Proven immunologically-mediated drug hypersensitivity in children with a history of multiple drug intolerances.

BACKGROUND: Children may be referred to pediatric allergy clinics for reactions to multiple drugs. Multiple drug hypersensitivity (MDH) is defined as immunologically-mediated hypersensitivity to 2 or more chemically different drugs. OBJECTIVE: The aim of this study is to report the allergy workup results of children who had a history of potential hypersensitivity reactions to 2 or more unrelated drugs. METHODS: This study was conducted in the Pediatric Allergy and Immunology department of our hospital. Children who described hypersensitivity reactions to 2 or more drugs were included and were evaluated by allergy workup (skin and/or provocation tests) between January 2011 and July 2016. RESULTS: During the study period, 886 children were evaluated for a history of drug intolerance. Of these children, 73 (8.2%) had a history of drug reactions to 2 or more chemically different drugs. The median age of the children who had a history of reactions to 2 or more drugs was 7.8 (min-max: 2.5-16.4) years, and 59% (n = 43) were male. Among the suspected drugs, antibiotics (65.9%) ranked first, and nonsteroid anti-inflammatory drugs (34.1%) were the second. All 73 children were evaluated with skin or provocation tests with the suspected drugs, and MDH was confirmed in only 2 (2.7%) children. CONCLUSION: Multiple drug hypersensitivity is uncommon in children. The incidence and prevalence of MDH may vary with the specific population studied. Evaluating children with a history of MDH, by performing drug hypersensitivity testing, will help avoid the morbidity associated with unnecessary drug avoidance.

[The intradermal tuberculin test: literature, directive and implementation in practice]. / Der Tuberkulin-Hauttest: Literatur, Richtlinie und Umsetzung in der Praxis.

OBJECTIVE: Because of an increase in the number of cases of bovine tuberculosis in southern Germany (Allgäu region, mainly in the administrative district Swabia) during recent years, blanket tuberculosis testing was resumed in this region. The aim of this study was to review the veterinarians' current knowledge regarding the technique of the intradermal tuberculin test. As a consequence, a guide with precise instructions for the execution and interpretation of intradermal tuberculin testing in cattle based on the current legislation should be created. MATERIAL AND METHODS: Using a questionnaire, farm-animal practitioners' knowledge and experiences of intradermal tuberculin testing were surveyed, collected and evaluated. Legislative texts on tuberculosis (particularly testing of tuberculosis) were evaluated in their current and previous versions, and compared with the experiences reported by the veterinarians. RESULTS: A total of 137 veterinarians participated and 130 returned questionnaires could be evaluated. Forty-four of the 130 participants were involved in tuberculosis testing when the survey was performed. Of these 44 questionnaires, 42 were incorporated in the final evaluation. The majority of the veterinarians perform the intradermal tuberculosis test as laid down in the Commission Regulation (EC) no. 1226/2002 of 8 July 2002 amending Annex B to Council Directive 64/432/EEC. However, many practitioners do not comply with the requirements of the Commission Regulation (EC) no. 1226/2002 when evaluating the results of the intradermal tuberculosis test. Veterinarians showing the least accordance with required standards only test single animals or work in areas other than Swabia. CONCLUSIONS: In areas severely affected by tuberculosis, the technique of intradermal tuberculosis testing is performed almost as demanded by the Commission Regulation (EC) no. 1226/2002. However, a more uniform and careful approach should be sought when monitoring the results. The guide designed in the context of this study can help to improve the performance of the intradermal tuberculosis test. The information from the literature review also shows that there is currently no standardized method of intradermal tuberculosis testing.

The level of specialist assessment of adult asthma is influenced by patient age.

BACKGROUND: Late onset asthma is associated with more severe disease and higher morbidity than in younger asthma patients. This may in part relate to under recognition of asthma in older adults, but evidence on the impact of patient age on diagnostic assessment of asthma in a specialist setting is sparse. AIM: To examine the impact of patient age on the type and proportion of diagnostic tests performed in patients undergoing specialist assessment for asthma. METHODS: Data from a clinical population consisting of all patients consecutively referred over a 12 months period to a specialist clinic for assessment of asthma were analysed. RESULTS: A total of 224 patients with asthma or suspected asthma were referred during the 12 month period; 86 adults aged <35 years, 95 aged 35-55 years and 43 aged >55 years. Symptom characteristics were similar, but adults >35 years had a lower lung function than younger adults, and were more frequently smokers. However, a regression analysis showed that older age was associated with a lower likelihood of diagnostic assessment with a reversibility test, a bronchial challenge test, or measurement of exhaled NO, independently of a known diagnosis of asthma, smoking habits and lung function at referral. CONCLUSION: A lower level of diagnostic assessment was observed already after the age of 35 years, indicating a risk for under diagnosis of asthma at an earlier patient age than previously thought.

Is referring patients with a positive history of allergic drug reactions or atopy for allergy testing to local anesthetics justified?

Although no more than 1% of adverse reactions to local anesthetics (LA) are thought to be immunologically mediated, many patients continue to be referred to allergy clinics for allergy workup. We evaluated the impact of a history of drug hypersensitivity or atopy on results of allergy testing to LA, with the aim of determining the appropriateness of allergy testing to LA in such patients. We retrospectively analyzed medical records of 112 consecutive patients referred for allergy testing to LA in a 9-year period (1996-2005). Intradermal tests with diluted (1:10) LA were performed to identify patients at risk for immunoglobulin E (IgE)-mediated hypersensitivity reaction. The odds for being testpositive were calculated with regard to the defined risk factors (atopy, history of adverse reactions to LA or other drugs, underlying autoimmune disease). Eleven of 112 patients (9.8%) tested positive for allergy to LA. Atopy, history of adverse reactions to LA or other drugs and underlying autoimmune disease did not increase the odds for being test-positive. The prevalence of multiple drug hypersensitivity, IgE values and eosinophil count were not significantly higher among the patients who tested positive as compared to the patients who tested negative. According to our data, allergy testing to LA is not justified in patients with atopy or histories of adverse drug reactions other than to LA. Further studies using validated methods of allergy testing to LA coupled with analysis of defined risk factors are needed to definitively establish the indications for referral of patients for allergy testing to LA.

Canine atopic dermatitis: a retrospective study of 169 cases examined at the University of California, Davis, 1992-1998. Part II. Response to hyposensitization.

One hundred and sixty-nine dogs were diagnosed with atopic dermatitis, and treated with hyposensitization for at least 1 year based on the results of either intradermal skin tests (IDST) or enzyme-linked immunosorbant serum assays (ELISA). Excellent (i.e. hyposensitization alone controlled clinical signs), good (> 50% improvement), moderate (< 50% improvement) and no (clinical signs were unchanged) responses were seen in 19.5, 32.5, 20.1 and 27.8%, respectively. Age of onset, age when treatment was initiated or the duration of clinical signs had no influence on response to hyposensitization. Dogs having concurrent flea allergy dermatitis were statistically more likely to respond better than dogs with concurrent food allergies. Although not statistically significant, there were trends for Golden Retriever and male dogs to respond better than other breeds and female dogs, respectively. Dogs having more than 21 positive reactions in allergy tests and treated with more than 21 allergens had lower response scores, and a longer time course before achieving beneficial response. Lower response scores were seen in dogs having positive reactions to cultivated plants, grasses, trees or insects. There was no difference in response to hyposensitization whether based on IDST or ELISA results.

Inquérito intradérmico com histoplasmina e paracoccidioidina em duas regiöes do Rio Grande do Sul / Intradermal inquest with histoplasm and paracoccidioidin in two regions of Rio Grande do Sul

From August to October 1992 a study of prevalence of cutaneous positivity to histoplasmin and paracoccidioidin was carried out in the cities of Cachoeira do Sul (Valley of Jacuí River) and Santo Angelo (western hillside of the PlateAn), Rio Grande do Sul, Brazil. Skin tests were made in 193 soldiers from Cachoeira do Sul and 161 soldiers from Santo Angelo, both groups of 17 to 19 years of age. In Cachoeira do Sul the prevalence of positive tests to histoplasmin was 89 per cent and to paracoccidioidin 82 per cent. In Santo Angelo 48 per centof the intradermical reactions were positive to histoplasmin and 39 per centto paracoccidioidin.

[An intradermal test with histoplasmin and paracoccidioidin in 2 regions of Rio Grande do Sul]. / Inquérito intradérmico com histoplasmina e paracoccidioidina em duas regiões do Rio Grande do Sul.

From August to October 1992 a study of prevalence of cutaneous positivity to histoplasmin and paracoccidioidin was carried out in the cities of Cachoeira do Sul (Valley of Jacuí River) and Santo Angelo (western hillside of the PlateAn), Rio Grande do Sul, Brazil. Skin tests were made in 193 soldiers from Cachoeira do Sul and 161 soldiers from Santo Angelo, both groups of 17 to 19 years of age. In Cachoeira do Sul the prevalence of positive tests to histoplasmin was 89% and to paracoccidioidin 82%. In Santo Angelo 48% of the intradermical reactions were positive to histoplasmin and 39% to paracoccidioidin.

[The diagnostic potentials of the method for the intradermal administration of denatured gamma-globulin in coniotuberculosis of the intrathoracic lymph nodes]. / Diagnosticheskie vozmozhnosti metoda vnutrikozhnogo vvedeniia denaturirovannogo gamma-globulina pri koniotuberkuleze vnutrigrudnykh limfaticheskikh uzlov.

A direct relationship exists between coniotuberculosis of occupational origin, thoracic lymph node coniotuberculosis in the elderly and frequency and intensity of the body response to intracutaneous administration of denatured gamma-globulin (DNGG). Positive DNGG test is a nonspecific test for dust content, anthracosilicotic induration and coniotuberculosis of thoracic lymph nodes. As additional to clinicoroentgenological examination of thoracic lymph node coniotuberculosis of occupational and non-occupational origin.

Giardia lamblia allergenic extract as diagnosis procedures for determining sensitization to this protozoa.

We studied 200 patients assisting at the Allergy Department and the Gastroenterology Department in "Hermanos Ameijeiras" Clinical-Surgical Hospital. They were clinically and immunologically tested for giardiasis through duodenal fortis or gall bladder drainage and total IgE serum levels. All patients underwent intradermal and skin prick tests with Giardine allergenic extract. These skin tests showed high sensitivity and increased specificity. Thus, our procedure in diagnosis is accurate, accessible and economical.

Leishmaniasis tegumentaria americana: trabajo realizado en 340 trabajadores del proyecto hidroelectrico de San Carlos Antioquia / American tegumentary leishmaniasis

De un grupo de 3500 trabajadores que construyen la Central Hidroelectrice de San Carlos (Antioquia-Colombia), se tomo una muetra de 340 individuos para buscar el indice alergico y parasitario de la leishmaniasis tegumentaria americana. A todos ellos se les aplico la intradermorreaccion de Montenegro y se les busco anticuerpos, utilizando la tecnica de inmunofluorescencia indirecta. Mediante un formulario se registraron las variables de persona, tiempo y lugar. A dos individuos que presentaron lesiones clinicamente compatibles, se les hizo biopsia, frotis coloreado con Wright y cultivo en medio NNN