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Thirty-three Navajo patients were seen in a private allergy consultation practice in Flagstaff, Arizona between 1978 and 1990. Sufficient skin test and historical data were available from nine atopic patients to evaluate hypersensitivity reactions to oral corn pollen used in the Navajo ceremonials. Six of the nine patients had positive skin test reactions to corn pollen and four of these six reported symptoms from oral corn pollen. The symptoms included various combinations of oral and ear itching, sneezing, cough, and wheezing. One corn pollen skin test-negative patient reported slight throat itching from the pollen. In no case did the patient or referring primary care physician associate the symptoms with ceremonial oral corn pollen use. This is the first report of hypersensitivity reactions to the ceremonial use of oral corn pollen in native Americans.

Thirty patients were skin tested by Multi-Test and Morrow Brown needle using antigens, histamine, glycerosaline, and blank controls to examine reproducibility and influence of positive reactions on adjacent negative controls. There was no evidence that histamine or strongly positive antigen reactions affected adjacent negative controls. Multi-Test was more reproducible, and preferred by patients over Morrow Brown.

We report 16 cases of latex allergy and the diagnostic methods used to determine sensitivity. By history, eight had usually experienced anaphylaxis during operative procedures, and eight experienced contact urticaria. Skin prick tests were positive in all subjects and negative in ten controls. In vitro analysis by ELISA for latex-specific IgE was positive in only three subjects. No adverse reactions occurred during testing. We conclude that prick skin testing is the preferred diagnostic method, and that the in vitro method used in this study has an unacceptable lack of sensitivity.

Between December 1989 and June 1990, 1,874 reports of alleged malathion application related illness from repeated spraying of a mixture of malathion corn syrup bait to eradicate a Mediterranean fruit fly infestation in Southern California were received by the Toxics Epidemiology Program of Los Angeles County. Among these complaints were 47 reports of urticaria, 38 reports of angioedema and 213 reports of a nonspecific skin rash. In order to determine whether these alleged skin reactions were the result of an immediate or delayed type of hypersensitivity reaction to malathion or to the corn syrup bait we studied ten subjects referred for testing by the local health department. All ten subjects had no reaction on patch testing. One child exhibited a positive reaction to the bait and one child had irritant reactions to malathion and to the bait. This study documented one case of a possible immediate IgE reaction to malathion bait. Due to the low participation rates in this study, no specific conclusions concerning the rate of sensitivity in the population can be drawn, although it appears that such reactions are uncommon.

Immediate hypersensitivity reactions to natural rubber pose a significant risk to patients with spina bifida and urogenital abnormalities, health care workers, and rubber industry workers. Other patients, outside of these high risk groups, have experienced severe allergic reactions to natural rubber as well. Awareness of this life-threatening condition by health care providers is essential if reactions are to be prevented. History alone is inadequate to identify all patients at risk, and reliable testing materials are not yet approved or widely available. Nonrubber medical devices are readily available for most uses; however, the only rubber-free condoms currently on the market do not prevent the transmission of sexually transmitted disease. The identification and detection of rubber antigens, along with mandated labeling for rubber antigen content, will contribute to the care of this growing population of patients. Efforts by the rubber industry to decrease the antigen content of natural rubber products will decrease the risk of reaction among sensitized patients and will, very likely, decrease the rate of sensitization in the future.

Forty-six atopic asthmatic subjects aged 3 to 58 years attending the allergy clinic of a university hospital were evaluated for prick skin test reactivity with commercially available extracts of cockroach (CCE) and house dust (HD). Additionally, skin testing was performed with American cockroach whole body (AWBE) and fecal extracts (AFE) as well as German cockroach whole body (GWBE) and fecal extracts (GFE) prepared in our laboratory. Commercial cockroach extract was prepared from American, German, and Oriental cockroach whole bodies. Skin test reactivity to the different extracts were as follows: 83% to HD, 70% to CCE, 70% to AWBE and/or GWBE, 63% to AWBE, 57% to GWBE, 63% to AFE and/or GFE, 52% to AFE, 50% to GFE, 48% to both AWBE and GWBE, and 39% to both AFE and GFE. The subjects with positive skin tests to AWBE and/or GWBE (70%) were the same individuals who showed skin test reactivity to CCE (70%). Subjects from lower income families (less than $10,000) had a significantly higher skin test reactivity to cockroach allergens than those from families with an annual income of $11,000 to $24,000 (P = .04). These results demonstrate the significance of cockroach sensitization in atopic asthmatics, suggest the importance of fecal cockroach allergens, and support earlier observations of shared interspecies allergens between American and German cockroach whole bodies.

The present study investigated the sensitivity, specificity, and predictive value of a new in vitro test, the Phadiatop, which detects the presence in serum of specific IgE to a balanced mixture of the most frequent inhalant allergens. Ninety-eight children (63 males, 35 females) 2-12 years old (median age = 6), suffering from rhinitis and/or conjunctivitis and/or asthma were studied. Our data show that Phadiatop has an 87% sensitivity, a 100% specificity, a 92% efficiency, a 100% positive predictive value, and an 86% negative predictive value. These results indicate that Phadiatop is very effective in diagnosing atopy (no false positive). However, a negative Phadiatop does not exclude the diagnosis of atopy.

The present study consisted of 124 patients with bronchial asthma or chronic asthmatic bronchitis due to immediate hypersensitivity (Type I allergy). A total of 329 bronchial challenges with house dust, grass pollen, cat and dog danders were performed in these patients who were randomly selected and the specific IgE antibodies in the serum to the same allergens were quantitatively determined (serum RAST). Of 329 bronchial challenges, 147 positive and 109 negative bronchial challenges correlated with intracutaneous tests and disease history (77.8%). In the group of 147 "positive correlating bronchial challenges" (positive challenges, positive skin tests, positive histories), 29.9% showed as positive serum RAST while 50.3% were RAST plus doubtful. In the group of 109 "negative correlating bronchial challenges" (negative challenges, negative skin tests, negative histories), negative serum RAST was found in 51.4% cases. The over-all correlation between the serum RAST and the "correlating bronchial challenges" (chi 2 = 5.19; d.f. = 2; 0.05 less than p less than 0.10) as well as the correlation for the individual allergens were found to be non-significant. It is concluded that bronchial challenges with allergens, being an in vivo parameter, are of a greater value for the diagnostic confirmation of the allergic component due to the immediate hypersensitivity (Type I allergy) in asthmatics than the serum RAST, being only a useful in vitro supplementary parameter. Serum RAST cannot substitute the bronchial challenges generally, only in some special cases.

With a modified Morrow Brown needle it proved possible to obtain duplicate skin-test values with almost the same reliability as those obtained with the intracutaneous method described in one of the preceding papers of this series. The results of the present study also showed that 50% glycerin has a distinct inhibitory effect when added to the extracts, whereas 0.0005% Tween 80 produces a distinct enhancement of the skin reaction.

Controversy surrounds studies of the incidence and clinical importance of atopic disease in tropical populations. This could be due in part to the methods of evaluation employed. The value of some of the tests commonly used in the diagnosis of atopic disease was therefore examined in a tropical situation. Extracts of environmental allergens are usually obtained from suppliers located in more temperate regions of the world, and skin tests, the radio-allergosorbant test (RAST) and RAST-inhibition demonstrate that these can lack important tropical allergens. In addition, although some local extracts are used in clinical practice, these have great variability in their protein content, allergenicity and toxicity. In the tropical environment serum IgE levels can have a greater relation to intestinal helminthic infestation than to atopic disease, even after anti-parasitic treatment, and thus the definition of "normal" IgE values must take into account the socio-economic status of the groups examined. The helminth-induced elevation of total serum IgE levels can also cause false-positive RAST results.

Puncture skin tests with crude food extracts correlate well with proved IgE-mediated food allergy. The RAST may be effective in the diagnosis of IgE-mediated food hypersensitivity when purified allergens are used and when crude food extracts are used. A positive RAST to a food may demonstrate IgE antibody directed to that food but not necessarily implies clinical sensitivity. The RAST may not be efficacious for diagnosing in food allergy if the total IgE value is greatly elevated.

Nasal challenges performed in 182 patients with allergic rhinitis revealed 273 positive and 125 negative responses to house dust, grass pollen, cat and dog danders and aspergillus fumigatus, which all correlated with disease history and intracutaneous tests. In these randomly selected patients the specific IgE antibodies in the serum to the same allergens as those used for nasal challenges were determined quantitatively by serum RAST. Additionally, blood and nasal eosinophilia were recorded during the nasal provocation tests. In all 273 positive challenges protection tests with disodium cromoglycate (DSCG) were also performed. In 24.2% of the positive nasal challenges serum RAST was found positive and in 18.7% of them serum RAST was doubtful. In 52% of the negative nasal challenges negative serum RAST also occurred. No significant correlation was found between serum RAST and nasal challenges (X2 = 0.92; d.f. = 1; 0.20 less than p less than 0.40). No significant correlation was found between serum RAST and nasal challenges for individual allergens tested. Since the nasal provocation test is an in vivo technique, it is likely to be of value for the diagnostic confirmation of the allergic component (due to immediate hypersensitivity) in patients with allergic rhinitis than serum RAST alone. Although serum RAST cannot substitute the nasal provocation tests, it may be a useful supplementary diagnostic parameter.

Nine healthy subjects were given 1 mg ketotifen orally and were skin tested with histamine (4, 10, and 20 micrograms/mL), codeine (0.001%, 0.01%, and 0.1%) and normal saline at varying time intervals up to 96 hours. Seven subjects allergic to tree and dust allergens were studied in the same way and were skin tested with both allergens. The suppression of skin responses in both studies occurred maximally between 4 and 24 hours, and did not disappear until 72 hours. The control subjects not taking ketotifen did not show any suppression. These results suggest that oral ketotifen should be withheld for 72 hours prior to immediate type hypersensitivity skin tests.

Some formulas are given for the relationship between the sizes of wheals and flares of skin reactions to three allergen extracts and to histamine and compound 48/80. Only compound 48/80 shows a somewhat different wheal/flare relationship.

Desensitization with aqueous grass-pollen extracts led to a considerable decrease in skin reactivity (by a factor of 50). This decrease proved not to be specific for the grass-pollen species used.

With a perfected technique of skin testing it was impossible to demonstrate any significant difference in skin reactivity to pollen extracts deriving from four grass species. When pollen allergen from three grass species were used, The RAST-test results did not differ from duplicate values either.

One hundred and seventeen patients with cystic fibrosis (CF) were evaluated for criteria suggestive of allergic bronchopulmonary aspergillosis (ABPA) and atopy. We found positive skin tests to Aspergillus to be more common in patients with CF than comparison groups with asthma or non-specific nasal symptoms. This increased prick skin test reactivity to Aspergillus was especially noticeable in a group of CF patients having only one or two skin tests positive, preponderantly Aspergillus. Twelve of the CF patients (10%) had further immunologic criteria suggestive of ABPA. These patients had significantly worse lung function than the CF patients without such criteria.

Among 1,651 children, 80.2% of those with high cord blood IgE concentrations (greater than or equal to 0.9 kU/l) developed atopic disease before six years of age. Only 3.5% of children with no atopic disease showed high neonatal IgE concentrations. Of children with early-developing and long-lasting symptoms, 93.7% showed high cord blood IgE concentrations.

Immediate (IgE-mediated) skin tests are widely used in the diagnosis of allergic diseases. Skin tests correlate well with more specialized studies (RAST, histamine release and provocation tests) in the diagnosis of allergic disease. Lack of standardization and quantitation of biologic potency of allergens make critical comparison of skin test results impossible. A survey of practicing allergists yielded widely divergent opinions concerning the effect of anti-allergic drugs on skin tests. The results of published studies indicate that only antihistamines cause significant depression of skin reactivity. Therefore, therapy for asthma may be continued while diagnostic skin testing is in progress, avoiding the possible morbidity associated with discontinuing pharmacologic therapy.

Intense occupational exposure to laboratory animal dander allergens plus the appropriate genetic background are the two major factors influencing development of symptoms of laboratory animal dander allergy (LADA). On quantitative evaluation by provocative bronchial challenge disodium cromoglycate afforded at least ten-fold clinical protection.

In private practice the majority of patients evaluated by allergists are truly atopic. To assess the clinical value of determining the serum level of immunoglobulin E (IgE) in such patients the records of an individual private allergist were reviewed and all new patients were evaluated. Over an eight year period 7,000 new patients were seen and 5,500 measurements of IgE were performed. An elevated serum IgE value was indicative of the atopic state with few false positives. Successful immunotherapy as determined by patient reports, the decreased use of medications and reduced clinical visits was correlated positively with a decrease in serum IgE levels. This was true regardless of the initial value of the IgE. Unsatisfactory results in immunotherapy were often accompanied by an increase in IgE levels. Serial determinations of serum IgE levels over several years of treatment are of value in the evaluation of allergic patients in private practice.

The safety, dosage and efficacy of human IgE pentapeptide (HEPP) was evaluated in 12 patients with IgE-mediated atopic disease. Statistically significant differences were observed in allergy symptom scores, allergy medication usage and skin test results between the HEPP treatment and placebo control groups. HEPP appears to be a safe, new therapeutic modality for the treatment of allergic disease.

We studied 72 adult asthmatics prospectively for the purpose of detecting atopy by the use of screening methods employing total serum IgE, RAST and prick tests. Fifty-one of the patients were considered to be atopic on the basis of prick test reactivity or a positive RAST. Although the total IgE values of the atopic and nonatopic individuals demonstrated some overlap, values over 150 U/mL were found only in atopics. We determined that 89% of the atopic individuals could be detected by a combination of total IgE greater than 150 U/mL and the use of five specific IgE determinations from the frequency of positive RAST to 20 environmental antigens. Ninety percent of the atopics were detected by four prick tests. Regional data are required to develop and effective set of screening tests. The use of such tests can reduce costs and technical time in the investigation of atopy.

The protective effects of disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDA) on the late nasal mucosa response to allergen challenge (LNR) were investigated in 42 patients with allergic rhinitis. The 42 patients, selected from a group of 370 patients, developed a total of 52 later nasal responses (LNR), 13 of which were isolated later responses (ILNR) and 29 of which were dual responses (DNR), i.e., where the later response (DLNR) has been preceded by an immediate response (INR). Significant protective effects on the immediate and on the late nasal mucosa responses were seen following the use of DSCG. The late response, being a part of the dual response was decreased by DSCG to a higher degree than the isolated late response. Although BDA also decreased the late response, the isolated late response was decreased to a greater degree than that demonstrated as a part of the dual response. The immediate response was not influenced by BDA at all. It is suggested that DSCG should be used as a drug of first choice to control the allergic rhinitis symptoms. However, in the presence of the later nasal response, BDA should be added, at least at the beginning of the treatment and during the period of peak exposure to allergen, i.e., the pollen season.

The concomitant injection of isoproterenol with house dust allergen inhibited the immediate skin allergic reaction in asthmatic patients. Pretreatment with dibutyryl cyclic AMP showed an inhibitory effect on the whealing formation to the allergen. Those results showed the inhibitory effect of isoproterenol on the skin reaction through increasing intracellular cyclic AMP levels.

For decades food allergists have sought a simple, inexpensive test for food allergy. Intradermal tests of aqueous material have not proved reliable. When positive, they are probably only 10% accurate. The newer laboratory tests for food allergy are expensive and highly sophisticated. They are impractical for use in the laboratories of practicing allergists with whom individuals with a potential food allergy are most liable to consult. The RAST is capable of identifying only Type I of the Gell-Coombs' reaction classification. Since 1980, a patch test of individual foods suspended in dimethylsulfoxide has been used as a screen for sensitivity to foods. Controlled clinical studies suggest this might prove to be a valuable test for food allergy. Immune studies appear to confirm the accuracy and reliability of this inexpensive test. No systemic reactions have been observed in the 400 patients tested indicating it to be a safe procedure.

The role of Basidiospores in the allergic diathesis is poorly understood. Dialyzed extracts of Agaricus campestris, Coprinus micaceus, Fuligo septica, Lycoperdon perlatum, Scleroderma lycoperdoides, Ustilago maydis, and sooty mold were prepared from fresh spores. The study group consisted of 100 patients with asthma and 100 patients with allergic rhinitis. These 200 patients had symptoms occurring during October and November. All were intradermally skin tested with the seven extracts at concentrations of 1 microgram/mL or 10 micrograms/mL. No scratch or pressure puncture tests were performed. Skin tests were recorded at 15 minutes (pos = 5-mm wheal with 10-mm erythema or greater) and at six or 24 hours (pos = 6 mm or greater of induration and erythema). A total of 436 immediate reactions were observed in the asthmatic group (4.4/patient) compared with 129 in the rhinitic group (1.3/patient). The late phase reactions were just the opposite. The asthmatic group had 66 late phase reactions or 0.7/patient compared with 382 or 3.8/patient in the rhinitic group. This study demonstrates that patients with bronchial asthma have a higher incidence of immediate skin sensitivity by intradermal testing, whereas patients with allergic rhinitis have late phase sensitivity to these fungal spores. This study was performed in the eastern United States only; therefore, the clinical significance of the results will become more apparent once this study is repeated in other parts of the country by other investigators.

In order to determine the diagnostic performance of the Quidel Allergen Screen (QAS), 43 patients characterized by standard skin prick test and intradermal testing for atopic sensitivity were evaluated, in parallel, using Phadebas RAST and QAS to detect the presence of serum IgE. The Quidel Allergen Screen and RAST were compared with the investigator's clinical assessment. The differences between QAS and RAST are not statistically significant. The QAS appears to be equal to the Phadebas RAST in sensitivity and specificity and thus offers a rapid, easily interpreted in vitro method for the detection of specific serum IgE.

The protective effects of disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDA) on the "delayed nasal response" to allergen challenge (DNR) were investigated in 37 patients with allergic rhinitis. These thirty-seven patients, from a group of 268, developed 43 "delayed nasal responses" (DNR), 16 cases of "isolated delayed responses" (IDNR) and 27 cases of "dual delayed responses" (DDNR), where the delayed response (DLDNR) was preceded by an immediate response (INR). BDA demonstrated significant protective effects on the DNR in both its modifications; however, to a higher degree in the case of the IDNR. DSCG significantly decreased only the INR, being a part of the DDNR, while in the case of the DNR in both its modifications, DSCG was completely ineffective. It is suggested that BDA should be the drug of first choice in allergic rhinitis patients demonstrating the DNR. When immediate responses to the same or other allergens are also present, DSCG should be added at the beginning of the treatment for a temporary period of a few months.

Ten patients with irritable bowel syndrome were evaluated for food hypersensitivity with skin testing (IgE) and IgG serum antibodies (RAST panel) to common food antigens. Patients also underwent an open elimination diet for 2 weeks followed by a 48-hour challenge of each food that was considered to be suspicious from patients diary, positive skin prick test, and/or positive IgG antibodies. Six patients had positive skin scratch test results and only one patient had RAST IgG food antibodies greater than 3,000 cpm which is a marked increase above normal. None of the patients however had an exacerbation of their irritable bowel symptoms with a food challenge. We conclude therefore that positive skin testing and IgG serum antibodies are not reliable indicators of food hypersensitivity in irritable bowel syndrome and that food hypersensitivity does not seem to play a role in the symptoms related to the irritable bowel syndrome.

We carried out sequential measurements of the intensity of simultaneously occurring late onset skin and bronchial reactivity in seven atopic subjects following skin and inhalation challenge with pollen antigen. All subjects demonstrated dual bronchial and cutaneous reactions. Although the intensity of the late onset bronchial responses correlated temporally and quantitatively with the degree of increase in serum neutrophil chemotactic activity, the intensity of the late onset skin responses correlated with the level of specific antigen-IgE in the serum. This suggests that even in the same subjects, different factors govern the intensity of late onset skin and bronchial responses.

From further studies on identification of etiologies in chronic and recurrent urticaria, two conclusions stand out: (1) that multiple, differing drugs and chemicals may form a single family group, with cross-hypersensitivity to other substances within the group and (2) that many patients tend to develop hypersensitivity to substances in multiple groups.

The Multi-Test applicator is a disposable plastic device for the simultaneous prick-puncture administration of different antigens at eight sites, in a rapid, relatively painless and reproducible manner. To determine its utility in immediate or reaginic skin testing, it was compared with the intradermal technique in children and adults. Skin test responses to glycerinated inhalant antigens, 1:20 or 1:10 W/V, administered by Multi-Test were comparable to those obtained from the same antigens applied intradermally in aqueous dilutions of 1:1,000 or 1:1,500 W/V.