Search

Background: Many patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT. Methods: We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. Results: Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p

Many patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT. We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p < 0.05). Testing with betalactams applying simple, cheap, and safe skin and blood tests can solve a third of DHR-cases on a high throughput scale. [ABSTRACT FROM AUTHOR]

Background: Total nasal symptom score is widely used to evaluate the severity of allergic rhinitis, but the clinical significance of extranasal symptoms is largely unknown. We wished to analyze the presenting symptoms in allergic rhinitis, as well as their relationship with quality of life (QoL) and therapeutic outcomes. Methods: Presenting symptoms and QoL were assessed using the OptumTM SF-12v2® Health Survey in 260 patients with allergic rhinitis. Clinical response at 3 months after treatment was measured. Results: Ten most common symptoms presenting with at least moderate severity in allergic rhinitis were: blocked nose (82.7%), rhinorrhea (75.0%), sneeze (70.9%), itchy nose (68.5%), fatigue (63.6%), mouth breathing (61.1%), daytime somnolence (52.7%), postnasal drip (49.1%), itchy eyes (47.3%), and dry mouth (46.3%). Severity of sneeze was correlated with physical component summary (PCS) whereas postnasal drip and daytime somnolence were correlated with mental component summary (MCS). Severity of dry mouth was correlated with PCS and MCS. The symptoms with the highest severity scores after treatment were blocked nose, postnasal drip, fatigue, and dry mouth, respectively. Conclusions: Extranasal symptom scores correlated well with physical health and mental health in allergic rhinitis patients. Assessment of extranasal symptoms should be included to evaluate disease severity and assess therapeutic outcomes. Clinical trial NCT02000648, http://www.clinicaltrials.gov.

Background: The majority of patients with cholinergic urticaria presents with strong hypersensitivity to autologous sweat. Patients with severe cholinergic urticaria are frequently resistant to H1 antagonists which are used in conventional therapies for various types of urticaria. It has been reported that desensitization using partially purified sweat antigen was effective in a patient with cholinergic urticaria. Methods: The aim of this study is to determine the usefulness of rapid desensitization with autologous sweat in severe cholinergic urticaria, because rapid desensitization has proven to be a quick and effective immunotherapy for allergies to various allergens. Six patients with severe cholinergic urticaria who are resistant to H1 antagonists and have sweat hypersensitivity were enrolled in a rapid desensitization protocol. Results: In all six patients, the responses for skin tests with autologous sweat were attenuated after rapid desensitization with autologous sweat. Two of the three cholinergic urticaria patients showed reduced histamine release with autologous sweat after the rapid desensitization with autologous sweat. Further, the rapid desensitization and subsequent maintenance treatment reduced the symptoms in five of the six patients. Conclusions: This study provides evidence that rapid desensitization with autologous sweat is beneficial for treating cholinergic urticaria patients resistant to conventional therapy who have sweat hypersensitivity.

Background: Ortho-phthalaldehyde (OPA) has recently been used as a disinfectant for various medical apparatuses. OPA is not generally recognized as a potential allergen. Case Summary: Subsequent to our recent report describing a patient presenting with OPA-induced anaphylaxis following laryngoscopy, we experienced two more such cases. In all three cases, the basophil histamine release test was useful for identifying the allergen as OPA. OPA-specific IgE was successfully detected in the serum of the patients by ELISA. Discussion: Physicians and co-medical workers need to be aware of potential allergens to which patients may be exposed during routine medical procedures.

Background Total nasal symptom score is widely used to evaluate the severity of allergic rhinitis, but the clinical significance of extranasal symptoms is largely unknown. We wished to analyze the presenting symptoms in allergic rhinitis, as well as their relationship with quality of life (QoL) and therapeutic outcomes. Methods Presenting symptoms and QoL were assessed using the OptumTM SF-12v2 ® Health Survey in 260 patients with allergic rhinitis. Clinical response at 3 months after treatment was measured. Results Ten most common symptoms presenting with at least moderate severity in allergic rhinitis were: blocked nose (82.7%), rhinorrhea (75.0%), sneeze (70.9%), itchy nose (68.5%), fatigue (63.6%), mouth breathing (61.1%), daytime somnolence (52.7%), postnasal drip (49.1%), itchy eyes (47.3%), and dry mouth (46.3%). Severity of sneeze was correlated with physical component summary (PCS) whereas postnasal drip and daytime somnolence were correlated with mental component summary (MCS). Severity of dry mouth was correlated with PCS and MCS. The symptoms with the highest severity scores after treatment were blocked nose, postnasal drip, fatigue, and dry mouth, respectively. Conclusions Extranasal symptom scores correlated well with physical health and mental health in allergic rhinitis patients. Assessment of extranasal symptoms should be included to evaluate disease severity and assess therapeutic outcomes. Clinical trial NCT02000648 , http://www.clinicaltrials.gov . [ABSTRACT FROM AUTHOR]

Background: A case in which a 45-year-old female patient with peritonitis experienced immediate-type hypersensitivity on two occasions after administration of preparations containing six different medications was referred to us for closer inspection. Methods/Results: Skin tests performed on the six medications revealed a positive reaction to the vitamin B6 preparation Biosechs (Wakamoto Pharmaceutical, Tokyo, Japan). Further investigation showed that the principal ingredient, pyridoxal 5'-phosphate (PLP), produced a positive reaction, whereas the injection solvent with the principal ingredient removed produced a negative reaction. When compounds similar to PLP were tested, pyridoxine (PN), pyridoxamine and pyridoxal produced a negative reaction, whereas pyridoxine 5'-phosphate and pyridoxamine 5'-phosphate (PMP) produced a positive reaction. Adenosine 2'-phosphate and adenosine 5'-diphosphate were also tested and these produced a negative reaction. When a histamine-release test was performed, PLP and PMP produced a positive reaction, whereas PN produced a negative reaction. When all tests were performed on three control subjects, the results were all negative. Conclusions: In this very rare case, phosphate radical conjugates with a pyridine nucleus became haptenic-epitope and an immediate-type reaction occurred. In past cases involving hypersensitivity to vitamin B6, two cases involved a photoallergic reaction caused by PN and one case involved an immediate-type hypersensitivity caused by PLP In the past cases, closely related substances had not been tested and an epitope was not identified.

A high molecular weight allergen, M-177, was recently discovered in the house dust mite, Dermatophagoides farinae (D. farinae). The aims of this study were to develop a conventional purification procedure for M-177 and then to analyze some of the immunochemical properties of M-177. Mite extracts obtained from purified mite bodies were a suitable material for preparing M-177, because the purified mite extract contained large amounts of M-177. The purification of this allergen from the extract was achieved by ethanol fractionation, anion exchange chromatography, and gel filtration chromatography. The purified antigen was immunochemically equivalent to that of a preparation obtained by a previous affinity method using an anti-Mag 3-immobilized column. The yield of this purification procedure was 36.8% of the initial amount of M-177 in the extract, 40-fold greater than that of the previous immunoaffinity method. Our purification method was useful for preparing this allergen. The purified M-177 reacted in skin tests in 11 of 16 miteallergic patients, compared to 10 of 16 with Der f 2. The amount of M-177 in the purified mite extract determined by enzyme-linked immunosorbent assay inhibition was as much as 0.95% of the total protein, which was higher than the amounts of Der f 1 (0.52%) and Der f 2 (0.32%). The potent allergenic activity and large amount of M-177 in the mites indicate that it is an important mite allergen.

Skin prick tests (SPT) were performed on 2113 atopic patients (407 children and 1 706 adults) with asthma and/or rhinitis at 24 allergy clinics in Iceland, Norway, Denmark, Sweden, Estonia, Lithuania and Russia. Test extracts were Dermatophagoides pteronyssinus (D. pteronyssinus), Dermatophagoides farinae [D. farinae), cat, dog, horse, birch, timothy, mugwort, Cladosporium, Alternaria, cockroach, chironomids (red mosquito larvae, RML) and shrimp. Among the allergens, timothy followed by cat, birch and dog gave the highest number of positive SPT. Positive SPT with house dust mites (HDM), furred animals, RML and Cladosporium were more common in asthmatics than in patients with rhinitis; birch and timothy more common in patients with rhinitis. Sensitization against D. pteronyssinus, horse, timothy and Cladosporium was more common in men than in women. Although the general sensitization pattern of the atopic patients at the participating centers showed similarities, there were also significant differences between centers. Positive SPT with furred animals were most prevalent in Northern and Central Sweden and St Petersburg, and least common in Siberia and Denmark. Pollen allergy was most common in Novosibirsk and on the west coast of Sweden, and less common in Vladivostok. Sensitization against HDM was most common in Lithuania and least prevalent in Northern Sweden and Finland. Insect allergens gave the most positive reactions in St Petersburg and the least positive reaction in Novosibirsk. Sensitization against multiple allergens was found in 74% of the patients and a mono-allergy in 26%. The degree of atopy was higher in males than in females and higher in asthmatics than in patients with rhinitis. The month of birth of the patients did not influence significantly the test results. It is concluded that although the sensitization pattern shows similarities in different regions, it is also influenced to some extent by residence as well as by diagnosis, sex and age of the patients.

A letter to the editor is presented regarding the occurrence of anaphylaxis in a 65-year-old woman due to the presence of γ-cyclodextrin in sugammadex which was administered to her after her maxillary cyst surgery.

Background: Ortho-phthalaldehyde (OPA) has recently been used as a disinfectant for various medical apparatuses. OPA is not generally recognized as a potential allergen. Case Summary: Subsequent to our recent report describing a patient presenting with OPA-induced anaphylaxis following laryngoscopy, we experienced two more such cases. In all three cases, the basophil histamine release test was useful for identifying the allergen as OPA. OPA-specific IgE was successfully detected in the serum of the patients by ELISA. Discussion: Physicians and co-medical workers need to be aware of potential allergens to which patients may be exposed during routine medical procedures. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: A case in which a 45-year-old female patient with peritonitis experienced immediate-type hypersensitivity on two occasions after administration of preparations containing six different medications was referred to us for closer inspection. Methods/Results: Skin tests performed on the six medications revealed a positive reaction to the vitamin B6 preparation Biosechs (Wakamoto Pharmaceutical, Tokyo, Japan). Further investigation showed that the principal ingredient, pyridoxal 5′-phosphate (PLP), produced a positive reaction, whereas the injection solvent with the principal ingredient removed produced a negative reaction. When compounds similar to PLP were tested, pyridoxine (PN), pyridoxamine and pyridoxal produced a negative reaction, whereas pyridoxine 5′-phosphate and pyridoxamine 5′-phosphate (PMP) produced a positive reaction. Adenosine 2′-phosphate and adenosine 5′-diphosphate were also tested and these produced a negative reaction. When a histamine-release test was performed, PLP and PMP produced a positive reaction, whereas PN produced a negative reaction. When all tests were performed on three control subjects, the results were all negative. Conclusions: In this very rare case, phosphate radical conjugates with a pyridine nucleus became haptenic-epitope and an immediate-type reaction occurred. In past cases involving hypersensitivity to vitamin B6, two cases involved a photoallergic reaction caused by PN and one case involved an immediate-type hypersensitivity caused by PLP. In the past cases, closely related substances had not been tested and an epitope was not identified. [ABSTRACT FROM AUTHOR]

A high molecular weight allergen, M-177, was recently discovered in the house dust mite, Dermatophagoides farinae (D. farinae). The aims of this study were to develop a conventional purification procedure for M-177 and then to analyze some of the immunochemical properties of M-177. Mite extracts obtained from purified mite bodies were a suitable material for preparing M-177, because the purified mite extract contained large amounts of M-177. The purification of this allergen from the extract was achieved by ethanol fractionation, anion exchange chromatography, and gel filtration chromatography. The purified antigen was immunochemically equivalent to that of a preparation obtained by a previous affinity method using an anti-Mag 3-immobilized column. The yield of this purification procedure was 36.8% of the initial amount of M-177 in the extract, 40-fold greater than that of the previous immunoaffinity method. Our purification method was useful for preparing this allergen. The purified M-177 reacted in skin tests in 11 of 16 mite-allergic patients, compared to 10 of 16 with Der f 2. The amount of M-177 in the purified mite extract determined by enzyme-linked immunosorbent assay inhibition was as much as 0.95% of the total protein, which was higher than the amounts of Der f 1 (0.52%) and Der f 2 (0.32%). The potent allergenic activity and large amount of M-177 in the mites indicate that it is an important mite allergen. [ABSTRACT FROM AUTHOR]