Incidence of allergic rhinitis in children with residual snoring and sleep symptoms after adenotonsillectomy.

BACKGROUND AND OBJECTIVES: Allergic rhinitis may contribute to sleep disordered breathing (SDB) in children. Although adenotonsillectomy is commonly performed to treat SDB, some patients will return to their primary practitioners with residual sleep symptoms. The aim of this study was to assess the incidence of allergic rhinitis via radioallergosorbent testing (RAST) in children undergoing adenotonsillectomy who had residual snoring or sleep symptoms. METHOD: A retrospective analysis of 500 patients post-adenotonsillectomy was undertaken. The incidence of residual snoring, residual sleep symptoms and results of RAST, as well as total immunoglobulin E (IgE) after surgical intervention, were documented. RESULTS: Children with positive RAST results or elevated total IgE had a significantly greater incidence of residual snoring post-adenotonsillectomy (P = 0.049) and residual sleep symptoms after surgery (P <0.0001). DISCUSSION: A positive RAST or elevated IgE in children with SDB was associated with incomplete resolution of snoring and residual sleep symptoms after adenotonsillectomy. Thus, there should be raised suspicion of allergic rhinitis in this population.

Allergy Testing.

Allergic diseases are common in outpatient primary care. Allergy testing can guide management to determine allergy as a cause of symptoms and target therapeutic interventions. This article provides a review of common methods of allergy testing available so that physicians may counsel and refer patients appropriately. Immediate-type hypersensitivity skin tests can be used for airborne allergens, foods, insect stings, and penicillin. Radioallergosorbent testing can be used to evaluate immediate-type hypersensitivity. Delayed-type hypersensitivity or patch-type skin tests are used in patients with suspected contact dermatitis.

Diagnòstic molecular en al·lergologia pediàtrica. Implicacions diagnòstiques i terapèutiques / Diagnóstico molecular en alergología pediátrica. Implicaciones diagnósticas y terapéuticas / Component-resolved diagnostic in pediatric allergy. Diagnostic and therapeutic implications

Fonament: els extractes obtinguts a partir de les fonts al•lergògenes completes sovint són barreges mal definides d'al•lèrgens principals, al•lèrgens de reactivitat encreuada i material no al•lergogen. Quan són utilitzades en els mètodes diagnòstics de sensibilització al•lèrgica (tant in vivocom in vitro), sovint no permeten un diagnòstic precís de l'al•lergen responsable de la simptomatologia, especialment en els pacients sensibilitzats a més d'una font al•lergògena. Els avenços en la caracterització d'al•lèrgens (biologia molecular i tècniques de DNA recombinant) han permès que disposem de noves eines diagnòstiques, com els al•lèrgens recombinants i els al•lèrgens purificats. Objectiu: revisar si la utilització d'al•lèrgens recombinants i al•lèrgens purificats pot millorar l'eficàcia dels mètodes diagnòstics convencionals utilitzats fins ara en al•lergologia pediàtrica. Mètode: revisió bibliogràfica fins al desembre del 2014. Es revisen els articles en què s'ha avaluat la utilitat del diagnòstic molecular en població al•lèrgica pediàtrica. Resultats: la utilització d'al•lèrgens recombinants i al•lèrgens purificats millora l'eficàcia dels mètodes diagnòstics convencionals, ja que ens permet definir les sensibilitzacions genuïnes i les que són conseqüència dels fenòmens de reac tivitat encreuada amb més precisió diagnòstica. Amb l'apli cació del diagnòstic molecular s'espera aconseguir una millor tipificació de la patologia al•lèrgica de la població pediàtrica polisensibilitzada i amb patologia al•lèrgica complexa. Conclusions: el diagnòstic al•lergològic molecular pot ser una eina molt útil per prendre decisions clíniques apropiades i a temps per als pacients, i oferir als metges la possi-bilitat d'individualitzar les accions terapèutiques

Fundamento. Los extractos obtenidos a partir de las fuentes alergénicas completas a menudo son mezclas mal definidas de alérgenos principales, alérgenos de reactividad cruzada y material no alergénico. Cuando se utilizan en los métodos diagnósticos de sensibilización alergénica (tanto in vivo como in vitro), a menudo no permiten un diagnóstico preciso del alérgeno responsable de la sintomatología, especialmente en los pacientes sensibilizados a más de una fuente alergénica. Los avances en la caracterización de los alérgenos (biología molecular y técnicas de DNA recombinante) han permitido que dispongamos de nuevas herramientas diagnósticas, como los alérgenos recombinantes y los alérgenos purificados. Objetivo. Revisar si la utilización de alérgenos recombinantes y alérgenos purificados puede mejorar la eficacia de los métodos diagnósticos convencionales utilizados en alergología pediátrica hasta ahora. Método. Revisión bibliográfica hasta diciembre de 2014. Se revisan los artículos en los que se evaluó la utilidad del diagnóstico molecular en población alérgica pediátrica. Resultados. La utilización de alérgenos recombinantes y alérgenos purificados mejora la eficacia de los métodos diagnósticos convencionales, ya que nos permite definir las sensibilizaciones genuinas y las que son consecuencia de los fenómenos de reactividad cruzada con una mayor precisión diagnóstica. Con la aplicación del diagnóstico molecular se espera conseguir una mayor tipificación de la patología alérgica de la población pediátrica polisensibilizada y con patología alérgica compleja. Conclusiones. El diagnóstico molecular puede ser una herramienta muy útil a la hora de establecer decisiones clínicas apropiadas y a tiempo para nuestros pacientes alérgicos, y ofrecer a los médicos la posibilidad de individualizar las mejores acciones terapéuticas (AU)

Background. Extracts obtained from complete allergenic sources are usually poorly defined mixtures of major allergens, cross-reactive allergens, and non-allergenic material. The analysis of those extracts seldom allows for a precise diagnosis of the allergen responsible for the symptoms (in vivo or in vitro), especially in patients sensitized to more than one allergenic source. Advances in the characterization of allergens (molecular biology and recombinant DNA techniques) have allowed for the development of new diagnostic tools based on purified and recombinant allergens. Objective. To review the effect that advances in the characterization of purified and recombinant allergens have had in the diagnostics of pediatric allergy. Method. Literature review of manuscripts published until December 2014. Articles evaluating the usefulness of molecular diagnosis in pediatric allergy were reviewed. Results. Advances in the characterization of allergens have facilitated the development of new diagnostic tools based on purified and recombinant allergens that can improve the efficiency of conventional allergy diagnosis methods. The use of recombinant and purified allergens for the study of the allergic sensitization of polysensitized patients and of patients with complex allergic disease may help discern genuine sensitization of the patient from crossreactivity with greater accuracy. Conclusions. The identification of the specific allergen that is sensitizing the patient is an essential requirement for optimal diagnosis and treatment; multiplexed molecular diagnosis can provide very useful information to aid in the management of these children (AU)

Pruebas epicutáneas en pacientes con eczema perianal / Patch Testing in Patients With Perianal Eczema

INTRODUCCIÓN Y OBJETIVOS: La prevalencia de parches positivos en los pacientes afectados por una dermatitis anogenital oscila según las series entre un 25-78%, justificándose por tanto la realización de pruebas epicutáneas ante eczemas de esta localización. Los objetivos del presente estudio son por un lado determinar los alérgenos más frecuentes en los pacientes con eczema perianal y, por otro, establecer las baterías de alérgenos más útiles para el estudio con pruebas epicutáneas de esta afección. MATERIAL Y MÉTODOS: Se han revisado retrospectivamente (años 2001-2012) los resultados obtenidos al estudiar con pruebas epicutáneas a aquellos pacientes que presentaban exclusivamente un eczema perianal. RESULTADOS: De los 37 pacientes con esta clínica en 16 se observó alguna reacción positiva, siendo el metilcloroisotiazolinona/metilisotiazolinona el principal alérgeno implicado. Excepto un caso con sensibilización a gentamicina, todas las positividades con relevancia presente correspondieron a alérgenos de la batería estándar del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) o a productos propios del paciente. CONCLUSIONES: En nuestra experiencia la metilcloroisotiazolinona/metilisotiazolinona es el principal alérgeno implicado en los eczemas perianales, procediendo esta sensibilización frecuentemente del uso de toallitas higiénicas. El estudio epicutáneo de un eczema perianal deberá realizarse básicamente con la batería estándar y los productos propios

INTRODUCTION AND OBJECTIVES: Reports show that between 25% and 78% of patients with anogenital dermatitis have positive patch test results. Consequently, patch testing would appear to be warranted in patients presenting with eczema in the anogenital region. The objectives of the present study were to identify the most common allergens in patients with perianal eczema and to determine which allergen series are most useful for patch testing in patients with this condition. MATERIAL AND METHODS: We performed a retrospective review of patch test results in patients with only perianal eczema between 2001 and 2012. RESULTS: Of the 37 patients with perianal eczema, 16 had a positive reaction; methylchloroisothiazolinone/methylisothiazolinone was the main allergen involved. With the exception of 1 case of sensitization to gentamicin, all the positive results with present relevance were to allergens from the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) or to the patient's own products. CONCLUSIONS: In our experience, methylchloroisothiazolinone/methylisothiazolinone is the main allergen involved in perianal eczema, and sensitization often results from using wet wipes. Patch testing in perianal eczema should be based on the GEIDAC standard series and the patient's own products

Are profilins relevant allergens or confusion allergens?

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IgE to penicillins with different specificities can be identified by a multiepitope macromolecule: Bihaptenic penicillin structures and IgE specificities.

Quantitation of specific IgE by immunoassay is a recommended in vitro test for the diagnosis of immediate hypersensitivity reactions to betalactams (BLs), particularly when skin test results are negative. IgE antibodies that recognize the common nuclear structure of all BLs or the specific side chain structure can be mainly distinguished by immunoassays. The aim of this study was to develop an immunoassay system to detect IgE antibodies with different specificities. Cellulose discs conjugated with benzylpenicillin (BP), amoxicillin (AX) or both drugs, with poly-l-lysine (PLL) as carrier molecule, were used as solid phases in the radioallergosorbent test (RAST). Direct and inhibition radioimmunoassay studies were made to verify the structures recognized by serum IgE antibodies from penicillin-allergic patients. Our results indicated that the addition of both haptens did not decrease the capacity to capture IgE when serum specific to either BP or AX was used, at least in terms of sensitivity. In addition, the inclusion of two haptens improved significantly the levels of IgE detection in patients who recognized both BP and AX. Therefore, the use of a solid phase with a carrier molecule conjugated with two determinants (AX and BP) is helpful to recognize IgE antibodies against either of these determinants and is useful for screening sera with different specificities.

Soy Aeroallergens in Thoracic Fraction Particles (PM10)

Introducción: El diámetro aerodinámico de las partículas biológicas determina su habilidad para penetrar en el aparato respiratorio. Objetivo: Determinar el contenido de alérgenos de diámetro inferior a 10 μm en la materia particulada del aire, con el fin de mejorar el control de la exposición a los aeroalérgenos nocivos de la soja. Métodos: En este estudio, se muestrearon en paralelo 98 pares de filtros, siendo uno de materia particulada de diámetro <10 μm (PM10) y el otro de partículas suspendidas totales (PST). Mediante un método de ELISA de inhibición se analizó la concentración de aeroalérgenos de soja en todos los filtros. Resultados: La mediana de los niveles encontrados fue de 6 y 22,5 U/m3 para los filtros PM10 y PST, respectivamente. Se encontró una buena correlación entre el contenido de aeroalérgenos de soja en los filtros PM10 y PST. La proporción mediana de aeroalérgenos de soja en los filtros PM10 frente a PST fue de 28,6% y varió ampliamente entre los diferentes días. Conclusiones: Debido a la amplia variación de la proporción de aeroalérgenos de soja en los filtros PM10 frente a PST entre días, parece que el contenido de alérgeno de soja en los filtros PST no es un buen indicador del contenido de dichos alérgenos en los filtros PM10. Por ello, deben ser realizados más ensayos clínicos con el fi n de evaluar si el contenido de alérgenos de soja en los filtros PM10 y PST tienen diferente impacto sobre la salud (AU)

Background: The aerodynamic diameter of biological particles determines their ability to penetrate the human respiratory system. Objective: To assess the content of allergens less than 10 μm in diameter in the particle fraction of airborne dust in order to improve control of exposure to harmful soybean aeroallergens. Methods: In this study, 98 pairs of particulate matter measuring less than 10 μm in diameter (PM10) and total suspended particulate (TSP) filters were collected in parallel and analyzed for soy aeroallergens by the inhibition enzyme-linked immunosorbent assay. Results: The median levels found were 6 and 22.5 U/m3 for PM10 and TSP filters, respectively. A good correlation was found between soy aeroallergen content in PM10 and TSP filters. The median proportion of soy aeroallergen content in PM10 filters versus TSP filters was 28.6%, and varied widely across different days. Conclusions: Due to this wide variation between days, it seems that soy aeroallergen content in TSP filters is not a good surrogate of soy allergen content in PM10 filters. Further clinical studies should be conducted to assess differences in the health impact of soy allergen content in PM10 filters and TSP filters (AU)

Prevalence and real clinical impact of Cupressus sempervirens and Juniperus communis sensitisations in Tuscan “Maremma”, Italy

Objective: The aim was to evaluate the impact of Cupressus sempervirens (Cs) and Juniperus communis (Jc) sensitisations in "Maremma" in southern Tuscany. Methods: 811 consecutive outpatients (357 F - 57.86%; age: 36.9±16.6) with suspected allergic respiratory symptoms underwent skin prick tests (SPT) for common allergens and for Cs and Jc. Results: SPT resulted negative in 295 (36.37%) subjects. A Cs/Jc sensitisation was found in 294 (36.25%): 289 (98.3%) were sensitised to Cs whereas 198 (67.34%) to Jc. There was a co-sensitisation between Cs and Jc in 193 (65.6%) subjects. Cs/Jc mono-sensitisation was found in 39 (13.6%) subjects. A higher number (p < 0.0001) of Cs/Jc sensitised subjects reported winter (131-44.55%) and spring (124-42.2%) symptoms compared to Cs/Jc non-sensitised and non-allergic subjects. Most Cs/Jc sensitised subjects reported rhinitis and conjunctivitis (p < 0.0001), whereas only few reported coughing and asthma (p<0.01). The most frequent co-sensitisation was with grass, olive and other trees in Cs/Jc subjects (p<0.001). Those who reported winter symptoms, likely influenced by Cupressaceae, rhinitis was the main symptom whereas asthma was less frequent. Cs/Jc sensitisation resulted to be a risk factor (OR: 1.73 [CI95% 1.18–2.55]) for rhinitis whereas the probability of being asthmatic was reduced (OR: 0.62 [CI95% 0.44–0.85]). Conclusion: The prevalence of Cs/Jc sensitisation is about 36% in “Maremma”. However, only in 44% of the patients, Cs/Jc seem to cause typical winter symptoms. Rhinitis is the predominant symptom, whereas asthma is less frequent. Testing Cupressaceae sensitisation using Jc pollen extract, rather than Cs, may result to be less sensitive (AU)

The role of allergy evaluation in children with eosinophilic esophagitis.

BACKGROUND: To our knowledge, in Asia, data on utility of allergy tests in management of eosinophilic esophagitis are lacking. The objective of our study was to determine the role of allergy evaluation in management of Saudi children with eosinophilic esophagitis. METHODS: Children diagnosed as having eosinophilic esophagitis during the period from 2009 to 2012 were referred to an allergist for allergy evaluation. The allergy evaluation consisted of total IgE level, radio-allergosorbent assay, and skin prick test. Depending on the results of the allergy tests, a restricted or elemental diet was established. Swallowed fluticasone inhaler was prescribed to patients who rejected or failed to respond to the diet. Clinical, endoscopic, and histological evaluation was performed in 8 weeks to assess response. RESULTS: Eighteen children with eosinophilic esophagitis were included (13 males; mean age 5 years, range 1-11). Sensitization to foods was demonstrated in 14 patients: 4 with a positive test for a single food (28.5%), 1 for 2 food allergens (7%), and 9 for ≥3 food allergens (64.5%). The most common food allergens were milk, soybean, wheat, egg, and nuts. Three young children out of the total 14 patients responded to elemental formula. Four of the 10 older children on the allergy testing guided-dietary restriction achieved partial remission and the remaining 6 did not respond. All 10 patients responded to a swallowed fluticasone inhaler. CONCLUSION: Although food sensitizations in Saudi children with eosinophilic esophagitis are common, the allergy tests had limited predictive value for the response to dietary elimination.

Dendrimer-modified solid supports: nanostructured materials with potential drug allergy diagnostic applications.

Complex functional materials consisting of bioactive molecules immobilized on solid supports present potential applications in biosensoring. Advances in the fabrication of these surface materials are of growing interest for antibody-based diagnosis. This work exploits dendrimers as versatile nanostructures for templating sensor surfaces and the critical role of the immobilization protocol in the solid supports cellulose and zeolites, of organic and inorganic composition respectively. The fabrication and characterization, including the degree of functionalization and reproducibility, of different nanostructured materials are described. To validate the approach, the fabricated supports were further used as a solid phase for developing a radioimmunoassay to detect immunoglobulin E (IgE) specific to penicillin, the antibody involved in immediate allergy responses to this drug. The dendrimer-modified supports provide assays with significantly enhanced sensitivity, as well as increase the availability of biomolecules for specific interaction and minimize nonspecific adsorptions through appropriate functionalization protocols in each case. The manufacturing methodology involved the use of a long, flexible hydrophilic spacer in the cellulose materials, and a higher surface density of the immobilized dendrimers in the zeolite crystals. The ability of hybrid zeolite materials in such biosensing applications was evaluated for the first time. The assays were validated in human serum samples from patients allergic to penicillin and from non-allergic controls. The specificity and improved sensitivity of the dendrimer- modified supports make these strategies versatile for different bioactive molecules and could have significant implications for the quantification of a wide range of specific IgE antibodies and other biomolecules of diagnostic interest.

Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010) / Contact Sensitization to Allergens in the Spanish Standard Series at Hospital Costa del Sol in Marbella, Spain: a Retrospective Study (2005-2010)

La prevalencia de la alergia de contacto a los diferentes compuestos puede variar dependiendo de la población estudiada, de la técnica y del material empleado en las pruebas epicutáneas. En España el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) ha propuesto una batería de 29 alérgenos para estudiar a los pacientes con sospecha de dermatitis de contacto alérgica. Material y métodos: Análisis retrospectivo de 839 pacientes con sospecha de dermatitis de contacto, realizado en el Hospital Costa del Sol desde el 1 de enero de 2005 hasta el 31 de diciembre de 2010. Para ello se utilizaron pruebas epicutáneas estándar de 34 alérgenos en las que estuvieron incluidos los 29 compuestos de la batería estándar española propuesta por el GEIDAC. Objetivo: Valorar la prevalencia de la sensibilización de contacto entre los pacientes estudiados y estudiar su asociación con factores sociodemográficos (sexo, edad, localización, ocupación) y clínicos (dermatitis atópica). Resultados: El 48% de los pacientes presentó sensibilización al menos a uno de los alérgenos testados. Las mujeres presentaron una frecuencia de sensibilización más elevada que los hombres (56,9 vs. 33,1%). La localización afectada con mayor frecuencia fue la mano (36,1%). Los alérgenos más frecuentes fueron sulfato de níquel (25,9%), dicromato potásico (7,6%), tiomersal (5,1%), cloruro de cobalto (4,5%) y mezcla de fragancias I (3,8%). Por el contrario, se detectó una baja frecuencia de sensibilización a conservantes como mezcla de parabenos (0,1%), imidazolidinil urea (0,1%), diazolidinil urea (0,2%) y mezcla de quinoleínas (0,2%). No se registraron sensibilizaciones para lactonas sesquiterpénicas y metildibromoglutaronitrilo (euxyl K400). Conclusiones: Nuestros resultados son similares a los previamente publicados a nivel nacional. La baja sensibilización a ciertos alérgenos, como la mayoría de conservantes y las lactonas sesquiterpénicas, podría hacer necesario reconsiderar su utilidad como alérgenos en futuras series estándar (AU)

Background: The prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis. Objective: To determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis). Material and methods: A retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC. Results: Sensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed. Conclusions: Our results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered(AU)

Differentiating the cellular and humoral components of neuromuscular blocking agent-induced anaphylactic reactions in patients undergoing anaesthesia.

BACKGROUND: The significance of IgE antibodies to neuromuscular blocking agent (NMBA)-induced anaphylactic reactions during anaesthesia is unclear. We investigated the relevance of IgE to rocuronium using an in vitro technique. METHODS: Serum samples from 61 patients with anaphylactic reactions during anaesthesia were investigated. On the basis of clinical history, allergy to NMBA was considered likely in 48 patients, further assessed using intradermal skin tests for several commonly used NMBAs, including rocuronium, vecuronium, and succinylcholine. To determine the presence of rocuronium IgE in human serum, a rocuronium-human serum albumin (rocHSA) conjugate was coupled to a solid phase and a radioallergosorbent test performed. The biological effects of patient serum NMBA-IgE on histamine release were investigated using in vitro sensitized basophils from healthy blood donors. RESULTS: IgE to rocuronium was found in 23 of 48 serum samples (48%) with NMBA allergy, although only two of these were able to sensitize basophils to release histamine in response to rocHSA. IgE-responsiveness in the basophil test was only observed with conjugated rocHSA and not with unconjugated rocuronium or the other NMBAs evaluated. However, unconjugated rocuronium inhibited the histamine release induced by rocHSA. Correlation between skin-test reactivity to rocuronium and IgE to rocHSA was low (P>0.1). In contrast, striking correlation between IgE to rocuronium and skin-test reactivity to succinylcholine was found (P<0.001). CONCLUSIONS: Our results indicate that NMBA-related anaphylaxis requires not only IgE NMBA reactivity, but also altered cellular reactivity in the patient. The latter may be demonstrable by testing basophils from the patient, a skin test with (steroidal) NMBA, or both.

A comparison of methods for the construction of confidence interval for relative risk in stratified matched-pair designs.

A stratified matched-pair study is often designed for adjusting a confounding effect or effect of different trails/centers/ groups in modern medical studies. The relative risk is one of the most frequently used indices in comparing efficiency of two treatments in clinical trials. In this paper, we propose seven confidence interval estimators for the common relative risk and three simultaneous confidence interval estimators for the relative risks in stratified matched-pair designs. The performance of the proposed methods is evaluated with respect to their type I error rates, powers, coverage probabilities, and expected widths. Our empirical results show that the percentile bootstrap confidence interval and bootstrap-resampling-based Bonferroni simultaneous confidence interval behave satisfactorily for small to large sample sizes in the sense that (i) their empirical coverage probabilities can be well controlled around the pre-specified nominal confidence level with reasonably shorter confidence widths; and (ii) the empirical type I error rates of their associated test statistics are generally closer to the pre-specified nominal level with larger powers. They are hence recommended. Two real examples from clinical laboratory studies are used to illustrate the proposed methodologies.

Prospective analysis of epicutaneous testing for inhalant allergy: comparison of arm and back subsites with mRAST.

OBJECTIVES: 1) To compare epicutaneous testing (ET) from four skin subsites (forearm, upper arm, upper back, lower back) and 2) to compare ET to modified RAST (mRAST) for inhalant allergens. STUDY DESIGN: Prospective clinical trial. SUBJECTS AND METHODS: Fifty one patients underwent ET at four skin subsites and mRAST to six antigens and positive and negative controls. RESULTS: The forearm and upper back showed best sensitivity to positive controls and all subsites demonstrated similar specificity to negative controls. The forearm and upper back demonstrated best sensitivity and specificity for most antigens. No statistically significant differences were noted for antigen sensitivity and specificity for the four subsites. ET and mRAST agreed best on D. farinae and timothy grass and least on short ragweed and dog epithelium. CONCLUSION: This study confirms that forearm and upper back demonstrate very good sensitivity and specificity for positive and negative controls and most tested antigens. This has important diagnostic implications for clinical practice of inhalant allergy.

Correlations between alder specific IgE and alder-related tree pollen specific IgE by RAST method.

BACKGROUND: Wild birch trees grow in limited areas in Japan and are not a common aero-allergen. However, many patients who do not live in the area show positive birch pollen Radioallergosorbent Test (RAST). Therefore, being sensitized by another tree pollen which is closely related to birch may result in showing a specific IgE antibody to birch. Alder is a one of these trees and in the past it grew widely in Japan. However, there is no available RAST data as to the correlations between alder and alder-related trees. METHODS: We measured the alder specific IgE (CAP-RAST, Phadea) in stored sera which was positive in birch RAST (228 samples), beech RAST (36 samples), oak RAST (152 samples) and cedar RAST (411 samples) and examined correlations between the RAST of alder and other trees. RESULTS: The correlation coefficient value of birch was very high (0.971). The other coefficient values of beech and oak were high (0.884 in beech and 0.895 in oak) but were slightly lower than that of the birch. This means that in terms of allergenicities, birch pollen is almost the same as alder and beech and oak are partly different from the alder. CONCLUSIONS: The Japanese respond to alder pollen just same as they do to birch pollen in forming specific IgE antibody. In clinical practice, positive alder RAST has the same meaning as positive birch RAST.

Diagnostic testing for inhalant allergies.

Allergic rhinitis is one of the most commonly treated disorders seen in otolaryngology office settings. It is often difficult to distinguish the symptoms associated with allergic rhinitis from other causes of rhinitis. Many times these nasal symptoms can be effectively treated using nonspecific pharmacotherapeutic agents in conjunction with general information on ways to reduce exposure to allergens or irritants in the environment. When allergic rhinitis is suspected and a targeted treatment approach is needed, allergy testing can confirm the diagnosis and guide effective treatment for the condition. This paper discusses various methods for diagnosing inhalant allergies with a special focus on a newer approach to skin testing, known as modified quantitative testing or MQT. This paper also presents an overview of the immune response as it occurs in allergic rhinitis, along with a discussion of common inhalant allergens. Finally, this paper offers a general approach to allergy testing and patient preparation.

Penicillin allergy skin testing: what do we do now?

Drug-induced anaphylaxis remains a relatively infrequent event. However, penicillin and associated beta-lactam antibiotics remain a primary cause of anaphylaxis. Penicillin allergies are undoubtedly overreported, and patients with suspected penicillin allergy can be treated with antibiotic alternatives. Penicillin allergy skin testing is a simple and effective way to identify true penicillin allergy. Skin testing involves testing for both major and minor determinants and should be conducted in a facility with available life-support equipment. The commercial major determinant product, benzylpenicilloyl-polylysine, was removed from the market in 2004; this action compromised the ability of clinicians to evaluate a patient's likely response to penicillin therapy. Alternatives to skin testing include laboratory synthesis of major determinants, use of the radioallergosorbent test (RAST), or a combination of RAST and minor determinant skin testing. Patients with suspected penicillin allergy can undergo desensitization if they require penicillin therapy. The planned return of a commercial major determinant will hopefully resolve this issue.