RESUMO
BACKGROUND: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available. OBJECTIVES: The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization. METHODS: In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis. RESULTS: Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a. CONCLUSIONS: SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.
Assuntos
Alérgenos/imunologia , Fungos/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Imunoglobulina E/imunologia , Adolescente , Adulto , Idoso , Especificidade de Anticorpos/imunologia , Criança , Feminino , Humanos , Imunização , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Curva ROC , Testes Cutâneos , Adulto JovemRESUMO
BACKGROUND: Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. CONCLUSIONS: The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.
Assuntos
Alumínio/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Toxidermias/diagnóstico , Granuloma/induzido quimicamente , Granuloma/diagnóstico , Vacinas Virais/efeitos adversos , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Administração Tópica , Alumínio/administração & dosagem , Antialérgicos/administração & dosagem , Cetirizina/administração & dosagem , Pré-Escolar , Dermatite Alérgica de Contato/tratamento farmacológico , Dermatite Alérgica de Contato/imunologia , Toxidermias/tratamento farmacológico , Toxidermias/etiologia , Toxidermias/imunologia , Quimioterapia Combinada , Glucocorticoides/administração & dosagem , Granuloma/tratamento farmacológico , Granuloma/imunologia , Antagonistas não Sedativos dos Receptores H1 da Histamina/administração & dosagem , Humanos , Masculino , Sais/administração & dosagem , Sais/efeitos adversos , Resultado do Tratamento , Vacinas Virais/imunologiaRESUMO
A patient with mild oral allergy syndrome presented with a history of anaphylaxis induced by both hazelnuts and peaches. The ensuing work-up showed a double sensitization to proteins in both pathogenesis-related group 10 (e.g. Bet v1, Cor a1, Pru p1) and 14 (e.g. Pru p3, Cor a8). Such double sensitization profiles are increasingly being recognized in Europe.
Assuntos
Anafilaxia/diagnóstico , Anafilaxia/imunologia , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/imunologia , Proteínas de Plantas/imunologia , Proteínas de Plantas/intoxicação , Adulto , Diagnóstico Diferencial , Feminino , Humanos , ImunizaçãoRESUMO
Secondary food allergies to PR-10 proteins (Bet v1 homologues) are the most common food allergies in Germany. Clinically they present with an oral allergy syndrome (intraoral pruritus and perhaps swelling). When drinks containing PR-10 proteins are rapidly consumed, for example after sporting activities, large concentrations of allergen can be reached without any intraoral symptoms and then lead to anaphylaxis. This phenomenon has often been described for soja milk and occurred in our case with an apple drink with 60% fruit concentration. It seems likely that such cases of anaphylaxis are not adequately represented in the anaphylaxis registry.
Assuntos
Anafilaxia/induzido quimicamente , Antígenos de Plantas/intoxicação , Bebidas/intoxicação , Hipersensibilidade Alimentar/etiologia , Prurido/induzido quimicamente , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/prevenção & controle , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/prevenção & controle , Humanos , Masculino , Prurido/diagnóstico , Prurido/prevenção & controleRESUMO
We report on a patient with an iodine allergy. He developed a delayed cutaneous reaction after receiving an iodinated radiographic contrast media and at the same time topical disinfection with povidone-iodine. In the patch- and intradermal tests he showed positive results with various radiographic contrast media, povidone- iodine and iodine, but not with povidone.
Assuntos
Toxidermias/diagnóstico , Toxidermias/etiologia , Povidona-Iodo/efeitos adversos , Idoso , Meios de Contraste , Toxidermias/prevenção & controle , Humanos , Masculino , Testes do Emplastro , Excipientes Farmacêuticos/efeitos adversos , Povidona/efeitos adversosRESUMO
During the induction of anesthesia for strabismus correction, a six-year-old boy suffered anaphylaxis with hypotension. Midazolam, propofol, sufentanil, rocuronium, dexamethasone and ibuprofen had been administered. The boy's history failed to reveal any drug allergies. Intracutaneous testings with drugs used for anesthesia and other muscle relaxants verified a positive reaction to rocuronium as well as to cisatracurium, mivacurium, vecuronium and atracurium. There was no reaction to suxamethonium.
Assuntos
Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Androstanóis/efeitos adversos , Toxidermias/diagnóstico , Toxidermias/etiologia , Hipersensibilidade a Drogas/diagnóstico , Anafilaxia/terapia , Criança , Toxidermias/terapia , Hipersensibilidade a Drogas/terapia , Humanos , Masculino , Assistência Perioperatória/efeitos adversos , RocurônioRESUMO
Specific immunotherapy (SIT) of hymenoptera venom allergy, in particular, has become an example for the effectiveness of the treatment of IgE-mediated allergic diseases. In vitro diagnostic procedures and the measurement of serum tryptase for risk assessment are well-established in the process of diagnose finding and therapy preparation. For monitoring and validation of the effectiveness of the SIT, however, in vitro diagnostic procedures remain controversial. Potentially useful approaches include detection of specific IgE, specific IgG4, basophile activation - represented by the CD 63 expression - and the lymphocyte proliferation and its IL10 release. Preliminary data suggest that the latter method appear appropriate, whereas the detection of basophile activation did not produce definite results.
Assuntos
Venenos de Abelha/administração & dosagem , Venenos de Abelha/imunologia , Dessensibilização Imunológica/métodos , Epitopos/administração & dosagem , Epitopos/imunologia , Himenópteros/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Venenos de Vespas/administração & dosagem , Venenos de Vespas/imunologia , Animais , Teste de Degranulação de Basófilos , Humanos , Hipersensibilidade/terapia , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Técnicas In Vitro , Interleucina-10/sangue , Ativação Linfocitária/imunologia , Tetraspanina 30/sangue , Resultado do Tratamento , Triptases/sangueRESUMO
BACKGROUND: The lymphocyte transformation test (LTT) is the only in vitro test for detecting drug sensitization at the cellular level irrespective of the reaction's phenotype. However, the LTT includes working with radioactive substances and is considered impracticable for routine laboratory investigation. OBJECTIVE: The aim of this study was to assess drug-specific cytokine production by means of flow cytometry as an alternative nonradioactive approach which may be more appropriate for routine testing and may provide in addition more information about the pathophysiology of the reaction than proliferation-based assays, like the LTT. METHOD: Peripheral blood mononuclear cells of 19 patients were incubated with culprit drugs (n = 28) or irrelevant antigens (n = 10). Ten healthy persons served as controls for all different drugs (n = 15). Intracellular interleukin (IL)-5, interferon (IFN)-gamma and IL-10 production was investigated using flow cytometry. Accuracy of the flow cytometry test system was confirmed using different statistical tests, i.e. receiver operating characteristic curve and Mann-Whitney rank test. In addition, drug-specific secretion of IL-5, IL-2 and IFN-gamma were analysed using enzyme-linked immunosorbent assay (ELISA). RESULTS: Drug-specific cytokine production could be demonstrated in 75% of the patients using flow cytometry and in 79% using ELISA respectively. Combining ELISA and flow cytometry increased the sensitivity to 100%. Analysis of involved T-cell subsets [e.g. CD4(+) or CD8(+); T helper (TH) 1 or TH 2] allowed characterization of the in vitro lymphocyte reactivity pattern. CONCLUSIONS: Analysis of drug-specific cytokine production by means of flow cytometry proved a useful and reliable approach for the in vitro detection and characterization of drug hypersensitivities.
Assuntos
Hipersensibilidade a Drogas/diagnóstico , Citometria de Fluxo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Separação Celular , Citocinas/biossíntese , Ensaio de Imunoadsorção Enzimática , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e EspecificidadeRESUMO
This is a case report of a female patient showing a delayed allergic reaction to epoxy resin. The allergic contact dermatitis occurred after sitting in her new car equipped with artificial leather seats.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Têxteis/efeitos adversos , Automóveis , Feminino , Humanos , Adulto JovemRESUMO
Anaphylaxis represents a severe, systemic and potentially fatal hypersensitivity reaction that severely impairs the life of affected children and their caregivers. With an estimated life time prevalence of 0.05% to 2%, it is not a rare disease. Therefore every physician caring for children at risk for anaphylaxis should be familiar with this disease pattern. Foods are the most frequent triggers in children; less frequent causes include drugs and insect venom. Particularly in case of idiopathic anaphylaxis, systemic mastocytosis should be ruled out as a potential differential diagnosis in this age group as well. First line emergency treatment consists of parenteral epinephrine in a weight-adjusted dosage, and after cardiovascular stabilization systemic antihistamines and corticosteroids as well as inhaled beta-mimetics can be administered. Affected patients, their relatives and other caregivers should receive extensive training in order to guarantee an adequate emergency management of anaphylactic children.