tests (IDT), and serum specific IgE (sIgE) for the culprit venom. Objective This study aimed to assess the usefulness of SPT as the immunological marker in the diagnosis of insect venom sensitization in children with history of systemic reaction (SR) to insect sting evaluated by means of I-IV-grades Mueller's scale. There are no such studies in children. Methods This cross-sectional study sample consisted of 416 children aged 3-18 years (mean age 10.6 ± 3.8), 76% males, all with the history of a systemic reaction (SR) after a Hymenoptera sting (48% of grade III/IV according to Mueller scale), diagnosed between 1999 and 2019 in the tertiary referral centre. The standard diagnostic tests were used. Specificity, sensitivity, and positive and negative predictive values were computed to assess the diagnostic properties of the clinical tests to distinguish between mild and severe SR. To assess the relative value of an individual test in predicting the qualification to VIT we incorporated the Shapley value (SV). Results Positive SPT results were found in up to no more than 3% of children; among them less than 1% had only positive SPT and were negative for sIgE and IDT. Approximately 85% of the children had detectable venom sIgE, followed by positive IDT (75%). Almost 70% of children had positive both sIgE and IDT results. In children with grade III/IV reaction, about 80% of children had positive results of both of these tests. sIgE and IDT had sensitivity >0.80, whereas SPT had high specificity (>0.97) in differentiating between mild and severe SR. Relative value of diagnostic tests in predicting qualification to VIT varied between venoms. Bee venom IDT had higher SV (0.052) than sIgE (0.041). In contrast, wasp venom sIgE had higher SV (0.075) than IDT (0.035). Conclusion SPTs are not an useful immunological marker of venom sensitization in children, and eliminating SPT does not result in a loss of diagnostic accuracy. Limiting diagnostics to venom sIgE and IDT would shorten the procedure and reduce costs. Future studies are needed to determine if venom sIgE as the first line diagnostic test, with IDT added only if the venom sIgE is undetectable, is an optimal diagnostic process.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | | | - Urszula Jedynak-Wąsowicz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Nina Mól
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Barbara Klasa
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Zofia Mazurek-Durlak
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Grzegorz Lis
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics at NYU Grossman School of Medicine, New York, USA
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sharma M, Khaitan T, Vishal, Jain R. Skin Prick Test in Educating Population of Rural Part of Eastern India and Promoting Health in Allergic Rhinitis: An Epidemiological Study. Indian J Otolaryngol Head Neck Surg 2022; 74:980-983. [PMID: 36452796 PMCID: PMC9702273 DOI: 10.1007/s12070-020-02065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
Abstract
Skin prick testing (SPT) is one of the most extensively used screening and diagnostic tool in contemporary allergy practice. It plays a vital role in diagnosis of type 1 hypersensitivity reaction in patients with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and suspected food and drug allergy. The present study was undertaken to evaluate the pattern of allergenicity of aero-allergens and mites in the rural part of Eastern India using SPT. A total of 50 subjects (25 males and 25 females) were selected for the present study. Complete history and clinical symptoms were recorded according to ARIA guidelines. All the patients were subjected to SPT using 35 allergens. Positive sensitization was recorded in terms of frequency and measured in terms of maximum wheal diameter. The most common allergens observed were Gynandropsis gynandra (positive sensitization in 33 cases with wheal of 4.18 mm diameter) followed by Dermatophagoides farinae (25 cases, 6.12 mm diameter), Ageratum conyzoides (19 cases, 3.36 mm diameter), Cannabis sativa (17 cases, 3.52 mm diameter) and Cassia occidentalis (17 cases, 3.58 mm diameter). When the sensitivity was being compared between the most common allergens, statistical significance was obtained for Ageratum conyzoides and Cannabis sativa with Dermatophagoides farina (p value-0.0001). SPT is a reliable, minimally invasive procedure with immediate results useful in detection and promoting health of patients suffering from allergic rhinitis.
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Affiliation(s)
- Manuprita Sharma
- Department of ENT, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal 721645 India
| | - Tanya Khaitan
- Department of Oral Medicine and Radiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand 834009 India
| | - Vishal
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Ritika Jain
- Centre for Development Studies, Trivandrum, 695011 India
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Muacevic A, Adler JR. Can Anxiety Affect Dermographism and Atopy Test Outcomes? Cureus 2022; 14:e21994. [PMID: 35282539 PMCID: PMC8906829 DOI: 10.7759/cureus.21994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
AIM The effect of anxiety on dermographism and atopy test results had never been elaborated. Factors that may affect cutaneous reactivity in skin tests should be determined to improve the accuracy and reliability of results. Age, sex, dermographism, race, seasons of the year, circadian rhythm, and some drugs have been shown to affect skin test results. The aim of this study was to investigate the effect of anxiety on dermographism and atopy tests. METHOD According to Beck Anxiety Scale, 101 individuals with high anxiety levels were compared with the other 101 individuals with an anxiety level of 7 and below. Skin prick test response, presence of phadiatope, and dermographism were evaluated in all participants. RESULTS There were 41 (40.6%) and 34 patients (33.7%) with a Beck anxiety score >7 who tested positive in the skin test and Phadiatop, respectively. Moreover, 47 (46.5%) and 42 patients (41.6%) in the control group had positive results in the skin test and Phadiatop, respectively, and there was no statistical difference between the variables (p > 0.05). Dermographism was present in 37 (36.6%) and 30 patients (29.7%) in the study and control groups, respectively. According to Beck anxiety scores, there was no statistically significant difference between the groups in terms of the presence of dermographism, skin prick test positivity, and Phadiatop positivity (p = 0.078, p = 0.395, p = 0.245, respectively). Symptomatic dermographism was found more frequently in the anxiety group (p < 0.05). CONCLUSION In our study, anxiety does not affect atopy test results. Although anxiety levels did not affect the atopy test results, there was a relationship between anxiety levels and dermographism.
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The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy! Clin Rev Allergy Immunol 2021; 62:200-215. [PMID: 34536215 PMCID: PMC8818003 DOI: 10.1007/s12016-021-08901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/25/2022]
Abstract
Immunoglobulin E (IgE) is a well-known key factor in allergic airway disease; however, its central role in non-allergic airway inflammation is often underestimated. In some airway diseases, IgE is produced as a result of allergic sensitization. However, in others, IgE production occurs despite the lack of a specific allergen. Although multiple pathways contribute to the production of IgE in airway disease, it is its activity in mediating the inflammatory response that is associated with disease. Therefore, an understanding of IgE as the unifying component of upper and lower airway diseases has important implications for both diagnosis and treatment. Understanding the role of IgE in each upper and lower airway disease highlights its potential utility as a diagnostic marker and therapeutic target. Further classification of these diseases by whether they are IgE mediated or non–IgE mediated, rather than by the existence of an underlying allergic component, accounts for both systemic and localized IgE activity. Improvements in diagnostic methodologies and standardization of clinical practices with this classification in mind can help identify patients with IgE-mediated diseases. In doing so, this group of patients can receive optimal care through targeted anti-IgE therapeutics, which have already demonstrated efficacy across numerous IgE-mediated upper and lower airway diseases.
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Ramirez-Leyva DH, Díaz-Sánchez L, Citlaly-Ochoa M, Ornelas-Aguirre JM. Patterns of allergen sensitization in patients with asthma in Yaqui Valley, Mexico. J Asthma 2021; 59:1319-1327. [PMID: 34353199 DOI: 10.1080/02770903.2021.1941086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction. People who live in highly allergenic regions have a greater risk of being sensitized; therefore, these areas have a higher prevalence of mono and polysensitized patients. The aim of the present study was to investigate the allergen sensitization profiles in patients with asthma in an agricultural zone in Mexico.Methods. An analytical cross-sectional study was conducted in a secondary care hospital in Obregon City, Mexico. The allergen sensitization pattern profiles were analyzed through a skin prick test (SPT) in 294 patients. Data was collected before SPT: asthma control was classified according to the Global Initiative for Asthma Criteria, nutritional status was assessed with the Body Mass Index (BMI) using Quetelet's index (BMI = weight/height2), and comorbidities, asthma, and smoking habits were collected from the patients' medical records.Results. In this study, in a group of adults with asthma, the prevalence of sensitization was 77%. The most frequent categories of aeroallergens were in indoors, in zones with weeds and abundant trees. A low proportion of monosensitized patients (2%) was observed. House dust mites were the most common allergens.Conclusions. Our study describes the sensitization pattern among asthma patients. This study will help identify the panel of most common allergens in this region of Mexico, and aid in selection of specific treatment through immunotherapy.
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Affiliation(s)
| | - Leticia Díaz-Sánchez
- Instituto Mexicano del Seguro Social, Allergology and Immunology, Avenida Guerrero S/N, Colonia Bellavista., Ciudad Obregón, 85000 Mexico
| | - Maria Citlaly-Ochoa
- Instituto Mexicano del Seguro Social, Pediatric Pneumology, Avenida Guerrero S/N. Colonia Bellavista, Ciudad Obregón, 85000 Mexico
| | - Jose Manuel Ornelas-Aguirre
- Universidad de Sonora, Ciencias de la Salud, Avenida Bordo Nuevo S/N, Antiguo Ejido Providencia, Cd., Obregón, 85010 Mexico
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Kwon OE, Lee YC, Park JM, Kim SW, Eun YG, Ko SG. Measurement of Tryptase and CC16/Albumin in Nasal Lavage Fluid as a Screening Tool of Allergic Rhinitis. Am J Rhinol Allergy 2021; 35:768-773. [PMID: 33631947 DOI: 10.1177/1945892421998260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no trial to make a diagnostic tool of allergic rhinitis (AR) utilizing biomarkers from nasal fluid. Base on previous studies, we selected following five biomarkers in nasal fluids that represent the characteristics of allergic reactions: tryptase, eosinophil cationic protein (ECP), interleukin 5 (IL-5), Clara cell protein 16 (CC16) and CC16-to-albumin ratio. OBJECTIVE This study aimed to identify biomarkers in nasal discharge that may be used in biosensors to diagnose AR as an additional diagnostic tool. METHODS Patients showed rhinorrhea and tested positive on allergic skin and specific immunoglobulin E (IgE) tests were included in the AR group. The non-AR group included individuals no dominant nasal symptoms and tested negative on allergy tests. Nasal lavage fluid samples were collected from all participants. Biomarkers in the samples were quantified using enzyme-linked immunosorbent assay. RESULTS Forty-five patients with AR and 28 non-AR subjects were enrolled in this study. Comparing the concentrations of biomarkers, the concentrations of tryptase and IL-5 were significantly higher in the AR group than in the NAR group. And CC16 level and CC16-to-albumin ratio were significantly lower in the AR group. In the combination of tryptase or CC16-to-albumin ratio, the sensitivity was 90.7% and the specificity was 64.3% (p = 0.013). CONCLUSION The combination of "tryptase or CC16-to-albumin" could be used as a screening tool for AR. Although this diagnostic method could not replace conventional diagnostic tools, we could consider the method we proposed as an additional screening tool for patients who could not undergo allergy tests.
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Affiliation(s)
- Oh Eun Kwon
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Min Park
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Wan Kim
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Gyu Eun
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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Popov TA, Passalacqua G, González-Díaz SN, Plavec D, Braido F, García-Abujeta JL, Dubuske L, Rouadi P, Morais-Almeida M, Bonini S, Cheng L, Ansotegui IJ. Medical devices in allergy practice. World Allergy Organ J 2020; 13:100466. [PMID: 33024482 PMCID: PMC7529824 DOI: 10.1016/j.waojou.2020.100466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Subsequently, medical devices used in allergology could be regarded as: 1) general, servicing the integral diagnostic and management principles and features of allergology, and 2) organ specific, which are shared by organ specific disciplines like pulmonology, otorhinolaryngology, dermatology, and others. The present position paper of the World Allergy Organization (WAO) is meant to be the first integral document providing structured information on medical devices in allergology used in daily routine but also needed for sophisticated diagnostic purposes and modern disease management. It is supposed to contribute to the transformation of the health care system into integrated care pathways for interrelated comorbidities.
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Key Words
- AAP, Asthma Action Plan
- ATS, American Thoracic Society
- Airway inflammation
- Allergic rhinitis
- Allergology
- Allergy
- Allergy diagnosis
- Asthma
- CE mark, Conformité Européenne mark
- CO, Carbon monoxide
- DPIs, Dry Powder Inhalers
- EAI/AAI, Epinephrine/Adrenaline Auto-Injector
- EBC, Exhaled Breath Condensate
- EBT, Exhaled Breath Temperature
- EDS, Exhalation Delivery Systems
- EMA, European Medicines Agency
- ERS, European Respiratory Society
- ERV, Expiratory Reserve Volume
- FDA, Food and Drug Administration
- FEF, Forced Expiratory Flows
- FEV1, Forced Expiratory Volume in 1 second
- FOT, Forced Oscillation Technique
- FRC, Functional Residual Capacity
- FVC, Forced Vital Capacity
- FeNO, Fractional Exhaled Nitric Oxide
- GLI, Global Lung Function Initiative
- IOS, Impulse Oscillometry
- IRV, Inspiratory Reserve Volume
- Lung function tests
- MDPS, Metered-Dose Pump Sprays
- Medical devices
- NDDD, Nasal Drug Delivery Device
- NO, Nitric oxide
- PDMI, Pressurized Metered Dose Inhaler
- PEF, Peak Expiratory Flow
- PNIF, Peak Nasal Inspiratory Flow
- PT, Patch Tests
- PhPT, Photopatch tests
- Ppb, part per billion
- RV, Residual Volume
- SPT, Skin Prick Test
- Skin tests
- TLC, Total Lung Capacity
- UV, Ultra Violet
- VC, Vital Capacity
- VT, Tidal Volume
- WAO, World Allergy Organization
- WHO, World Health Organization
- m-health
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Affiliation(s)
| | | | | | | | | | | | - Lawrence Dubuske
- The George Washington University School of Medicine, Washington DC, USA
| | | | | | - Sergio Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy
| | - Lei Cheng
- Nanjing Medical University, First Affiliated Hospital, Nanjing, China
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Almeida ALM, Perger ELP, Gomes RHM, Sousa GDS, Vasques LH, Rodokas JEP, Olbrich Neto J, Simões RP. Objective evaluation of immediate reading skin prick test applying image planimetric and reaction thermometry analyses. J Immunol Methods 2020; 487:112870. [PMID: 32961242 DOI: 10.1016/j.jim.2020.112870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
The skin prick test is used to diagnose patients' sensitization to antigens through a mediated IgE response. It is a practical and quick exam, but its diagnosis depends on instruments for measuring the allergic response and observer's interpretation. The conventional method for inferring about the allergic reaction is performed from the dimensions of the wheals, which are measured using a ruler or a caliper. To make this diagnosis less dependent on human interpretation, the present study proposes two alternative methods to infer about the allergic reaction: computational determination of the wheal area and a study of the temperature variation of the patient's skin in the puncture region. For this purpose, prick test using histamine was performed on 20 patients randomly selected. The areas were determined by the conventional method using the dimensions of the wheals measured with a digital caliper 30 min after the puncture. The wheal areas were also determined by a Python algorithm using photographs of the puncture region obtained with a smartphone. A variable named circularity deviation was also determined for each analyzed wheal. The temperature variation was monitored using an infrared temperature sensor, which collected temperature data for 30 min. All results were statistically compared or correlated. The results showed that the computational method to infer the wheal areas did not differ significantly from the areas determined by the conventional method (p-value = 0.07585). Temperature monitoring revealed that there was a consistent temperature increase in the first minutes after the puncture, followed by stabilization, so that the data could be adjusted by a logistic equation (R2 = 0.96). This adjustment showed that the optimal time to measure the temperature is 800 s after the puncture, when the temperature stabilization occurs. The results have also shown that this temperature stabilization has a significant positive correlation with wheal area (p-value = 0.0015). Thus, we concluded that the proposed computational method is more accurate to infer the wheal area when compared to the traditional method, and that the temperature may be used as an alternative parameter to infer about the allergic reaction.
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Affiliation(s)
- Ana Laura Mendes Almeida
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Edson Luiz Pontes Perger
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Ramon Hernany Martins Gomes
- Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil
| | - Guilherme Dos Santos Sousa
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Lucas Hecker Vasques
- Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil
| | - José Eduardo Petit Rodokas
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil; School of Engineering, Sao Paulo State University (UNESP), 14-01 Eng. Luiz Edmundo Carrijo Coube Avenue, Bauru, SP, Brazil
| | - Jaime Olbrich Neto
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Rafael Plana Simões
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil; Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil.
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12
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Improving allergy skin testing proficiency. Ann Allergy Asthma Immunol 2019; 123:108-109. [PMID: 30959100 DOI: 10.1016/j.anai.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
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13
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Gong Z, Yang Z, Wu R, Ye H, Jia M, Zhang N, Bachert C. Comparison of a new Skin Prick Test Tape with the conventional skin prick test. J Allergy Clin Immunol 2018; 143:424-427. [PMID: 30218676 DOI: 10.1016/j.jaci.2018.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Zhengpeng Gong
- Department of Otolaryngology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhijie Yang
- Guizhou Wecare Technology Co, Ltd, Guiyang, Guizhou, China
| | - Ran Wu
- Department of Dermatology, The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Huiping Ye
- Department of Otolaryngology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Min Jia
- Department of Dermatology, The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Nan Zhang
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium.
| | - Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden
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Gonzales-González VA, Díaz AM, Fernández K, Rivera MF. Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children. Allergy Asthma Clin Immunol 2018; 14:23. [PMID: 29946340 PMCID: PMC6004676 DOI: 10.1186/s13223-018-0245-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients. Objectives The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria. Methods Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016. Results A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow’s milk allergy 6%, hen’s egg allergy 5.2% and wheat allergy 1.9%. Conclusions Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow’s milk allergy, hen’s egg allergy and wheat allergy.
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Affiliation(s)
| | - Adolfo Martin Díaz
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - Karla Fernández
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - María Félix Rivera
- 3Division of Epidemiology, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
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15
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Justo X, Diaz I, Gil JJ, Gastaminza G. Medical Device for Automated Prick Test Reading. IEEE J Biomed Health Inform 2018; 22:895-903. [DOI: 10.1109/jbhi.2017.2680840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Kim H, Ellis AK, Fischer D, Noseworthy M, Olivenstein R, Chapman KR, Lee J. Asthma biomarkers in the age of biologics. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2017; 13:48. [PMID: 29176991 PMCID: PMC5691861 DOI: 10.1186/s13223-017-0219-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/25/2017] [Indexed: 02/08/2023]
Abstract
The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories of allergic and non-allergic asthma have given way to more precise phenotypes that hint at underlying biologic mechanisms of variable airflow limitation and airways inflammation. Understanding these mechanisms is of particular importance for the approximately 10% of patients with severe asthma. Biomarkers that aid in phenotyping allow physicians to "personalize" treatment with targeted biologic agents. Unfortunately, testing for these biomarkers is not routine in patients whose asthma is refractory to standard therapy. Scientific advances in the recognition of sensitive and specific biomarkers are steadily outpacing the clinical availability of reliable and non-invasive assessment methods designed for the prompt and specific diagnosis, classification, treatment, and monitoring of severe asthma patients. This article provides a practical overview of current biomarkers and testing methods for prompt, effective management of patients with severe asthma that is refractory to standard therapy.
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Affiliation(s)
- Harold Kim
- Division of Clinical Immunology & Allergy, Department of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
- Division of Clinical Immunology & Allergy, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Anne K. Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen’s University, 15 Arch Street, Kingston, ON K7L 3N6 Canada
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Kingston, ON Canada
| | - David Fischer
- Division of Clinical Immunology & Allergy, Department of Medicine, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
- Canadian Society of Allergy and Clinical Immunology, P.O. Box 51045, Orleans, ON K1E 3W4 Canada
| | - Mary Noseworthy
- Alberta Children’s Hospital, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Ron Olivenstein
- Division of Respiratory Medicine, Faculty of Medicine, McGill University, 3605 Rue De la Montagne, Montreal, QC H3G 2M1 Canada
- Acute Care Division, Montreal Chest Institute, 1001 Décarie Blvd, Montreal, QC H4A 3J1 Canada
| | - Kenneth R. Chapman
- Asthma and Airway Centre, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
- Division of Respirology, Department of Medicine, University of Toronto, 1 King’s College Circle, #3172, Toronto, ON M5S 1A8 Canada
| | - Jason Lee
- Toronto Allergy and Asthma Centre, 123 Edward St, Toronto, ON M5G 1E2 Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
- Department of Surgery, School of Medicine, University of Toronto, 1 King’s College Circle, #3172, Toronto, ON M5S 1A8 Canada
- Evidence Based Medical Educator Inc., 123 Edward St., Suite 920, Toronto, ON M5G 1E2 Canada
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17
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Ito Y, Matsumoto K, Osakama N, Yoshioka R, Kobuchi S, Sakaeda T, Takada K. Dissolving Microneedles as Skin Allergy Test Device. Biol Pharm Bull 2017; 40:531-534. [PMID: 28381808 DOI: 10.1248/bpb.b16-00768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The possibility of using dissolving microneedles (DMs) as a skin allergy test device was studied in rats. Poly-L-arginine was used as a model allergen. Dextran was used to prepare three kinds of DM array chips containing different doses of poly-L-arginine: 17.1±0.5 µg (low-dose DM), 42.2±0.8 µg (medium-dose DM), and 87.4±1.1 µg (high-dose DM); each 1.0 cm2 chip contained 300 DMs. The mean lengths of the low-, medium-, and high-dose DM were 489±3, 485±3, and 492±1 µm and mean diameters of the base were 301±2, 299±1, and 299±2 µm, respectively. Furthermore, for the low-, medium-, and high-dose DM, the administered doses of poly-L-arginine were estimated to be 9.3±1.9, 31.1±1.3, and 61.9±4.7 µg and the scratching behavior per 30 min was 9.8±3.4, 60.4±8.3, and 95.7±10.6 times, respectively. These results demonstrate the dose dependence of the immunoreactivity of the poly-L-arginine DMs, suggesting that DMs can be used an alternative skin allergy device.
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Affiliation(s)
- Yukako Ito
- Department of Pharmacokinetics, Kyoto Pharmaceutical University
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18
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Abstract
Among the atopic disorders, allergic rhinitis is the most prevalent. Patients who suffer from allergic rhinitis sustain significant morbidity and loss of productivity. Cardinal symptoms include nasal congestion, rhinorrhea, sneezing, and nasal itching, although multiple related symptoms may occur. Causes should be ruled out with a thorough history and physical examination, with particular attention to red flag or atypical symptoms. Skin testing or serum sampling can confirm diagnosis and also guide therapy. Therapy is multimodal, tailored to a particular patient's symptom burden and quality of life.
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Affiliation(s)
- Hasan A Kakli
- Penn State Milton S. Hershey Medical Center, Department of Family & Community Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Timothy D Riley
- Penn State Milton S. Hershey Medical Center, Department of Family & Community Medicine, 500 University Drive, Hershey, PA 17033, USA
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19
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Hirashima R, Itoh T, Tukey RH, Fujiwara R. Prediction of drug-induced liver injury using keratinocytes. J Appl Toxicol 2017; 37:863-872. [PMID: 28138970 DOI: 10.1002/jat.3435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 01/07/2023]
Abstract
Drug-induced liver injury (DILI) is one of the most common adverse drug reactions. DILI is often accompanied by skin reactions, including rash and pruritus. However, it is still unknown whether DILI-associated genes such as S100 calcium-binding protein A and interleukin (IL)-1β are involved in drug-induced skin toxicity. In the present study, most of the tested hepatotoxic drugs such as pioglitazone and diclofenac induced DILI-associated genes in human and mouse keratinocytes. Keratinocytes of mice at higher risk for DILI exhibited an increased IL-1β basal expression. They also showed a higher inducibility of IL-1β when treated by pioglitazone. Mice at higher risk for DILI showed even higher sums of DILI-associated gene basal expression levels and induction rates in keratinocytes. Our data suggest that DILI-associated genes might be involved in the onset and progression of drug-induced skin toxicity. Furthermore, we might be able to identify individuals at higher risk of developing DILI less invasively by examining gene expression patterns in keratinocytes. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rika Hirashima
- School of Pharmacy, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Tomoo Itoh
- School of Pharmacy, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Robert H Tukey
- Laboratory of Environmental Toxicology, Department of Pharmacology, University of California San Diego, La Jolla, CA, USA
| | - Ryoichi Fujiwara
- School of Pharmacy, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
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20
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Dong SH, Jung SY, Min JY, Kim SJ, Lee KH, Cho JS, Kim SW. Difference according to Interpretation Methods in Allergic Skin Test. JOURNAL OF RHINOLOGY 2017. [DOI: 10.18787/jr.2017.24.2.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sung Hwa Dong
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
| | - Su Young Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
| | - Jin Young Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Kun Hee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
| | - Joong Saeng Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
| | - Sung Wan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea
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21
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Milner MS, Beckman KA, Luchs JI, Allen QB, Awdeh RM, Berdahl J, Boland TS, Buznego C, Gira JP, Goldberg DF, Goldman D, Goyal RK, Jackson MA, Katz J, Kim T, Majmudar PA, Malhotra RP, McDonald MB, Rajpal RK, Raviv T, Rowen S, Shamie N, Solomon JD, Stonecipher K, Tauber S, Trattler W, Walter KA, Waring GO, Weinstock RJ, Wiley WF, Yeu E. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment. Curr Opin Ophthalmol 2017; 27 Suppl 1:3-47. [PMID: 28099212 PMCID: PMC5345890 DOI: 10.1097/01.icu.0000512373.81749.b7] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.
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Affiliation(s)
- Mark S. Milner
- Yale University School of Medicine, New Haven
- The Eye Center of Southern Connecticut, Hamden, Connecticut
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Kenneth A. Beckman
- Ohio State University, Columbus
- Comprehensive Eye Care of Central Ohio, Westerville, Ohio
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Jodi I. Luchs
- Hofstra Northwell School of Medicine, Hempstead
- South Shore Eye Care, Wantagh, New York
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | | | - Richard M. Awdeh
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | - John Berdahl
- Vance Thompson Vision, Sioux Falls, South Dakota
| | - Thomas S. Boland
- Northeastern Eye Institute, Scranton
- Commonwealth Medical College, Scranton, Pennsylvania
| | - Carlos Buznego
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - Damien F. Goldberg
- Jules Stein Eye Institute, Los Angeles
- Wolstan & Goldberg Eye Associates, Torrance, California
| | | | - Raj K. Goyal
- Rush University Medical Center, Chicago
- Chicago Eye Specialists
| | | | - James Katz
- Midwest Center for Sight, Des Plaines, Illinois
| | - Terry Kim
- Duke Eye Center, Durham, North Carolina
| | - Parag A. Majmudar
- Rush University Medical Center, Chicago
- Chicago Cornea Consultants, Ltd, Hoffman Estates, Illinois
| | - Ranjan P. Malhotra
- Washington University Department of Ophthalmology and Ophthalmology Associates, St. Louis, Missouri
| | - Marguerite B. McDonald
- NYU Langone Medical Center, New York, New York
- Tulane University School of Medicine, New Orleans, Louisiana
- Ophthalmic Consultants of Long Island, Lynbrook, New York
- The Center for Ocular Surface Excellence of New Jersey, Woodland Park, New Jersey
| | - Rajesh K. Rajpal
- Georgetown University Medical Center, George Washington University Medical Center, Washington, DC
| | - Tal Raviv
- New York Eye and Ear Infirmary of Mount Sinai and Eye Center of New York, New York, New York
| | - Sheri Rowen
- NVision EyeCenters of Newport Beach, Newport Beach, California
- University of Maryland, Baltimore, Maryland
| | - Neda Shamie
- Advanced Vision Care, Century City, California
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Karl Stonecipher
- University of North Carolina and TLC Laser Eye Centers, Greensboro, North Carolina
| | | | - William Trattler
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - George O. Waring
- Storm Eye Institute and Magill Vision Center, Medical University of South Carolina, Charleston
- Clemson University, Mt. Pleasant, South Carolina
| | - Robert J. Weinstock
- University of South Florida, Tampa
- The Eye Institute of West Florida, Largo, Florida
| | - William F. Wiley
- Cleveland Eye Clinic, Clear Choice Custom LASIK Center, Brecksville, Ohio
| | - Elizabeth Yeu
- Eastern Virginia Medical School and Virginia Eye Consultants, Norfolk, Virginia, USA
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22
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Low K, Ruane L, Uddin N, Finlay P, Lau KK, Hamza K, Holmes PW, Hamilton G, Bardin PG. Abnormal vocal cord movement in patients with and without airway obstruction and asthma symptoms. Clin Exp Allergy 2016; 47:200-207. [PMID: 27664415 DOI: 10.1111/cea.12828] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Abnormal vocal cord movements can cause laryngeal extrathoracic airway obstruction (often called vocal cord dysfunction - VCD) leading to asthma-like symptoms. These aberrant movements are characteristically present during inspiration and termed paradoxical vocal cord movement (PVCM). We have reported PVCM in up to 40% of severe asthmatics, but it is not known if PVCM is detectable in all patients with asthma-like symptoms and if the condition is more often associated with abnormal lung function. OBJECTIVE We hypothesized that PVCM is frequently associated with asthma symptoms accompanied by airflow limitation. Studies examined whether PVCM is solely linked to experiencing asthma symptoms, or if PVCM is related to airflow limitation and/or other disease characteristics. METHODS Patients with asthma symptoms were recruited from general practice and severe asthma clinics (n = 155). Pulmonary function measurements were conducted, asthma control and Nijmegen (dysfunctional breathing) questionnaires were administered and skin prick testing was carried out. PVCM was quantified using dynamic 320-slice computerized tomography of the larynx. Groups were divided into patients with FEV1 ≥ 80% predicted or FEV1 < 80% predicted and FEV1 /FVC < 0.7. ATS/ERS definitions of severity were also applied and evaluated. Detection of PVCM in the groups was compared and analyses performed to identify features associated with PVCM. RESULTS Overall (n = 155), PVCM was detected in 42 cases (27.1%). Patients with FEV1 < 80% predicted had PVCM more often (25/68, 36.8%) than individuals with normal spirometry (17/87, 19.5%; P = 0.016). PVCM was associated with older age (P = 0.003) and with Nijmegen scores > 20 (P = 0.04). Patients with FEV1 < 80% predicted plus Nijmegen scores > 20 were more likely to have PVCM (OR = 9.3, P = 0.02). CONCLUSIONS AND CLINICAL RELEVANCE Paradoxical vocal cord movement is more often associated with asthma symptoms accompanied by airflow limitation and dysfunctional breathing. Further studies are needed to determine whether PVCM is induced by dysfunctional breathing practices and/or airway obstruction. How PVCM links with symptomatic asthma and VCD also requires evaluation.
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Affiliation(s)
- K Low
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia.,Hudson Institute, Monash University and Hospital, Melbourne, Vic., Australia
| | - L Ruane
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia.,Hudson Institute, Monash University and Hospital, Melbourne, Vic., Australia
| | - N Uddin
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia
| | - P Finlay
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia
| | - K K Lau
- Diagnostic Imaging, Monash University and Hospital, Melbourne, Vic., Australia
| | - K Hamza
- Statistical Services, Monash University and Hospital, Melbourne, Vic., Australia
| | - P W Holmes
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia
| | - G Hamilton
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia.,Hudson Institute, Monash University and Hospital, Melbourne, Vic., Australia
| | - P G Bardin
- Monash Lung and Sleep, Monash University and Hospital, Melbourne, Vic., Australia.,Hudson Institute, Monash University and Hospital, Melbourne, Vic., Australia
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23
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Malling HJ, Allesen-Holm P, Karved LS, Poulsen LK. Proficiency testing of skin prick testers as part of a quality assurance system. Clin Transl Allergy 2016; 6:36. [PMID: 27688875 PMCID: PMC5034588 DOI: 10.1186/s13601-016-0126-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin prick test is an important diagnostic procedure in clinical allergy but documentation of the quality is often missing. METHODS We describe a proficiency system to evaluate staff members in relation to the international recommended reproducibility in terms of coefficient of variation (CV < 40 %) and the linearity (coefficient of regression >0.85) based on blinded octuplicate histamine testing using histamine 3, 10, 30 and 100 mg/ml. RESULTS Fourteen trained allergy nurses participated in the proficiency testing. More than 95 % of the nurses, generated coefficient of variation less than 40 %, and for around 35 % of testers the CV were below 20 % based on wheal area. Regarding the linearity (coefficient of regression), only two nurses produced tests with a value below 0.85. On the contrary, 79 % of testers demonstrated a coefficient of regression >0.95. Depending on the gentleness of the prick procedure, the inter-nurse variability in wheal area varied more than twofold corresponding to a 10-doubling of histamine concentration. This would never have been detected without using a proficiency testing system. CONCLUSION The described histamine testing provides an objective system for the evaluation of basic skin test quality assessment standards especially for documentation in scientific studies.
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Affiliation(s)
- Hans-Jørgen Malling
- Allergy Clinic, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Pernille Allesen-Holm
- Allergy Clinic, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Lisbeth Sys Karved
- Allergy Clinic, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Lars K. Poulsen
- Allergy Clinic, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark
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24
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Brevard J, Elder MA, Berman G, Tan Y, Volfson D, Ogden A, Evans B, Bednar MM. The histamine skin prick test: An analysis of the method for use in clinical trials. Ann Allergy Asthma Immunol 2016; 117:433-435. [PMID: 27519579 DOI: 10.1016/j.anai.2016.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Julie Brevard
- Pfizer Worldwide Research & Development, Neuroscience and Pain Research Unit, Cambridge, Massachusetts; Idera Pharmaceuticals, Cambridge, Massachusetts
| | | | - Gary Berman
- Clinical Research Institute Inc, Minneapolis, Minnesota
| | - Ye Tan
- Pfizer Worldwide Research & Development, Neuroscience and Pain Research Unit, Cambridge, Massachusetts
| | - Dmitri Volfson
- Pfizer Worldwide Research & Development, Neuroscience and Pain Research Unit, Cambridge, Massachusetts
| | - Adam Ogden
- Pfizer Worldwide Research and Development, Groton, Connecticut
| | - Barbara Evans
- Pfizer Worldwide Research & Development, Neuroscience and Pain Research Unit, Cambridge, Massachusetts
| | - Martin M Bednar
- Pfizer Worldwide Research & Development, Neuroscience and Pain Research Unit, Cambridge, Massachusetts.
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25
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Philpott H, Nandurkar S, Royce SG, Thien F, Gibson PR. Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis. A comprehensive prospective study using five modalities. Aliment Pharmacol Ther 2016; 44:223-33. [PMID: 27247257 DOI: 10.1111/apt.13676] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of allergy tests to guide dietary treatment for eosinophilic oesophagitis (EoE) is controversial and data are limited. Aeroallergen sensitisation patterns and food triggers have been defined in Northern Hemisphere cohorts only. AIMS To determine if allergy tests that are routinely available can predict food triggers in adult patients with EoE. To define the food triggers and aeroallergen sensitisation patterns in a novel Southern Hemisphere (Australian) cohort of patients. METHODS Consecutive patients with EoE who elected to undergo dietary therapy were prospectively assessed, demographic details and atopic characteristics recorded, and allergy tests, comprising skin-prick and skin-patch tests, serum allergen-specific IgE, basophil activation test and serum food-specific IgG, were performed. Patients underwent a six-food elimination diet with a structured algorithm that included endoscopic and histological examination of the oesophagus a minimum of 2 weeks after each challenge. Response was defined as <15 eosinophils per HPF. Foods defined as triggers were considered as gold standard and were compared with those identified by allergy testing. RESULTS No allergy test could accurately predict actual food triggers. Concordance among skin-prick and serum allergen-specific IgE was high for aeroallergens only. Among seasonal aeroallergens, rye-grass sensitisation was predominant. Food triggers were commonly wheat, milk and egg, alone or in combination. CONCLUSIONS None of the currently-available allergy tests predicts food triggers for EoE. Exclusion-rechallenge methodology with oesophageal histological assessment remains the only effective investigation. The same food triggers were identified in this southern hemisphere cohort as previously described.
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Affiliation(s)
- H Philpott
- Monash University, Melbourne, Vic., Australia.,Eastern Health Department of Gastroenterology, Eastern Health Clinical School, Melbourne, Vic., Australia.,The Alfred Hospital, Melbourne, Vic., Australia
| | - S Nandurkar
- Monash University, Melbourne, Vic., Australia.,Eastern Health Department of Gastroenterology, Eastern Health Clinical School, Melbourne, Vic., Australia
| | - S G Royce
- Monash University, Melbourne, Vic., Australia
| | - F Thien
- Monash University, Melbourne, Vic., Australia.,Eastern Health Department of Gastroenterology, Eastern Health Clinical School, Melbourne, Vic., Australia
| | - P R Gibson
- Monash University, Melbourne, Vic., Australia.,The Alfred Hospital, Melbourne, Vic., Australia
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26
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Zimmer J, Vieths S, Kaul S. Standardization and Regulation of Allergen Products in the European Union. Curr Allergy Asthma Rep 2016; 16:21. [PMID: 26874849 DOI: 10.1007/s11882-016-0599-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Product-specific standardization is of prime importance to ensure persistent quality, safety, and efficacy of allergen products. The regulatory framework in the EU has induced great advancements in the field in the last years although national implementation still remains heterogeneous. Scores of methods for quantification of individual allergen molecules are developed each year and also the challenging characterization of chemically modified allergen products is progressing. However, despite the unquestionable increase in knowledge and the subsequent improvements in control of quality parameters of allergen products, an important aim has not been reached yet, namely cross-product comparability. Still, comparison of allergen product potency, either based on total allergenic activity or individual allergen molecule content, is not possible due to a lack of standard reference preparations in conjunction with validated standard methods. This review aims at presenting the most recent developments in product-specific standardization as well as activities to facilitate cross-product comparability in the EU.
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Affiliation(s)
- Julia Zimmer
- Division of Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany.
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany.
| | - Susanne Kaul
- Division of Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany.
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Tversky JR, Hamilton RG. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:791. [PMID: 27178965 DOI: 10.1016/j.jaip.2016.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Jody R Tversky
- Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Md.
| | - Robert G Hamilton
- Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Md
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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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Skin Testing for Allergic Rhinitis: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2016; 16:1-45. [PMID: 27279928 PMCID: PMC4897001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Allergic rhinitis is the most common type of allergy worldwide. The accuracy of skin testing for allergic rhinitis is still debated. This health technology assessment had two objectives: to determine the diagnostic accuracy of skin-prick and intradermal testing in patients with suspected allergic rhinitis and to estimate the costs to the Ontario health system of skin testing for allergic rhinitis. METHODS We searched All Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment Database, Cochrane Central Register of Controlled Trials, and NHS Economic Evaluation Database for studies that evaluated the diagnostic accuracy of skin-prick and intradermal testing for allergic rhinitis using nasal provocation as the reference standard. For the clinical evidence review, data extraction and quality assessment were performed using the QUADAS-2 tool. We used the bivariate random-effects model for meta-analysis. For the economic evidence review, we assessed studies using a modified checklist developed by the (United Kingdom) National Institute for Health and Care Excellence. We estimated the annual cost of skin testing for allergic rhinitis in Ontario for 2015 to 2017 using provincial data on testing volumes and costs. RESULTS We meta-analyzed seven studies with a total of 430 patients that assessed the accuracy of skin-prick testing. The pooled pair of sensitivity and specificity for skin-prick testing was 85% and 77%, respectively. We did not perform a meta-analysis for the diagnostic accuracy of intradermal testing due to the small number of studies (n = 4). Of these, two evaluated the accuracy of intradermal testing in confirming negative skin-prick testing results, with sensitivity ranging from 27% to 50% and specificity ranging from 60% to 100%. The other two studies evaluated the accuracy of intradermal testing as a stand-alone tool for diagnosing allergic rhinitis, with sensitivity ranging from 60% to 79% and specificity ranging from 68% to 69%. We estimated the budget impact of continuing to publicly fund skin testing for allergic rhinitis in Ontario to be between $2.5 million and $3.0 million per year. CONCLUSIONS Skin-prick testing is moderately accurate in identifying subjects with or without allergic rhinitis. The diagnostic accuracy of intradermal testing could not be well established from this review. Our best estimate is that publicly funding skin testing for allergic rhinitis costs the Ontario government approximately $2.5 million to $3.0 million per year.
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Ginsberg DN, Eichenfield LF. Debates in allergy medicine: Specific immunotherapy in children with atopic dermatitis, the "con" view. World Allergy Organ J 2016; 9:16. [PMID: 27134697 PMCID: PMC4836074 DOI: 10.1186/s40413-016-0107-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/17/2016] [Indexed: 02/02/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic skin condition in children that has a proven association with other atopic conditions and allergies. These associations, like the general pathophysiology of AD, are complex and not fully understood. While there is evidence for the efficacy of specific immunotherapy (SIT) in pediatric asthma and allergic rhinitis (AR), there is a lack of strong data to support its use in AD. IgE has been shown to be elevated in many patients with AD, but it is an unreliable biomarker due to variability and great fluctuation over time, poor positive predictive value for clinically relevant allergy, and poor correlation with disease state. In spite of this, almost all studies of SIT use either positive skin prick testing (SPT) or serum specific IgE levels to guide therapy. Allergen avoidance, with some exceptions, is generally not effective at controlling AD in children. The few studies that have investigated the efficacy of SIT in children with AD have produced conflicting results, and a lack of reproducibility with a standard treatment protocol. Limited studies have shown clinical improvement in mild to moderate AD cases, but no effect on more severe patients. Uncontrolled studies are difficult to interpret, due to the natural history of remission or “outgrowing” of AD over time in many patients without specific interventions. Drawbacks to SIT include the length of treatment, poor compliance, cost, and potential side effect profile. The potential for misdirection of time and energy away from skin directed therapy could negatively impact on AD outcomes.
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Affiliation(s)
- David N Ginsberg
- Department of Dermatology, Rady Children's Hospital, San Diego, CA USA
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego, La Jolla USA ; Division of Dermatology, Rady Children's Hospital, San Diego, CA USA
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House Dust Mite Respiratory Allergy: An Overview of Current Therapeutic Strategies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:843-55. [PMID: 26342746 DOI: 10.1016/j.jaip.2015.06.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 01/24/2023]
Abstract
Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence on the efficacy of pharmacotherapy treatment for known HDM-allergic patients is weaker. The standard diagnostic techniques--skin prick test and specific IgE testing--can be confounded by cross-reactivity. However, component-resolved diagnosis using purified and recombinant allergens can improve the accuracy of specific IgE testing, but availability is limited. Treatment options for HDM allergy are limited and include HDM avoidance, which is widely recommended as a strategy, although evidence for its efficacy is variable. Clinical efficacy of pharmacotherapy is well documented; however, symptom relief does not extend beyond the end of treatment. Finally, allergen immunotherapy has a poor but improving evidence base (notably on sublingual tablets) and its benefits last after treatment ends. This review identifies needs for deeper physician knowledge on the extent and impact of HDM allergy in respiratory disease, as well as further development and improved access to molecular allergy diagnosis. Furthermore, there is a need for the development of better-designed clinical trials to explore the utility of allergen-specific approaches, and uptake of data into guidance for physicians on more effective diagnosis and therapy of HDM respiratory allergy in practice.
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