Rapid bacterial identification by MALDI-TOF MS directly from blood cultures and rapid susceptibility testing: A simple approach to reduce the turnaround time of blood cultures

Abstract Antimicrobial treatment of patients with bloodstream infections (BSI) is time-sensitive. In an era of increasing antimicrobial resistance, rapid detection and identification of bacteria with antimicrobial susceptibility are critical for targeted therapy early in the disease course. This study describes the performance of a rapid method for identifying and testing antimicrobial susceptibility of Gram-negative bacteria performed directly from blood culture bottles in a routine microbiology laboratory. A total of 284, 120, and 24 samples were analyzed by rapid identification (Rid), rapid susceptibility testing (RAST), and rapid broth microdilution for polymyxin B (rMIC), respectively, and compared with standard methods. Our protocol was able to identify 93% of isolates at the species level using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We obtained 100% agreement for RAST compared to the standard method and 96% agreement for rMIC. Our protocol has proven to be an excellent tool for rapid identification of Gram-negative bacilli causing BSIs. It can also be used in microbiology laboratory routine along with RAST and faster polymyxin microdilution, especially for carbapenemase-producing bacteria, allowing for rapid, simple, accurate, and cost-effective diagnosis.

Allergic Rhinitis: A Critical Modern Review

Allergic rhinitis addresses a hyperactivity of the resistant framework in any case harmless particles making a fiery reaction where none is required. Allergic Rhinitis is clinically represented by a mixture of two or additional nasal symptoms: running, blocking, itching and sneezing. Allergic rhinitis is regularly partitioned by age, seriousness, and duration of symptoms. Investigation represents how epidemiologic evaluations on the commonness of hypersensitive or allergic rhinitis shift considerably with whether both clinical appraisal and testing were utilized to make the determination. The treatment of allergic rhinitis should combine allergen avoidance, pharmacotherapy and allergen immunotherapy. Treatments of allergic rhinitis include intranasal corticosteroids, oral and topical antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics. First-generation and Second-generation oral antihistamines and intranasal corticosteroids are the most effective modality for treating allergic rhinitis. Immunotherapy is an efficient immune-modulating treatment that ought to be counseled if pharmacologic medical care for allergic rhinitis isn't effective or not tolerated. This article provides an overview of the prevalence, pathophysiology, diagnosis, and appropriate management of the allergic rhinitis.

Validade do RAST para avaliar o desempenho da potência anaeróbia em relação ao teste Wingate em ciclistas / Validad del RAST para evaluar el rendimiento de potencia anaeróbica en comparación con el test de Wingate en los atletas de ciclismo / Validity of the RAST for evaluating anaerobic power performance as compared to Wingate test in cycling athletes

The validity of the Running-based Anaerobic Sprint Test (RAST) was investigated to evaluate the anaerobic power performance in comparison to Wingate test in cycling athletes. Ten mountain-bike male cyclists (28.0±7.3 years) randomly performed Wingate Test and RAST with two trials each. After several anthropometric measurements, peak power (PP), mean power (MP) and fatigue index (FI) for RAST and Wingate Test were analyzed using Student's paired t-test, Pearson's linear correlation test (r) and Bland and Altman's plots. Results showed that, with the exception of FI (33.8±4.6% vs. 37.8±7.9%; r=0.172), significant differences were detected between the Wingate and RAST tests with regard to PP and MP. Although there was a strong correlation for PP and MP, or rather, 0.831 and 0.714 respectively, agreement of analysis between Wingate and RAST protocols was low. The above suggested that RAST was not appropriate to evaluate the performance of anaerobic power by Wingate test in cycling athletes.

O objetivo foi investigar a validade do teste de RAST (Running-based Anaerobic Sprint Test) em avaliar o desempenho da potência anaeróbia a partir do teste de Wingate em ciclistas treinados. Participaram do estudo 10 ciclistas do sexo masculino (28,0±7,3 anos) da modalidade de Mountain bike. Após a mensuração das variáveis antropométricas, a potência pico (PP), média (PM) e o índice de fadiga (IF) foram determinados randomicamente a partir de dois testes de Wingate e dois testes de RAST. Foram utilizados o teste t independente de Student, a análise de correlação linear de Pearson (r) e o teste de Bland-Altman. Os resultados demonstraram, exceto para o IF (33.8±4.6% vs. 37.8±7.9%; r=0.172), diferenças significativas entre o teste de Wingate e o RAST para PP e PM (W.kg-1 e W). Embora os valores de correlação para a PP e PM (W) tenham sido fortes (0.831 e 0.714, respectivamente) a concordância entre os protocolos de Wingate e RAST foi baixa, sugerindo que o teste de RAST não é válido para avaliar o desempenho da potência anaeróbica a partir do teste de Wingate em ciclistas.

El objetivo fue investigar la validad del teste de RAST (Running-based Anaerobic Sprint Test) en evaluar el desempeño de la potencia anaeróbica través del uso del teste de Wingate en ciclistas trenados. Participaron del estudio 10 ciclistas masculinos (28,0±7,3 años) de la modalidad de Mountain bike. Después de la mensuración de las variables antropométricas, la potencia pico (PP), media (PM) y el índice de fatiga (IF) fueron determinados al acaso a partir de dos testes de Wingate y de dos testes de RAST. Fueron utilizados el test t independiente de Student, el análisis de correlación linear de Pearson (r) y el test de Bland-Altman. Los resultados demostraron, contrariamente al IF (33.8±4.6% vs. 37.8±7.9%; r=0.172), diferencias significativas entre el teste de Wingate y el RAST para PP y PM (W.kg-1 e W). Mismo que los valores de correlación de PP e PM (W) tengan sido fortes (0,831 e 0,714, respectivamente), la concordancia entre los protocolos de Wingate y RAST fue baja, sugiriendo que el teste de RAST no es válido para evaluar el desempeño de la potencia anaeróbica a partir del teste de Wingate en este grupo.

Características aeróbias e anaeróbias de mesatenistas brasileiros treinados / Aerobic and anaerobic characteristics of Brazilian trained table tennis players

O objetivo deste estudo foi determinar, em mesatenistas bem treinados, as aptidões aeróbia e anaeróbia. Participaram do presente estudo oito mesatenistas brasileiros treinados do sexo masculino (18±2 anos). Os sujeitos foram submetidos a um teste incremental específico para determinação do consumo pico de oxigênio (VO2PICO), intensidade associada ao VO2PICO(iVO2PICO) e do ponto de compensação respiratório (PCR) e a dois testes de esforço repetitivo, sendo o teste de RAST e o índice anaeróbio alático (IAA), para determinação dos índices anaeróbios. O VO2PICO correspondeu a 50,5±4,4ml kg-1 min-1, a VO2PICO a 52,1±9,6 bolas min-1 e o PCR a 44,9±8,0 bolas min-1. No RAST, a potência pico (PP) e a potência média (PM) relativa corresponderam a 9,0±1,3W kg-1 e 7,0±0,9W kg-1, respectivamente, enquanto que o IAA foi 1,14±0,51 mM/m s-1. Esses valores de VO2PICO e dos parâmetros anaeróbios quando comparados a valores de outros esportes com raquetes caracterizaram que mesatenistas brasileiros treinados apresentam potência aeróbia moderada e potência anaeróbia é baixa.

The purposes of this study were to determine the aerobic conditioning and anaerobic conditioning in trained table tennis players. Eigth Brazilian male table tennis players (18±2 years) participated of the study. Subjects performed graded exercise test in specific procedure to measure peak oxygen uptake (VO2peak), intensity associated at VO2PEAK (iVO2PEAK) and respiratoty conpensation point (RCP), and two repeated-sprint abilit tests (i.e., RAST and alactic anaerobic índex (AAI)), which were considered as anaerobic parameters. VO2PEAK corresponded to 50.5±4.4ml kg-1 min-1 , iVO2PEAK to 52.1±9.6balls min-1 e o RCP 44.9±8.0balls min-1. Peak power (PP) and mean power (MP) relative to body mass (PPr and MPr, respectively) measured during RAST were 9.0±1.3W kg-1 and 7.0±0.9W kg-1, respectively, whereas AAI (i.e., ratio of blood lactate and average speed) was 1.14±0.51mM/m s-1. Thus, we can conclude that trained Brazilian table tennis players have moderated aerobic power, low anaerobic conditioning.

Diagnóstico em doenças alérgicas mediadas por IgE / Diagnosis in IgE-mediated allergic diseases

Doenças alérgicas são frequentes na população em geral e estão associadas à sensibilização a alérgenos do ambiente, como alimentos, pólens, ácaros, fungos, insetos e medicamentos. A presença de anticorpos IgE específicos para alérgenos caracteriza a sensibilização alérgica. Esta revisão aborda a orientação atual para correta avaliação das doenças alérgicas. São discutidos os principais métodos para o diagnóstico - determinação sérica de IgE específica e testes cutâneos com alérgenos - assim como, o teste de contato atópico e novas técnicas em desenvolvimento.

Alergic diseases are frequent conditions in general population. These diseases are linked to allergic sensitization to common environmental allergens, like pollens, mites, molds, foods, insects and drugs. Identification of allergen specific IgE antibody characterizes an allergic sensitization. In this review is analyzed the current approach to diagnosis allergic conditions. The authors discuss major diagnostic methods, as serum specific IgE antibody and allergen skin test, atopy patch test and new techniques that are in development.

A Follow-Up Study of Hematochezia in Neonates and During Early Infancy

PURPOSE: There are many causes of hematochezia in neonates and during early infancy. Cow`s milk allergy is considered to be the most common cause of bloody stools in infants; however, cow`s milk allergy is diagnosed in relatively few patients. In a significant proportion of case investigations, the etiology of hematochezia is not determined. The objectives of this study were to evaluate the clinical course and prognosis of patients with hematochezia of unknown etiology. METHODS: The patients were <4-month-old infants with hematochezia in whom infectious and surgical etiologies had been excluded. We investigate retrospectively the clinical course and laboratory finding. We also perform 2-years follow-up study and evaluate prognosis of the patients. RESULTS: In all study patients, RAST milk was negative. All patients had self-limited hematochezia. In 2-years of follow-up, the prognosis of patients was good. There were no differences at 2-year regarding allergic tendencies of the patients, as determined by the increase in total eosinophil count. CONCLUSION: Hematochezia in neonates and during early infancy is generally a benign and self-limiting symptom. Based on 2-years of follow-up, the prognosis of the patients is good.

Biological activity of components, protein concentration of althernaria alternate lysates by different methods / 基础医学与临床

Objective To find the best methods to make the extraction of alternaria alternate. Methods Alternaria alternate was harvested from air and identified, cultured at 26 ℃ for four weeks. Protein was extracted by different methods and its concentration was determined using the Bradford assay, its bioactivity was tested by RAST inhibition, and residual proteins were analyzed by SDS-PAGE.Results The extraction methods like grinder(a), grinder plus ultrasonic(b), ground with liquid nitrogen(c) and liquid nitrogen plus ultrasonic(d) were applied in the extraction procedure. The concentrations of protein extractions were as follows (g/mL): a was 0.44?0.04;b was 0.75?0.03;c was 0.72?0.03 and d; 1.29?0.05. From SDS-PAGE, we found that the most component in the extraction was that obtained by liquid nitrogen plus ultrasonic. From RAST, 50% inhibition was as follows(g/mL): a was 8.5, b was 9.4, c was 7.0,d was 3.7. Conclusion Ground with liquid nitrogen plus disintegration by ultrasonic was the most effective method of extraction.

The Relationship between Anti-Pityrosporum IgE Level and Clinical Manifestations in Atopic Dermatitis Patients with Head and Neck Dermatitis / 대한피부과학회지

BACKGROUND: Head and neck dermatitis is a variant of atopic dermatitis often seen in young adult. Though the pathogenesis of atopic dermatitis is still not well elucidated, Pityrosporum is considered to be one of the triggering factors for head and neck dermatitis. OBJECTIVE: We investigated the relationship between Pityrosporum infection and clinical features of head and neck dermatitis patients. METHODS: We evaluated anti-Pityrosporum IgE levels using RAST method in 68 outpatients with atopic dermatitis and other allergen specific antigens with MAST-CLA techniques. RESULTS: Among the 68 atopic dermatitis, 36 were diagnosed as atopic dermatitis with head and neck dermatitis and 24 out of 36 head and neck dermatitis patients showed RAST positive for Pityrosporum and the level of RAST was higher than atopic dermatitis patients without head and neck dermatitis with correlation coefficient (p<0.05). The severity of erythema and eczematous reaction was also correlated with the positivity of RAST with statistical significance (p<0.05). CONCLUSION: From these results, we speculate Pityrosporum can influence the severity and clinical manifestations in atopic dermatitis patients with head and neck dermatitis.

A Study of Food Allergy in Patients with Urticaria / 대한피부과학회지

BACKGROUND: Although urticaria is a common skin reaction pattern occuring at some time in the life of approximately 15% to 20% of the population, the exact prevalence of food-induced acute or chronic urticaria remains unknown. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in patients with urticaria and the potential utility of the skin prick test and CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred patients with urticaria were evaluated for food hypersensitivity by history, eosinophil count, IgE, skin prick test, CAP-RAST FEIA, and open food challenge test (OFCT). RESULTS: 1) The prevalence of specific food allergies in the study population was 35% in history and 8, 18 and 6% in prick, CAP-RAST FEIA and OFCT, respectively. 2) The frequent food allergens were milk, egg, peanut, and wheat. 3) There were no correlations between the duration of urticaria and prick test, CAP-RAST FEIA and OFCT results. 4) Serum IgE levels were correlated with the prick test and CAP-RAST FEIA results, but not the OFCT results. 5) According to the history, 35 patients with urticaria answered that their symptoms were related to food, and of the 35 patients, positive reactions to the prick test and CAP-RAST FEIA were observed in 6 and 10 patients, respectively. Among the other 65 patients who answered that there was no relation between urticaria and food, 2 patients reacted positively to the prick test and 8 patients showed positive result to CAP-RAST FEIA. CONCLUSION: In contrast to high prevalence of food history, the prevalence of food-induced allergic urticaria in Korean patients is only 6%. In contrast to the prick test, CAP-RAST FEIA provides a standardized measurement of food specific IgE antibodies, which may be more useful diagnostic test than prick test to diagnose food allergy in urticaria.

A Study of Food Allergy in Atopic Dermatitis Using CAP-RAST FEIA and Open Food Challenge Test / 대한피부과학회지

BACKGROUND: The role of dietary factors in atopic dermatitis has been the subject of debate for several decades. Recently it has received convincing support from a double-blind controlled trial of an exclusion diet, showing benefit from careful avoidance of egg and milk in a group of atopic children. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in Korean atopic dermatitis and the potential utility of the Pharmacia CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred ten patients with atopic dermatitis were evaluated for food hypersensitivity by history, skin prick test, CAP-RAST FEIA, and open food challenge test(OFCT). RESULTS: The prevalence of specific food allergies in the study population was 28.2% in history and 18.2% in CAP-RAST FEIA and OFCT. The frequent food allergens were milk, egg, peanut, and wheat. There was no correlation between the clinical severity of atopic dermatitis and CAP-RAST FEIA and OFCT results. Plasma eosinophil and IgE levels were correlated with CAP-RAST FEIA results, but not OFCT results. According to the history, 31 atopic dermatitis patients answered that their dermatitis was related to food, and of the 31 patients, positive reactions to prick test and CAP-RAST FEIA were observed in 8 and 22 patients, respectively. Among the other 79 patients who answered that there was no relation between atopic dermatitis and food, 14 patients reacted positively to prick test and 47 patients showed positive result to CAP-RAST FEIA. CONCLUSION: The CAP-RAST FEIA provides standardized measurement of food specific IgE antibodies which may be useful to diagnose food allergy in atopic dermatitis.

Comparative Study for Detection of Specific IgE in Allergic Disease; Skin Prick Test, RAST, and Dipstick Test / 소아알레르기및호흡기학회지

PURPOSE: To evaluate the valuability of dipstick IgE detection method as a screening test for allergic diseases, we compared the results of dipstick test to that of RAST and skin prick test. METHODS: Twenty children who visited to pediatric allergy clinic in Soon Chun Hyang University were enrolled to comparative study of dipstick IgE detection method to Skin prick test and RAST. Dipstick IgE detection method was performed by using AllergodipR(Allergopharma Joachim Ganzer KG). We compared the sensitivity and specificity of dipstick IgE detection method to RASt and skin prick test. RESULTS: The sensitivity and specificity of AllergodipR for inhalant allergen(D.pteronyssinus) to RAST were 100%, respectively. The sensitivity and specificity of AllergodipR for inhalant allergen(D. pteronyssinus) to skin prick test were 77.8% and 90.9%, respectively. The sensitivity and specificity of AllergodipR for food allergen to RAST were 0% and 100%, respectively. The sensitivity and specificity of AllergodipR for inhalant allergen(D. pteronyssinus) to skin prick test were 0% and 100%, respectively. CONCLUSION: The dipstick method(AllergodipR) can be used as a screening test for detection of specific IgE to inhalant allergen.

Correlation between Clinical History, Skin Test, RAST and Nasal Provocation Test in Patients with Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Correct diagnosis for allergic rhinitis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. The role of diagnostic tests in the evaluation of patients with allergic rhinitis continues to evolve. This clinical study was performed to identify the relationship between clinical history and diagnostic tests. MATERIALS AND METHODS: Questionnaire surveys for clinical history, skin test, RAST, and nasal provocation test (acoustic rhinometry and symptom score) to the house dust mites (Dermatophagoides pteronyssinus) were performed in 100 patients from July, 1996 to August, 1998 at Inha University Hospital. The relationship between clinical history (change of syagoides pteronyssinus antigen (Allergopharma, Reinbeck, USA) was sprayed and 15 with PC-SAS. (ver 6.120) RESULTS: There was no correlation between clinical history and the diagnostic tests. However there was a correlation between the results of either skin or RAST testing and those of nasal provocation test. CONCLUSIONS: More careful and complete history taking is needed for diagnosis of allergic rhinitis. The combined use of RAST, skin testing and nasal provocation test yields more information.

Detection of Specific lgE Antibody from Nasal Secretion in Allergic Rhinitis with Negative Results of Skin Test and RAST on D.P / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The diagnosis of allergic rhinitis due to specific antibody is essentially dependent upon the patients' clinical histories, physical examinations, skin test results, and especially on the immunological technique in vitro used for the detection for specific IgE antibody in serum. However, some patients with positive results from nasal provocation tests with allergen can have the negative results from skin tests and the immunological technique in vitro. Therefore, systemic allergic reactions are not completely correlative to those of the localized allergy. MATERIALS AND METHODS: This study was therefore designed to explore the relationship between RAST (radioallergosorbent test) results in nasal secretion of 6 localized allergic patients and 10 controls (5 systemic allergic and 5 non-allergic patients). The nasal secretion was collected by nasal suction method each in three groups before and 20 minutes after antigen (Dermatophagoides pteronyssinus) nasal spray, respectively. RESULTS: There were negative RAST results in nasal secretion of localized allergic patients and controls (5 non- allergy patients) before the antigen nasal spray but, positive RAST results in those of localized allergic patients and controls (5 systemic allergic patients) after the antigen nasal spray. This means that there was statistically a significant difference between localized allergic patients and controls of non-allergy patients after the antigen nasal spray (p<0.01). CONCLUSION: We suggest that localized al1ergic reaction is a specific antigen-antibody allergic immunologic reaction and RAST in nasal secretion is good assistant diagnostic technique in localized allergy.

Study of Serum IgE Level and RAST (D. pteronyssinus, D. farinae, Egg White and Cow Milk) at Preschool Children / 소아알레르기및호흡기학회지

PURPOSE: The tests of Serum IgE and allergen specific antibodies are important for screening and diagnosis of allergic disease. This study was conducted find out the distributions of allergic diseases, level of IgE, and usual allergen specific antibodies in healthy well-being preschool childrenin Inchon city. METHODS: We gained the level of serum IgE and RAST (radioallergosorbent test : D. pteronyssinus, D. farinae, Egg white and Cow milk) for 274 (Male 130, Female 144) preschool children in Inchon city during January through June in 1997. The history of allergic diseases (allergic asthma, allergic rhinitis, atopic dermatitis, food allergy and urticaria) was taken by each children's parent over telephone interviews. The personal computer SAS program was used for data analysis. RESULTS: 1) The 274 preschoolers (female 144, male 130 F:M=1:0.9) were composed of 74 (female 44, male 30) 3 year-old, 99 (female 52, male 47) 4 year-old, and 101 (female 48, male 53) 5 year-old children. 2) 30.1% of the children were with history of allergic diseases. 3) The mean and standard deviation of serum IgE levels were 215.8+/-171.0 IU/mL with a history of allergic diseases and 60.4+/-73.2 IU/mL without a history of allergic diseases for 3 year-old; 237.0+/-233.5 IU/mL and 48.5+/-74.4 IU/mL for 4 year-old; and 223.6+/-247.5 IU/ml and 45.2+/-41.9 IU/mL for 5 year-old children (P<0.001), respectively. 4) The rate of positive RAST (D. pteronyssinus, Dp) was 66.7% with a history of allergic diseases and 2.6% without a history of allergic diseases for 3 year-old girls, and 41.7% and 5.6% for 3 year-old boys; 58.3% and 2.5% for 4 year-old girls, and 53.8% and 2.9% for 4 year-old boys; and 61.1% and 3.3% for 5 year-old girls, and 54.5% and 0.0% for 5 year-old boys (P<0.001), respectively. 5) The rate of positive RAST (D. farinae, Df) was 66.7% with a history of allergic diseases and 0.0% without a history of allergic diseases for 3 year-old girls, and 16.7% and 0.0% for 3 year-old boys; 50.0% and 0.0% for 4 year-old girls, and 46.2% and 5.9%, for 4 year-old boys; and 55.6% and 3.3% for 5 year-old girls, and 54.5% and 0.0% for 5 year-old boys (P<0.001), respectively. 6) The rate of positive RAST (Egg white, F1) was 66.7% with a history of allergic diseases and 21.1% without a history of allergic diseases for 3 year-old girls, and 66.7% and 38.9% for 3 year-old boys; 75.0% and 15.0% for 4 year-old girls, and 46.2% and 5.9% for 4 year-old boys; and 38.9% and 13.3% for 5 year-old girls, and 50.0% and 19.4% for 5 year-old boys (P<0.001), respectovely. 7) The rate of positive RAST (Cow milk F2) was 0.0% for 3, 4 and 5 year-old and boys both with and without a history of allergic diseases. CONCLUSION: We conclude that serum IgE level and RAST (Dp, Df, F1) are important screening methods for allergic disease of preschool children, and milk allergy is little over 3 year-old children in Inchon. Further studies will be needed.

A Case of Allergic Fungal Sinusitis / 대한이비인후과학회지

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. AFS was first reported in 1983. The first case of AFS was associated with Aspergillus, but recently other fungal organisms have been implicated. AFS should be suspected in any atopic patients with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but definite diagnosis requires histopathologic examination which shows characteristic allergic mucin. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. Adjunctive systemic steroids are often helpful. The authors present a case of allergic fungal sinusitis for the first time in Korea. The patient had nasal polyp and showed hypersitivity to fungus in RAST, elevation of total IgE, peripheral eosinophilia. On histopathologic examination, typical allergic mucin including Charcot-Leyden crystals, eosinophils and fungal hyphae were found.

Evaluation of the MAST CLA Assay System for Measuring Total IgE: Comparison with the Pharmacia CAP System / 대한임상병리학회지

BACKGROUND: Multiple allergosorbent test chemiluminescent assay (MAST CLA) is a simple method for measuring total and allergen-specific IgE in human serum. Total IgE level, however, was much frequently high, even if no allergen-specific IgE could be detected in serum. The aim of this study was to evaluate the total IgE class of the MAST CLA system. METHODS: We studied 649 patients in whom MAST CLA (MAST Immunosystems, Inc., Mountain View, CA, USA) was tested and compared the results with those of total IgE, Phadiatop FEIA & RAST FEIA using Pharmacia CAP system (Pharmacia AB, Uppsala, Sweden). RESULTS: MAST CLA specific IgE was positive in 139 (21.4%) among 649 patients. Total IgE was increased over class 2 in 379 (74.3%) among 510 MAST CLA allergen-specific IgE -negative patients. Total IgE assayed by Pharmacia CAP system was increased over 100 kU/L in 33 (54.1%) among 61 MAST CLA allergen-specific IgE -negative patients. Especially, total IgE assayed by Pharmacia CAP system was increased over 100 kU/L in 25 (69.4%) of 36 patients when MAST CLA total IgE class is over 2. Phadiatop FEIA which is a screening test for inhalant allergy was positive in 11 (50.0%) of 22 MAST CLA allergen-specific IgE -negative patients, and especially, positive in 8 (66.7%) of 12 MAST CLA allergen-specific IgE -negative patients who had MAST CLA total IgE class over 2. Nine of 11 patients with positive Phadiatop FEIA were also found to be positive in d1 and/or d2 by RAST FEIA. CONCLUSIONS: It is concluded that another allergen screening tests should be used for detecting allergen-specific IgE, when MAST CLA total IgE is increased over class 2 with no detectable MAST CLA specific IgE because the sensitivity of MAST CLA allergen-specific IgE could be low.

Analysis of MAST Chemiluminescent Assay (MAST CLA) Results Performed in Asan Medical Center: Suggestion for the improvement of MAST CLA performance / 대한임상병리학회지

BACKGROUND: Multiple allergosorbent test chemiluminescent assay (MAST CLA) is a simple method for in vitro measurement of allergen-specific IgE antibodies. In the present study, the diagnostic performance of MAST CLA was evaluated from the data of Asan Medical Center. METHODS: With the test results of Korea IgE Panel, Korean Food Panel and Korean Inhalant Panel, we evaluated the next following. First, the change of the positive rates of allergen-specific IgE antibodies after the Korea IgE panel was divided into each Food Panel and Inhalant Panel; Second, the diagnostic performance of total IgE determined by MAST CLA in comparison with those determined by RIA; Third, the discrepancy of reactive intensity in Food and Inhalant Panels tested with the same specimens; Fourth, the diagnostic performance of MAST CLA compared with RAST, in detecting the IgE antibodies to three most common allergens. RESULTS: Overall positive rate was 33.9% (548/1,617); 39.3% for Korea IgE Panel, 22.9% for Food Panel, 34.6% for Inhalant Panel. Positive rate was increased only 0.5% for Food Panel and only 0.3% for Inhalant Panel by the new allergens added. The sensitivity, specificity, and concordance rate of total IgE levels determined by MAST CLA in comparison with those determined by RIA was 68.4%, 64.9%, 66.8% in Food Panel, and, 87.6%, 44.4%, 68.5% in Inhalant Panel. Five of the eighteen specimens tested by Food and Inhalant Panels simultaneously showed discrepant reactivity with the extent of class 1. The sensitivity, specificity, and concordance rate of MAST CLA compared with RAST were 36.1%, 100.0%, 67.1% for D. farinae, 30.8%, 96.8%, 60.6% for D. pteronyssinus, and 21.4%, 96.2%, 70.0% for housedust. CONCLUSIONS: The allergens newly added to Food and Inhalant Panels were not contributable to the detection of allergen-specific IgE. The specificity of total IgE was so low that positive total IgE result without specific IgE should be interpreted as false positive. The sensitivity to common allergens was also too low. So, MAST CLA needs further improvement to be used as a primary screening test for allergy.

Availability of IgE MAST for Diagnosis of Asthmatic Children

PURPOSE: The Skin prick test is simple and cheap in diagnosis of allergic diseases. So the skin prick test has been widely used as the initial diagnostic method of IgE-mediated allergic diseases with the merit of fast detection of causative allergens. But the skin test has some difficulties in application for the infants and young children. IgE MAST(multiple antigen simultaneous test) and IgE RAST(radioallergosorbent test) are representative in vitro diagnostic tests in allergic diseases. IgE MAST has several merits, such as cheap price, simultaneous detection of many allergens, and needlessness of gamma counter, but it has been known to have less sensitivity and specificity. We performed this study to know the differences between the availability of IgE MAST and that of IgE RAST in allergic patients who were diagnosed by clinical findings and skin prick test. METHODS: We have studied 35 asthmatic children (over 3 years of age) who visited allergy clinic from September 1993 to May 1995. All of them were positive in skin prick test on one more allergens among 6 allergens(D.p, D.f, house dust, dog, egg, ragweed). IgE MAST and IgE RAST were evaluated simultaneously. RESULTS: The results were as follows 1) Sensitivity of RAST was 87.1% in D.p, 87.1% in D.f, 68% in house dust and the specificity of RAST was 94.1%, 97.1% and 87.5% respectively. 2) Sensitivity of MAST was 90.3% in D.p, 93.5% in D.f, 80% in house dust and the specificity of MAST was 94.1%, 94.1% and 85% respectively. 3) Total sensitivity of RAST was 70.5% and that of MAST was 73.2%, but there were no significant differences between them(p>0.05). 4) Total specificity of RAST was 91.4% and that of MAST was 89.9%, but there were no significant differences between them(p>0.05). 5) The stronger positive skin reaction, the higher sensitivity and specificity of the two in vitro tests. CONCLUSIONS: There was no significant differences between the two in vitro tests for the diagnosis of asthmatic children, and the both test results correlated well. IgE MAST system is easier, faster and has more cost benefit than IgE RAST. So we conclude that the MAST system is available as a screening test in the diagnosis of allergic diseases.

Cow mild allergy in infant who neonatal onset

Cow milk allergy can be defined as an adverse immunologic reactions to cow milk protein. The term is often mistakenly applied to other causes of milk intolerence, such as lactase deficiency and galactosemia, which must be differenciated and excluded. We have experienced 10 children of cow milk allergy at neonatal onset who had suffered from G-I symtoms, such as diarrhea, irritability, weight loss, vomiting and abdominal distension. One half of this patients had family history of allergic diseas. All patients have positive specific IgE RAST to cow's milk protein, milk elimination test and milk challenge test. Brest milk feeding and soy bean formula feeding and soy bean formula feeding have started after diagnosis and then gastrointestinal symtoms and signs of all patients are improved but other allergic diseases are combined in 5 children.

A study of skin scratch test reactivity, total serum IgE and RAST in atopic patients / 대한피부과학회지

This study was done for the evaluation of correlation among skin test reactivity, total serum IgE and RAST level in 202 atopic disease patients, who weie composed of 165 patients with allergic rhinitis, 22 patients with bronchial asthma, 11 patients with urticaria and 4 patients with atopic dermetitis. The results were as follows: 1. The sex ratio of male to female of 202 pat,ients with atopic disease was 1.3:1(114:88) and patients with age grciup of 2nd and 3rd decades occupied 64.9%. 2. The positive reactivity of the skin scratch test in general was 62.9%. The positive ratio was highest in 2nd and 3rd decades, 76.5% and 63.8% respectirely. The positive ratio was decreased as the age of patients increased. 3. The individual allergens which showed higher positive reaction in skin scratch test were D. farinae, house dust, cat hair, cockroach and Trichophyton ii descending order. In group allergens, the house dust groups consisted 45.5% of positiv. reaction of total number of the positive allergens. The positive ratio of aeroallergen was 84.5% whereas that of foods was only 11.5%. 4. The positive ratio of house dust group was 45.0% of total patients. 5. 41.1% of patients showed positive reactivity to two or more allegens while 21.8% was positive to single allergen. The most frequent combinations were 2 to 4 allergens(95.2%). 6. The mean of total serum IgE level in 63 patients who were poitiie skin scratch test was 470.5 IU/ml. 81.0% of these patients showed high serum IgE level. 7. As the positive reactivity of skin scratch test was increased, the mean level of total serum IgE was elevated(r=0.919). 8. A highly significant correlation was existed between the mear size of D. farinae scratch test reactions and the level of specific IgE to D. farinae(r=0.977).