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Alberto Gómez-Buendía es titular de una beca de doctorado (referencia CT58/21-CT59/21) de la Universidad Complutense de Madrid y el Banco Santander. Javier Ortega es titular de un contrato-beca de Formación del Profesorado Universitario (referencia FPU18/05197) del MICINN., Limitations in diagnostic test performance are one of the major challenges hampering the eradication of bovine tuberculosis (bTB). Non-tuberculous mycobacteria (NTM) are considered one of the main causes of non-specific reactions in the intradermal tuberculin test, the most widely used bTB diagnostic test. To determine the role of NTMs in bTB misdiagnosis in Spain, an experimental study including the NTM species most commonly found in bTB-positive animals from bTB-free farms in the country (M. avium subsp. avium (Maa), “Mycobacterium avium subsp. hominissuis” (Mah), M. bourgelatii, M. intermedium, M. kansasii and M. nonchromogenicum) was carried out on guinea pigs and cattle. First, guinea pigs were sensitized with the selected NTMs, and six weeks post-sensitization four antigen mixtures (bovine-PPD, avian-PPD, P22 and ESAT6-CFP10) were inoculated intradermally and their effect was measured 24- and 48-h post-inoculation. Larger erythematous reactions were observed in guinea pigs sensitized with Mah, M. kansasii, and Maa, with significant differences in the reactions measured at the bovine-PPD inoculation site for the two first bacteria compared with other NTMs. The sensitization process was repeated in cattle, and five months post-sensitization the same antigen mixtures were inoculated in the cervical region and responses were measured at 48- and 72-h post-inoculation. A significantly higher increase in the skinfold thickness measured at the bovine-PPD inoculation site was observed in calves sensitized with Mah, Maa, M. intermedium and M. kansasii. These results demonstrate that certain NTM species may play a more significant role in bTB diagnostic interferences and show that results obtained in guinea pig and bovine models do not always coincide., Ministerio de Ciencia, Innovación y Universidades (España), European Commission, Ministerio de Agricultura,Pesca y Alimentación (España), Depto. de Sanidad Animal, Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Fac. de Veterinaria, TRUE, pub

We report a case of a patient who suffered generalized urticaria, chest tightness, wheezing, nausea, vomiting, hypotension, and loss of consciousness. Two hours earlier she had taken Eulitop Retard® following lunch. She had tolerated all the implicated food after the reaction. Allergy evaluation revealed intense positive responses to intradermal tests with bezafibrate active component and Eulitop Retard® (skin tests in control subjects were negative). Specific lgE tests (RAST) to Eulitop Retard® were negative. An lgE mechanism is suggested to be responsible for this adverse reaction on the basis of the positive skin tests. The delayed onset (two hours) of this anaphylactic shock is unusual. Although infrequent, it may be caused by the specific pharmacokinetic characteristics of this drug, which is a slow releasing agent, mainly absorbed in the gut. The drug was taken just after lunch, and this concomitant food ingestion could also have produced a delay in gastric drainage and a retarded drug absorption. An lgE-mediated accelerated type reaction could also explain this delay. Apparently the patient reacted after the first contact to the drug, and the absence of a sensitization period is not usual in this type of immune response. Finally, we recommend the performance of prick and intradermal skin tests prior to any systemic challenge when allergic reactions to fibric acid derivatives are suspected., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Author contributions: AG-B: Data curation, Formal analysis, Writing—original draft, Writing—review & editing. JAl: Data curation, Funding acquisition, Resources, Supervision, Writing—review & editing. JB: Funding acquisition, Writing—review & editing. JM: Conceptualization, Supervision, Writing—review & editing. JAm: Data curation, Resources, Writing—review & editing. JS: Investigation, Resources, Writing—review & editing. LdJ: Data curation, Funding acquisition, Writing—review & editing. BR: Data curation, Methodology, Supervision, Writing—review & editing., Non-tuberculous mycobacteria (NTM) are considered a relevant cause of non-specific reactions to the most widely applied bovine tuberculosis (bTB) test, the intradermal tuberculin test. In order to establish which NTM species might act as a potential source of such diagnostic interference, a collection of 373 isolates obtained from skin test positive cows from 359 officially tuberculosis-free (OTF) herds, culled in the framework of the bTB eradication campaign in Spain, were identified at the species level through PCR and Sanger sequencing of the 16S rDNA, hsp65 and rpoB genes.. Of the 308 isolates for which a reliable identification was achieved, 32 different mycobacterial species were identified, with certain species being most represented: among M. avium complex members (n = 142, 46.1%), M. avium subsp. hominissuis (98; 69.0%) was the most abundant followed by M. avium subsp. avium (33, 23.2%), and M. intracellulare(7, 4.9%). Among non-MAC members (n = 166, 53.9%), M. nonchromogenicum (85; 27.6%) and M. bourgelatii (11; 5.6%) were the predominant species. In addition, mixed results were obtained in 53 isolates presenting up to 30 different genotypes, which could be indicative of new mycobacterial species. Our results represent a first step toward characterizing the diversity of NTM species that could interfere with official diagnostic tests for bTB eradication in Spain., European Union Reference Laboratory for Bovine Tuberculosis, Ministerio de Agricultura, Pesca y Alimentación, Ministerio de Ciencia, Innovación y Universidades, Depto. de Sanidad Animal, Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Fac. de Veterinaria, TRUE, pub

Background. International guidelines suggested skin tests with Polyethylene-glycol (PEG) and polysorbate 80 (PS-80), to investigate a possible hypersensitivity to these excipients either to identify subjects at risk of developing allergic reactions to Covid-19 vaccines, or in patients with suspected IgE mediated hypersensitivity reactions (HR) to the Covid-19 vaccine. The main purpose of this study was to investigate the prevalence of PEG and PS sensitization in patients with a clinical history of HR to drugs containing PEG/PS and in patients with a suspected Covid-19 vaccine immediate HR. Methods. This was a multicenter retrospective study conducted by allergists belonging to 20 Italian medical centers. Skin testing was performed in 531 patients with either a clinical history of suspected hypersensitivity reaction (HR) to drugs containing PEG and/or PS-80 (group 1:362 patient) or a suspected HR to Covid-19 vaccines (group 2: 169 patient), as suggested by the AAIITO/SIAAIC guidelines for the "management of patients at risk of allergic reactions to Covid-19 vaccines" [1]. Results. 10/362 (0.02%) had positive skin test to one or both excipients in group 1, 12/169 (7.1%) in group 2 (p less than 0.01). In group 2 HRs to Covid-19 vaccines were immediate in 10/12 of cases and anaphylaxis occurred in 4/12 of patients. Conclusions. The positivity of skin test with PEG and or PS before vaccination is extremely rare and mostly replaceable by an accurate clinical history. Sensitization to PEG and PS has to be investigated in patients with a previous immediate HR to a Covid-19 vaccine, in particular in patients with anaphylaxis.

INTRODUCTION: Allergic rhinitis is a global health problem but often neglected and its burden, underestimated. Knowledge on its epidemiology is important for its diagnosis and treatment. Hence, this study was conducted to assess the prevalence and pattern of various inhalant allergens among allergic rhinitis patients in Vellore district. METHODS: Cross sectional study was conducted among 300 adult patients diagnosed with allergic rhinitis in Vellore district, between July - December 2019. Detailed history with a structured questionnaire & skin prick test after informed consent was done. The common inhalant (house dust, cotton dust, aspergillus, pollens, parthenium and cockroach) were tested. Chi square test was done and P<0.05 was considered statistically significant RESULTS: Majority,75%(n=225) were allergic to house dust, 68%(n=204) to cockroach and 67% (n=201) to parthenium,54.3% (n=163) to pollen. 44% (n=132) to cotton dust and 42.7%(n=128) to aspergillus respectively. Middle age group (26-40 years) was commonly affected. Though gender and place of residence showed difference clinically there was no statistical significance CONCLUSION: Prevalence of inhalant allergens is high. Majority affected with house dust and cockroach. Allergic rhinitis varies in accordance with location & environmental conditions. In addition to the well-established pharmacotherapy, self-management after understanding their trigger will help reduce the morbidity.

INTRODUCTION: Allergic rhinitis is a global health problem but often neglected and its burden, underestimated. Knowledge on its epidemiology is important for its diagnosis and treatment. Hence, this study was conducted to assess the prevalence and pattern of various inhalant allergens among allergic rhinitis patients in Vellore district. METHODS: Cross sectional study was conducted among 300 adult patients diagnosed with allergic rhinitis in Vellore district, between July - December 2019. Detailed history with a structured questionnaire & skin prick test after informed consent was done. The common inhalant (house dust, cotton dust, aspergillus, pollens, parthenium and cockroach) were tested. Chi square test was done and P<0.05 was considered statistically significant RESULTS: Majority,75%(n=225) were allergic to house dust, 68%(n=204) to cockroach and 67% (n=201) to parthenium,54.3% (n=163) to pollen. 44% (n=132) to cotton dust and 42.7%(n=128) to aspergillus respectively. Middle age group (26-40 years) was commonly affected. Though gender and place of residence showed difference clinically there was no statistical significance CONCLUSION: Prevalence of inhalant allergens is high. Majority affected with house dust and cockroach. Allergic rhinitis varies in accordance with location & environmental conditions. In addition to the well-established pharmacotherapy, self-management after understanding their trigger will help reduce the morbidity.

INTRODUCTION: Allergic rhinitis is a global health problem but often neglected and its burden, underestimated. Knowledge on its epidemiology is important for its diagnosis and treatment. Hence, this study was conducted to assess the prevalence and pattern of various inhalant allergens among allergic rhinitis patients in Vellore district. METHODS: Cross sectional study was conducted among 300 adult patients diagnosed with allergic rhinitis in Vellore district, between July - December 2019. Detailed history with a structured questionnaire & skin prick test after informed consent was done. The common inhalant (house dust, cotton dust, aspergillus, pollens, parthenium and cockroach) were tested. Chi square test was done and P<0.05 was considered statistically significant RESULTS: Majority,75%(n=225) were allergic to house dust, 68%(n=204) to cockroach and 67% (n=201) to parthenium,54.3% (n=163) to pollen. 44% (n=132) to cotton dust and 42.7%(n=128) to aspergillus respectively. Middle age group (26-40 years) was commonly affected. Though gender and place of residence showed difference clinically there was no statistical significance CONCLUSION: Prevalence of inhalant allergens is high. Majority affected with house dust and cockroach. Allergic rhinitis varies in accordance with location & environmental conditions. In addition to the well-established pharmacotherapy, self-management after understanding their trigger will help reduce the morbidity.

Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients. Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally. The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe. This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning c

Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients. Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally. The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe. This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning c

Background: Recent single-center studies promote oral penicillin challenges, without skin testing, in patients with low risk/likelihood of true allergy. However, how best to define a low-risk penicillin allergy history is uncertain. Objective(s): To statistically determine an optimal low-risk definition, to select patients for safe outpatient penicillin challenges, without skin testing. Method(s): In a multicenter Australian study (February 2016 to May 2018), testing strategy (skin test and/or oral penicillin challenge) and outcomes were retrospectively collected for all penicillin-allergic patients. Statistical modeling was performed with 8 low-risk definitions, to determine an optimal low-risk definition. Result(s): A total of 447 subjects (mean age, 45.3 years; 63.8% females) were analyzed. A history of benign, immediate, or delayed rash, more than 1 year before review, was the optimal low-risk definition. A total of 244 of 447 (54.6%) patients met this definition, of which 97.1% tolerated a 1- or 2-dose penicillin challenge, with no anaphylaxis in those who reacted. Of 203 patients designated higher risk, 54 (26.6%) had their allergy confirmed by skin test (n = 45) or challenge (n = 9). Conclusion(s): History of penicillin-associated rash (without angioedema, mucosal ulceration, or systemic involvement), more than 1 year ago, is sufficient to select a patient for a direct oral penicillin challenge. This large multicenter study demonstrates that this approach appears safe, and risk is comparable to that in other procedures being performed in primary care in Australia. The higher risk patients are more likely to benefit from skin testing. This simple risk-based delabeling strategy could potentially be used by nonallergists, leading to more efficient penicillin allergy delabeling service provision.Copyright © 2019 American Academy of Allergy, Asthma & Immunology

Background: Recent single-center studies promote oral penicillin challenges, without skin testing, in patients with low risk/likelihood of true allergy. However, how best to define a low-risk penicillin allergy history is uncertain. Objective(s): To statistically determine an optimal low-risk definition, to select patients for safe outpatient penicillin challenges, without skin testing. Method(s): In a multicenter Australian study (February 2016 to May 2018), testing strategy (skin test and/or oral penicillin challenge) and outcomes were retrospectively collected for all penicillin-allergic patients. Statistical modeling was performed with 8 low-risk definitions, to determine an optimal low-risk definition. Result(s): A total of 447 subjects (mean age, 45.3 years; 63.8% females) were analyzed. A history of benign, immediate, or delayed rash, more than 1 year before review, was the optimal low-risk definition. A total of 244 of 447 (54.6%) patients met this definition, of which 97.1% tolerated a 1- or 2-dose penicillin challenge, with no anaphylaxis in those who reacted. Of 203 patients designated higher risk, 54 (26.6%) had their allergy confirmed by skin test (n = 45) or challenge (n = 9). Conclusion(s): History of penicillin-associated rash (without angioedema, mucosal ulceration, or systemic involvement), more than 1 year ago, is sufficient to select a patient for a direct oral penicillin challenge. This large multicenter study demonstrates that this approach appears safe, and risk is comparable to that in other procedures being performed in primary care in Australia. The higher risk patients are more likely to benefit from skin testing. This simple risk-based delabeling strategy could potentially be used by nonallergists, leading to more efficient penicillin allergy delabeling service provision.Copyright © 2019 American Academy of Allergy, Asthma & Immunology

Current eradication strategies of tuberculosis (TB) in goats mainly rely on the single intradermal tuberculin test (SIT) and single intradermal cervical comparative tuberculin tests (SICCTs). TB vaccination has been proposed as a cost-effective option in high-prevalence herds or countries where economic compensation for the slaughter of positive animals is not affordable. However, TB vaccination compromises the efficiency of tuberculin-based diagnostic tests. In this study, the performance of a new diagnostic platform, based on the P22 antigenic complex, was assessed for skin test (ST), interferon-gamma release assay (IGRA), and serology under different TB scenarios. The sensitivity (Se) of diagnostic tests was assessed in TB-infected goats from the same farm (herd A, N = 77). The specificity (Sp) was assessed in two TB-negative farms (both vaccinated against paratuberculosis): one TB unvaccinated (herd B, N = 77) and another vaccinated with bacille Calmette-Guérin (BCG) (herd C, N = 68). The single (s) P22-IGRA showed the highest Se among IGRA tests (91%), and the comparative (c) P22-ST showed the highest Sp (100% in herd B and 98% in herd C). Combined interpretation of techniques enabled the best diagnostic performances. Combining the SICCT + sP22-IGRA improved Se (97%) compared to SICCT + tuberculin-based IGRA (95%), with a reduction of Sp (95 and 100%, respectively). Besides, combination of P22-ELISA with cP22-ST or SICCT elicited a similar performance in the non-vaccination context (Se: 94 and 95%; Sp: 95 and 95%, respectively), but Sp was significantly higher for the combination with cP22-ST compared to SICCT in the TB vaccination context (95 and 79%, respectively). The combination of serological tests based on P22 and MPB83 showed higher complementarity and improved 13 percentage points the Se of P22-ELISA alone. These findings suggest that either cell-mediated or antibody-based diagnostic techniques, using the P22 antigen complex, can contribute to improve t

Paratuberculosis (PTB) is an enteric granulomatous disease caused by Mycobacterium avium subsp. paratuberculosis (MAP) that mainly aects ruminants. Current vaccines have shown to be cost-eective control reagents, although they are restricted due to cross-interference with bovine tuberculosis (bTB). Therefore, novel vaccination strategies are needed and this study is focused on evaluating alternative vaccination routes and their eect on the local immune response. The MAP oral challenge rabbit model was used to evaluate and compare an experimental inactivated MAP vaccine through oral (VOR) and intradermal (VID) routes. The VID group presented the highest proportion of animals with no visible lesions and the lowest proportion of animals with MAP positive tissues. Immunohistochemistry analysis revealed that the VID group presented a dominantly M1 polarized response indicating an ability to control MAP infection. In general, all vaccinated groups showed lower calprotectin levels compared to the non-vaccinated challenged group suggesting less active granulomatous lesions. The VID group showed some degree of skin test reactivity, whereas the same vaccine through oral administration was completely negative. These data show that PTB vaccination has an eect on macrophage polarization and that the route influences infection outcome and can also have an impact on bTB diagnosis. Future evaluation of new immunological products against mycobacterial diseases should consider assaying dierent vaccination routes.

Background: The incidence of drug eruptions is increasing during the last few years due to a large number of new medications. Early detection of the causative agent and the prevention from exposure are crucial managements in terms of drug eruption, mainly to prevent its recurrence. Objective: To understand skin test as a diagnostic modality in drug eruption, which includes skin patch test, skin prick test, and intradermal test. Literature review: Drug eruption is a form of skin eruption triggered by the use of medications, topical or systemic, in the right dose and indication. The manifestation can vary from maculopapular, urticaria, pustular, and bullous eruption; from the most nonsignificant to a life-threatening reaction. A diagnostic procedure is critical to discover the type of drugs that cause the eruption, i.e., skin test, specific IgE measurement, histamine-release test, and provocation test. Skin test is the first choice in the diagnostic process as it is simple, easy, practical and has high sensitivity and specificity. Conclusion: Skin test is one of the many available diagnostic tools. However, both false positive and false negative results might still arise. The experts are currently attempting to come up with more accurate and practical tests to aid the diagnostic of drug eruption, thus preventing its occurrence.

The single intradermal comparative cervical tuberculin (SICCT) test and post-mortem examination are the main diagnostic tools for bovine tuberculosis (bTB) in cattle in the British Isles. Latent class modelling is often used to estimate the bTB test characteristics due to the absence of a gold standard. However, the reported sensitivity of especially the SICCT test has shown a lot of variation. We applied both the Hui–Walter latent class model under the Bayesian framework and the Bayesian model specified at the animal level, including various risk factors as predictors, to estimate the SICCT test and post-mortem test characteristics. Data were collected from all cattle slaughtered in abattoirs in Northern Ireland in 2015. Both models showed comparable posterior median estimation for the sensitivity of the SICCT test (88.61% and 90.56%, respectively) using standard interpretation and for post-mortem examination (53.65% and 53.79%, respectively). Both models showed almost identical posterior median estimates for the specificity (99.99% vs. 99.80% for SICCT test at standard interpretation and 99.66% vs. 99.86% for post-mortem examination). The animal-level model showed slightly narrower posterior 95% credible intervals. Notably, this study was carried out in slaughtered cattle which may not be representative for the general cattle population.

In the view of the epidemic growth of sensitization to indoor allergens in Southern Vietnam, there is a requirement to screen large population., info:eu-repo/semantics/published

IgE-mediated food allergy affects 6-8% of children. Our study aimed to define the correlations between the results obtained with skin prick tests (SPTs) using commercial extracts and fresh foods, and the correlations between these result and those obtained with specific IgE (sIgE) and/or challenge. Children aged from 2 months to 6 years were recruited prospectively. Overall 571 children were positive to one food. In all children we performed SPT using commercial extracts of suspected food and fresh foods and sIgE. If SPT and sIgE test results did not correspond to the history, we performed open oral food challenge. Sensitivity of SPT with commercial extracts for all tested food was poor (3-35%), while sensitivity of fresh food skin prick tests (FFSPT) was excellent (50-100%), and showed correlation with open oral food challenge (p lt 0.001). Our results suggest that fresh food extracts are more effective in detecting sensitization and with levels of sIgE greater than class 3 could predict clinical reactivity, without the need for potentially hazardous food challenges.

IgE-mediated food allergy affects 6-8% of children. Our study aimed to define the correlations between the results obtained with skin prick tests (SPTs) using commercial extracts and fresh foods, and the correlations between these result and those obtained with specific IgE (sIgE) and/or challenge. Children aged from 2 months to 6 years were recruited prospectively. Overall 571 children were positive to one food. In all children we performed SPT using commercial extracts of suspected food and fresh foods and sIgE. If SPT and sIgE test results did not correspond to the history, we performed open oral food challenge. Sensitivity of SPT with commercial extracts for all tested food was poor (3-35%), while sensitivity of fresh food skin prick tests (FFSPT) was excellent (50-100%), and showed correlation with open oral food challenge (p lt 0.001). Our results suggest that fresh food extracts are more effective in detecting sensitization and with levels of sIgE greater than class 3 could predict clinical reactivity, without the need for potentially hazardous food challenges.

IgE-mediated food allergy affects 6-8% of children. Our study aimed to define the correlations between the results obtained with skin prick tests (SPTs) using commercial extracts and fresh foods, and the correlations between these result and those obtained with specific IgE (sIgE) and/or challenge. Children aged from 2 months to 6 years were recruited prospectively. Overall 571 children were positive to one food. In all children we performed SPT using commercial extracts of suspected food and fresh foods and sIgE. If SPT and sIgE test results did not correspond to the history, we performed open oral food challenge. Sensitivity of SPT with commercial extracts for all tested food was poor (3-35%), while sensitivity of fresh food skin prick tests (FFSPT) was excellent (50-100%), and showed correlation with open oral food challenge (p lt 0.001). Our results suggest that fresh food extracts are more effective in detecting sensitization and with levels of sIgE greater than class 3 could predict clinical reactivity, without the need for potentially hazardous food challenges.

BackgroundNon-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as drug allergic' after considering only the clinical history. ObjectiveTo diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL MethodsA prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. ResultsUrticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. ConclusionsA diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.

[EN] Background: Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Methods: Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. Results: A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/ anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. Conclusions: SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites.

BackgroundNon-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as drug allergic' after considering only the clinical history. ObjectiveTo diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL MethodsA prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. ResultsUrticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. ConclusionsA diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.

[EN] Background: Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Methods: Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. Results: A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/ anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. Conclusions: SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites.

type:Original Article, identifier:http://igakkai.kms-igakkai.com/wp/wp-content/uploads/1988en/14(4)171-175.1988.pdf

BackgroundNon-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as drug allergic' after considering only the clinical history. ObjectiveTo diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL MethodsA prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. ResultsUrticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. ConclusionsA diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs.

Background and objective: Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported in patients of all age groups. The present study was aimed to investigate the relative prevalence of food allergy andallergens in patients with bronchial asthma and allergic rhinitis. Methods: Patients of all age groups and both sexes were screened using standard questionnaire and skin prick-test (SPT) with common foods. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy wasestablished. Results: Of 575 patients screened, 120 (21%) gave history of food allergy. Of the history positive patients skin testedall showed a marked positive reaction to food extracts. Egg whole, black gram and lemon elicited marked positive SPT reaction in maximum of 12 (10%) cases each followed by rice, mushroom and corn in 11 cases each (9.1%), milk and cheese 10 cases each (8.3%), paneer and sardine fish 9 cases each (7.5%), maize and tamarind 8 cases each (6.6%), peanut and brinjal 7 cases each (5.8%), garlic and cabbage 4 cases each (3.3%), banana, sago and mutton 3 cases each (2.5%0, pineapple, pork, potato and almond with 2 cases each (1.6%), 1 case of beef, lady finger and drumstick (0.8%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) againstrespective food allergens than normal controls (0.73 IU/mL, mean±2SD). The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%)at 95% confidence interval (95% CI) in test population (n=470). Conclusions: Food allergy is estimated to be 21% in adolescents and adults with asthma, rhinitis or both. Many food allergens were recorded as per the test.

Background and objective: Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported in patients of all age groups. The present study was aimed to investigate the relative prevalence of food allergy andallergens in patients with bronchial asthma and allergic rhinitis. Methods: Patients of all age groups and both sexes were screened using standard questionnaire and skin prick-test (SPT) with common foods. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy wasestablished. Results: Of 575 patients screened, 120 (21%) gave history of food allergy. Of the history positive patients skin testedall showed a marked positive reaction to food extracts. Egg whole, black gram and lemon elicited marked positive SPT reaction in maximum of 12 (10%) cases each followed by rice, mushroom and corn in 11 cases each (9.1%), milk and cheese 10 cases each (8.3%), paneer and sardine fish 9 cases each (7.5%), maize and tamarind 8 cases each (6.6%), peanut and brinjal 7 cases each (5.8%), garlic and cabbage 4 cases each (3.3%), banana, sago and mutton 3 cases each (2.5%0, pineapple, pork, potato and almond with 2 cases each (1.6%), 1 case of beef, lady finger and drumstick (0.8%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) againstrespective food allergens than normal controls (0.73 IU/mL, mean±2SD). The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%)at 95% confidence interval (95% CI) in test population (n=470). Conclusions: Food allergy is estimated to be 21% in adolescents and adults with asthma, rhinitis or both. Many food allergens were recorded as per the test.

The diagnosis of allergy and determination of the involved allergen is largely based on clinical history. Skin prick assessment and quantitation of specific IgE are supplementary tests in the overall assessment of the patient reporting an allergic reaction. We report a case of a 22 year old female with anaphylaxis characterised by urticaria, angioedema and hypotension post ingestion of a meal including cabbage. She tolerated broccoli, cauliflower, mustard and peach and reported no symptoms with latex exposure. Despite specific IgE to cabbage being negative, a skin prick test to fresh cabbage was positive. A control patient did not react to cabbage. This case is the first documentation of cabbage induced anaphylaxis with negative specific IgE but positive skin test. It highlights the limitation of in-vitro testing in the assessment of a patient with an allergic reaction. Important allergenic proteins may not be included in commercial test kits and a high index of suspicion should prompt further testing.

The diagnosis of allergy and determination of the involved allergen is largely based on clinical history. Skin prick assessment and quantitation of specific IgE are supplementary tests in the overall assessment of the patient reporting an allergic reaction. We report a case of a 22 year old female with anaphylaxis characterised by urticaria, angioedema and hypotension post ingestion of a meal including cabbage. She tolerated broccoli, cauliflower, mustard and peach and reported no symptoms with latex exposure. Despite specific IgE to cabbage being negative, a skin prick test to fresh cabbage was positive. A control patient did not react to cabbage. This case is the first documentation of cabbage induced anaphylaxis with negative specific IgE but positive skin test. It highlights the limitation of in-vitro testing in the assessment of a patient with an allergic reaction. Important allergenic proteins may not be included in commercial test kits and a high index of suspicion should prompt further testing.

Background Genomic data are lacking for many allergen sources. To circumvent this limitation, we implemented a strategy to reveal the repertoire of pollen allergens of a grass with clinical importance in subtropical regions, where an increasing proportion of the world's population resides. Objective We sought to identify and immunologically characterize the allergenic components of the Panicoideae Johnson grass pollen (JGP; Sorghum halepense). Methods The total pollen transcriptome, proteome, and allergome of JGP were documented. Serum IgE reactivities with pollen and purified allergens were assessed in 64 patients with grass pollen allergy from a subtropical region. Results Purified Sor h 1 and Sor h 13 were identified as clinically important allergen components of JGP with serum IgE reactivity in 49 (76%) and 28 (43.8%), respectively, of patients with grass pollen allergy. Within whole JGP, multiple cDNA transcripts and peptide spectra belonging to grass pollen allergen families 1, 2, 4, 7, 11, 12, 13, and 25 were identified. Pollen allergens restricted to subtropical grasses (groups 22-24) were also present within the JGP transcriptome and proteome. Mass spectrometry confirmed the IgE-reactive components of JGP included isoforms of Sor h 1, Sor h 2, Sor h 13, and Sor h 23. Conclusion Our integrated molecular approach revealed qualitative differences between the allergenic components of JGP and temperate grass pollens. Knowledge of these newly identified allergens has the potential to improve specific diagnosis and allergen immunotherapy treatment for patients with grass pollen allergy in subtropical regions and reduce the burden of allergic respiratory disease globally.

Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.

Sensitization profile of food and inhalant allergens in patients from the Instituto de Inmunología Clínica in Mérida State- VenezuelaAbstractAllergic diseases are inflammatory diseases induced by the exposure to the specific allergen. The prevalence of allergic disease has increased worldwide over the last few decades. So far in Mérida Venezuela, no studies have been carried out, in order to identify the most frequent triggering allergens. So a descriptive study was conducted in order to determine the sensitization profile. A cross-sectional study on 635 skin samples was carried out at the Instituto de Inmunología Clínica in Mérida State between January 2006 and December 2013 by using Skin-Prick test with ALK Abello extract, contained 12 inhalant and 12 food allergens. A screening was performed in pediatric patients < 18 years old (35%) and adult patients >=18 (65%). Our work shows that 484 (76,2%) were positive to allergy any allergic diseases, 39% were pediatric patients and 61% were adult patients. Aeroallergens were the most common triggering allergens, and mites such as Der f 80,5 %, Der p 76%, Blo t 71,4%, were the most frequently, followed by cockroaches and dog allergens. The most common triggering food allergens was shrimp was shrimp 14, 2% followed by fish, peanuts, chicken, gliadin and cow’s milk. The prevalence of diagnosis outpatient consultation were urticaria/angioedema 43,9%, rhinitis 40,2%, asthma 23%,1%, atopic dermatitis 20,7%, asthma and rhinitis 15,8% and others 4,8%. No statistically, relationship between diagnosis and allergens, was found. The identification of the sensitization profile in our allergic population allows us collect the allergens to be used in the panel test, the indication of the environment control measures, the diet elimination, and immunotherapy, Las enfermedades alérgicas son patologías inflamatorias producidas por la exposición a alergenos específicos. Su prevalencia ha aumentado en los últimos años, sin embargo en Mérida no existen reportes donde se identifiquen los alérgenos desencadenantes más frecuentes. El objetivo de este estudio fue determinar el perfil de sensibilización en pacientes alérgicos del Instituto de Inmunología Clínica (IDIC) del Estado Mérida-Venezuela entre enero 2006 y diciembre 2013. Se realizó un estudio observacional descriptivo, con datos de pruebas cutáneas realizadas por el método de punción (prick) con panel de extractos ALK Abello, doce alergenos inhalantes y 12 alimentarios. De las 635 pruebas registradas, pertenecían a pacientes de la consulta pediátrica (<18 años) 35% y de adultos (= 18 años) 65%. Resultaron positivas 484 (76,2%), provenientes de la población pediátrica 39% y de adultos 61%. Se determinó una mayor prevalencia de aeroalergenos, siendo los ácaros los más comunes con Der f 80,5%, Der p 76%, Blo t 71,4%, seguidos de cucaracha y perro. El desencadenante alimentario más frecuente fue el camarón 14,2%, seguido de pescados, maní, pollo, gliadina y leche de vaca. En la consulta ambulatoria los diagnósticos fueron urticaria/angioedema 43,9%, rinitis 40,2%, asma 23,1%, dermatitis atópica 20,7%, asma y rinitis 15,8% y otros 4,8%. No se evidenció ninguna relación estadísticamente significativa entre diagnóstico y alérgeno. La identificación del perfil de sensibilización entre la población alérgica nos permite seleccionar los alérgenos a utilizar en el panel de pruebas, indicar medidas de control ambiental, dieta de eliminación e inmunoterapia.

Sensitization profile of food and inhalant allergens in patients from the Instituto de Inmunología Clínica in Mérida State- VenezuelaAbstractAllergic diseases are inflammatory diseases induced by the exposure to the specific allergen. The prevalence of allergic disease has increased worldwide over the last few decades. So far in Mérida Venezuela, no studies have been carried out, in order to identify the most frequent triggering allergens. So a descriptive study was conducted in order to determine the sensitization profile. A cross-sectional study on 635 skin samples was carried out at the Instituto de Inmunología Clínica in Mérida State between January 2006 and December 2013 by using Skin-Prick test with ALK Abello extract, contained 12 inhalant and 12 food allergens. A screening was performed in pediatric patients < 18 years old (35%) and adult patients >=18 (65%). Our work shows that 484 (76,2%) were positive to allergy any allergic diseases, 39% were pediatric patients and 61% were adult patients. Aeroallergens were the most common triggering allergens, and mites such as Der f 80,5 %, Der p 76%, Blo t 71,4%, were the most frequently, followed by cockroaches and dog allergens. The most common triggering food allergens was shrimp was shrimp 14, 2% followed by fish, peanuts, chicken, gliadin and cow’s milk. The prevalence of diagnosis outpatient consultation were urticaria/angioedema 43,9%, rhinitis 40,2%, asthma 23%,1%, atopic dermatitis 20,7%, asthma and rhinitis 15,8% and others 4,8%. No statistically, relationship between diagnosis and allergens, was found. The identification of the sensitization profile in our allergic population allows us collect the allergens to be used in the panel test, the indication of the environment control measures, the diet elimination, and immunotherapy, Las enfermedades alérgicas son patologías inflamatorias producidas por la exposición a alergenos específicos. Su prevalencia ha aumentado en los últimos años, sin embargo en Mérida no existen reportes donde se identifiquen los alérgenos desencadenantes más frecuentes. El objetivo de este estudio fue determinar el perfil de sensibilización en pacientes alérgicos del Instituto de Inmunología Clínica (IDIC) del Estado Mérida-Venezuela entre enero 2006 y diciembre 2013. Se realizó un estudio observacional descriptivo, con datos de pruebas cutáneas realizadas por el método de punción (prick) con panel de extractos ALK Abello, doce alergenos inhalantes y 12 alimentarios. De las 635 pruebas registradas, pertenecían a pacientes de la consulta pediátrica (<18 años) 35% y de adultos (= 18 años) 65%. Resultaron positivas 484 (76,2%), provenientes de la población pediátrica 39% y de adultos 61%. Se determinó una mayor prevalencia de aeroalergenos, siendo los ácaros los más comunes con Der f 80,5%, Der p 76%, Blo t 71,4%, seguidos de cucaracha y perro. El desencadenante alimentario más frecuente fue el camarón 14,2%, seguido de pescados, maní, pollo, gliadina y leche de vaca. En la consulta ambulatoria los diagnósticos fueron urticaria/angioedema 43,9%, rinitis 40,2%, asma 23,1%, dermatitis atópica 20,7%, asma y rinitis 15,8% y otros 4,8%. No se evidenció ninguna relación estadísticamente significativa entre diagnóstico y alérgeno. La identificación del perfil de sensibilización entre la población alérgica nos permite seleccionar los alérgenos a utilizar en el panel de pruebas, indicar medidas de control ambiental, dieta de eliminación e inmunoterapia.

Sensitization profile of food and inhalant allergens in patients from the Instituto de Inmunología Clínica in Mérida State- VenezuelaAbstractAllergic diseases are inflammatory diseases induced by the exposure to the specific allergen. The prevalence of allergic disease has increased worldwide over the last few decades. So far in Mérida Venezuela, no studies have been carried out, in order to identify the most frequent triggering allergens. So a descriptive study was conducted in order to determine the sensitization profile. A cross-sectional study on 635 skin samples was carried out at the Instituto de Inmunología Clínica in Mérida State between January 2006 and December 2013 by using Skin-Prick test with ALK Abello extract, contained 12 inhalant and 12 food allergens. A screening was performed in pediatric patients < 18 years old (35%) and adult patients >=18 (65%). Our work shows that 484 (76,2%) were positive to allergy any allergic diseases, 39% were pediatric patients and 61% were adult patients. Aeroallergens were the most common triggering allergens, and mites such as Der f 80,5 %, Der p 76%, Blo t 71,4%, were the most frequently, followed by cockroaches and dog allergens. The most common triggering food allergens was shrimp was shrimp 14, 2% followed by fish, peanuts, chicken, gliadin and cow’s milk. The prevalence of diagnosis outpatient consultation were urticaria/angioedema 43,9%, rhinitis 40,2%, asthma 23%,1%, atopic dermatitis 20,7%, asthma and rhinitis 15,8% and others 4,8%. No statistically, relationship between diagnosis and allergens, was found. The identification of the sensitization profile in our allergic population allows us collect the allergens to be used in the panel test, the indication of the environment control measures, the diet elimination, and immunotherapy, Las enfermedades alérgicas son patologías inflamatorias producidas por la exposición a alergenos específicos. Su prevalencia ha aumentado en los últimos años, sin embargo en Mérida no existen reportes donde se identifiquen los alérgenos desencadenantes más frecuentes. El objetivo de este estudio fue determinar el perfil de sensibilización en pacientes alérgicos del Instituto de Inmunología Clínica (IDIC) del Estado Mérida-Venezuela entre enero 2006 y diciembre 2013. Se realizó un estudio observacional descriptivo, con datos de pruebas cutáneas realizadas por el método de punción (prick) con panel de extractos ALK Abello, doce alergenos inhalantes y 12 alimentarios. De las 635 pruebas registradas, pertenecían a pacientes de la consulta pediátrica (<18 años) 35% y de adultos (= 18 años) 65%. Resultaron positivas 484 (76,2%), provenientes de la población pediátrica 39% y de adultos 61%. Se determinó una mayor prevalencia de aeroalergenos, siendo los ácaros los más comunes con Der f 80,5%, Der p 76%, Blo t 71,4%, seguidos de cucaracha y perro. El desencadenante alimentario más frecuente fue el camarón 14,2%, seguido de pescados, maní, pollo, gliadina y leche de vaca. En la consulta ambulatoria los diagnósticos fueron urticaria/angioedema 43,9%, rinitis 40,2%, asma 23,1%, dermatitis atópica 20,7%, asma y rinitis 15,8% y otros 4,8%. No se evidenció ninguna relación estadísticamente significativa entre diagnóstico y alérgeno. La identificación del perfil de sensibilización entre la población alérgica nos permite seleccionar los alérgenos a utilizar en el panel de pruebas, indicar medidas de control ambiental, dieta de eliminación e inmunoterapia.

Background. Historically, 10 TU has been employed in Australia and the United Kingdom to perform the tuberculin skin test (TST). However, this makes it difficult to compare the rates of TST positivity with other countries such as the USA who use 5 TU. To assess the impact of the dose of tuberculin on the TST a comparison was made of TST responses in health care workers given a TST with both 5 and 10 TU. Methods. Two TSTs were performed simultaneously in each health care worker using 5 and 10 TU. Each dose was randomly assigned in a blinded manner to the right or left forearm and read at 48-72 hours by a single nurse who was blinded to the assignment of the 5 and 10 TU doses. Results. A total of 128 health care workers were enrolled, 119 (93%) of whom had a past history of BCG vaccination. The overall mean difference in paired reaction sizes for the two doses was 1.5 mm with 95% limits of agreement of -3.6 to 6.5 mm. Conclusion. A slightly larger TST reading was seen with 10 TU than with 5 TU. The mean difference of 1.5 mm between the two doses should be considered when comparing rates of TST positivity between countries who use different doses of tuberculin to perform the tuberculin skin test.

Patients commonly complain about sensitive skin, yet this condition is not fully appreciated or understood by the medical community. While it is broadly associated with discomfort induced by environmental factors, there is no consensus about its definition and classification. By contrast, the cosmetic industry has been well aware of consumers' perceived need for products suitable for sensitive skins and the resulting lucrative market for such products. Host factors identified as risk factors for the sensitive skin syndrome include young age, female gender and atopy. The variability in clinical manifestations and the lack of clarity regarding a definition of sensitive skin makes it hard to establish a single, reliable, diagnostic procedure. Bioengineering tools are a promising way to evaluate this condition; however, no particular method has been established as a gold standard. Similarly, there is no established treatment regime. © 2007 Future Drugs Ltd.

Background. Historically, 10 TU has been employed in Australia and the United Kingdom to perform the tuberculin skin test (TST). However, this makes it difficult to compare the rates of TST positivity with other countries such as the USA who use 5 TU. To assess the impact of the dose of tuberculin on the TST a comparison was made of TST responses in health care workers given a TST with both 5 and 10 TU. Methods. Two TSTs were performed simultaneously in each health care worker using 5 and 10 TU. Each dose was randomly assigned in a blinded manner to the right or left forearm and read at 48-72 hours by a single nurse who was blinded to the assignment of the 5 and 10 TU doses. Results. A total of 128 health care workers were enrolled, 119 (93%) of whom had a past history of BCG vaccination. The overall mean difference in paired reaction sizes for the two doses was 1.5 mm with 95% limits of agreement of -3.6 to 6.5 mm. Conclusion. A slightly larger TST reading was seen with 10 TU than with 5 TU. The mean difference of 1.5 mm between the two doses should be considered when comparing rates of TST positivity between countries who use different doses of tuberculin to perform the tuberculin skin test.

Patients commonly complain about sensitive skin, yet this condition is not fully appreciated or understood by the medical community. While it is broadly associated with discomfort induced by environmental factors, there is no consensus about its definition and classification. By contrast, the cosmetic industry has been well aware of consumers' perceived need for products suitable for sensitive skins and the resulting lucrative market for such products. Host factors identified as risk factors for the sensitive skin syndrome include young age, female gender and atopy. The variability in clinical manifestations and the lack of clarity regarding a definition of sensitive skin makes it hard to establish a single, reliable, diagnostic procedure. Bioengineering tools are a promising way to evaluate this condition; however, no particular method has been established as a gold standard. Similarly, there is no established treatment regime. © 2007 Future Drugs Ltd.

OBJECTIVE. We compared a whole-blood interferon-gamma release assay (QuantiFERON-TB Gold In-Tube test, hereafter "QFT-in tube test") with a tuberculin skin test (TST) to determine which test more accurately identified latent Mycobacterium tuberculosis infection in healthcare staff . METHODS. A total of 481 hospital staff members were recruited from 5 hospitals in Melbourne, Australia. They provided information about demographic variables and tuberculosis (TB) risk factors (ie, birth or travel in a country with a high prevalence of TB, working in an occupation likely to involve contact with M. tuberculosis or individuals with TB, or being a household contact of an individual with a proven case of pulmonary TB). The QFT-in tube test and the TST were administered in accordance with standardized protocols. Concordance between the test results and positive risk factors was analyzed using the kappa statistic, the McNemar test, and logistic regression. RESULTS. A total of 358 participants had both a TST result and a QFT-in tube test result available for comparison. There were fewer positive QFT-in tube test results than positive TST results (6.7% vs. 33.0%; P < .001). Agreement between the tests was poor (71%; kappa = 0.16). A positive QFT-in tube test result was associated with birth in a country with a high prevalence of TB, the number of years an individual had lived in a country with a high prevalence of TB (ie, the effect of each additional year, treated as a continuous variable), and high-risk occupational contact. A positive TST result was associated with older age, receipt of bacille Calmette-Guerin (BCG) vaccination, and working in an occupation that involved patient contact. Receipt of BCG vaccination was most strongly associated with discordant results in instances in which the TST result was positive and the QFT-in tube test result was negative. CONCLUSION. In a population of healthcare staff with a low prevalence of TB and a significant rate of BCG vaccination

Test-and-slaughter strategies have been the basis of bovine tuberculosis (BT) eradication programs worldwide; however, eradication efforts have not succeeded in certain regions, and imperfect sensitivity and specificity of applied diagnostic techniques have been deemed as one of the possible causes for such failure. Evaluation of tuberculosis diagnostic tools has been impaired by the lack of an adequate gold standard to define positive and negative individuals. Here, a Bayesian approach was formulated to estimate for the first time sensitivity (Se) and specificity (Sp) of the tests [single intradermal tuberculin (SIT) test, and interferon-gamma (IFN-γ) assay] currently used in Spain. Field data from the first implementation of IFN-γ assay (used in parallel with SIT test 2-6. months after a first disclosure SIT test) in infected beef, dairy and bullfighting cattle herds from the region of Castilla and Leon were used for the analysis. Model results suggested that in the described situation: (i) Se of SIT test was highly variable (40.1-92.2% for severe interpretation, median = 66-69%), and its Sp was high (>99%) regardless interpretation criteria; (ii) IFN-γ assay showed a high Se (median = 89-90% and 83.5% for 0.05 and 0.1 cut-off points respectively) and an acceptable Sp (85.7% and 90.3% for 0.05 and 0.1 thresholds) and (iii) parallel application of both tests maximized the combined Se (95.6% using severe SIT and 0.05 cut-off point in the IFN-γ assay). These results support the potential use of the IFN-γ assay as an ancillary technique for routine BT diagnosis.

In spite of great efforts for its control and eradication, tuberculosis remains one of the most important zoonosis worldwide. Its causative agents, the members of the Mycobacterium tuberculosis complex, have a wide host range that complicates the epidemiology of this disease. Among susceptible species to these pathogens, camelids from the New World (llama, alpaca and vicuña) and Old World (Bactrian camel and dromedary) are acquiring an increasing importance in several European countries because of its growing number and could act as reservoirs of the disease for livestock and humans in their natural habitat. In addition, tuberculosis caused by a number of M. tuberculosis complex members is a life-threatening disease in these animal species. Although tuberculosis has been known to affect camelids for a long time, ante-mortem diagnosis is still challenging because of the lack of standardized diagnostic techniques and the limited sensitivity and specificity of the most widely applied tests. However, in recent years, several techniques that can at least partially overcome these limitations have been developed. This paper reviews the results and advances achieved in tuberculosis diagnosis in camelids in the last decade as well as the progresses on ongoing investigations, with special attention to the remaining challenges that still have to be faced to assure the availability of reliable tools for the detection of tuberculosis-infected animals and herds.

The present study aimed to monitor skin test practices as performed by veterinarian field practitioners in Belgium. For this purpose, an anonymous postal questionnaire was elaborated and dispatched to veterinarians involved in bovine tuberculosis detection. The questionnaire included items focusing on the skin test performance. International experts in the field of bovine tuberculosis were asked to fill the questionnaire and a scoring scale was built as follows: 0 = 'ideal' answer, 1 = acceptable answer, whereas 2 = unacceptable answer. Furthermore, experts were asked to rank the questionnaire's items according to their possible impact on the risk of not detecting reactors. A global score was further calculated for each participant and a comparison of practices was carried out between the two regions of the country, i.e. Wallonia and Flanders. Significant differences were observed between both regions, a harmonization at the country level is thus essential. No veterinarian summed a null score, corresponding to the ideal skin test procedure, which suggests that skin-testing is far from being performed correctly. Field practitioners need to be sensitized to the importance of correctly performing the test. The authors recommend the questionnaire is suitable for application in other countries or regions., Evaluation Studies, Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

The gold standard for the diagnosis of peanut allergy is the oral peanut food challenge (OPFC). However, OPFCs may cause anaphylaxis and could be negatively perceived by patients. Therefore peanut skin prick testing (SPT), serum peanut specific-IgE level or immediate-skin-application-food-testing (I-SAFT) are adjuvants in the diagnosis of peanut allergy. Cut-offs of tests that are predictive of peanut allergy have been proposed but are not thought to predict reaction severity. The relevance of a skin contact reaction with peanut in a peanut sensitised child is unclear. We prospectively determined the validity of reported diagnostic cutoff levels of peanut allergen skin tests and specific-IgE, and the usefulness of combining these. Eighty-four peanut sensitised children were included. Fifty-two of 85 OPFC were positive. SPT specificity was 67% at  8 mm and 100% at  15 mm. Combinations of a SPT of  8 mm with a positive I-SAFT and a peanut specific-IgE  0.37 kU/L were 88% specific and 38% sensitive. Thus combining available allergy tests does not improve their clinical usefulness. Previously described diagnostic cutoff levels do not have general applicability. Next we determined the frequency and significance of contact sensitivity to peanut in peanut sensitised children. I-SAFTs were performed with one gram of peanut butter in 281 peanut sensitised children and 41% were positive. No systemic reactions occurred following topical application of peanut butter. I-SAFT sensitivity and specificity was 50% and 82% respectively. Systemic reactions following peanut butter skin contact appear unlikely.The third study determined the usefulness of allergy tests for predicting the risk of anaphylaxis on challenge. Peanut sensitised children who completed open-label OPFCs were included. The challenge protocol provided for challenges to be continued beyond initial mild reactions. There were 34 in the control group and 21 who developed anaphylaxis. The

The administration of molecules per transdermic way offers many advantages: ousting of an effect of first-pass metabolism in the liver and constant release of various active ingredients ensuring consequently perfectly stable plasmatic concentrations. Nevertheless, cutaneous reactions, in particular allergic, can compromise the use of these transdermal therapeutic systems. We report the case of a patient having presented an allergic contact dermatitis, with secondary generalization, from transdermal buprenorphine (Transtec®). An assessment with patch tests was made and it confirmed hypersensitivity to buprenorphine itself and excluded any reaction to the adhesives or excipients. The transdermal systems of buprenorphine can be responsible for localised but also generalized allergic contact reactions, testifying the systemic absorption of the molecule. © Nouv Dermatol 2010.

This study aimed to maximize the sensitivity of bovine tuberculosis detection in living wild fallow deer (Dama dama) under field conditions. We evaluated the rapid test (RT; CervidTB STAT-PAK Assay, Chembio Diagnostic Systems, Inc., USA) in comparison with the comparative cervical skin test (CCT). A total of 134 fallow deer were captured between January and March 2008. At time 0, 0.1 ml of avian purified protein derivative (avian PPD; Cooper-Zeltia, Spain), 0.1 ml bovine PPD (Cooper-Zeltia, Spain), 0.1 ml negative control PBS and 0.1 ml of a positive control (the mitogen phytohaemagglutinin, PHA; containing 250 mg PHA, diluted in PBS) were injected intradermally at four shaved sites in the neck. The skin fold thickness at each injection site was measured at time 0 and 72 h (3 repeats each time). Animals with a skin test response of 2 mm or more at the bovine PPD injection site and animals with any visible reactivity in the RT were necropsied and tissues submitted for culture and for histopathology. A total of 36 fallow deer were considered reactors to bovine PPD or to the RT (apparent prevalence 27%). Regarding both bovine PPD reactivity and the skin fold increase at the PHA injection site, we found significant effects of age and sex by age interaction. Adult males had the largest responses. Mycobacterium bovis was isolated from lymphoid tissues of 21 fallow deer. Skin test sensitivity, as compared to M. bovis culture confirmed deer, was 80.1% (17/21). But, the CCT alone would have missed 4 of 21 culture confirmed animals. RT sensitivity, based on culture confirmed deer, was also 80.1% (17/21). Similarly, the RT alone would have missed another 4 of 21 culture confirmed deer. However, combining the CCT and the RT allowed for detecting all 21 culture positive fallow deer. We conclude that the combined application of the RT and the skin testing can maximize the sensitivity of bTB detection in living fallow deer, thus facilitating control programs for wildlife disease s

Eurasian wild boar (Sus scrofa) are able to maintain bovine tuberculosis (bTB) in the wild and are most probably able to transmit the disease to other species, thus acting as a true wildlife reservoir. Translocation of wild boar is a common practice in European countries. Therefore, identifying effective tools for bTB diagnosis in living wild boar is crucial for the implementation of control measures. We describe for the first time the sex and origin related differences in the skin-test response to mycobacterial antigens (bPPD and aPPD) and to a non-mycobacterial antigen (PHA, a plant derived mitogen) in wild and farmed wild boar, and used a small sample of known M. bovis infected wild boar to establish whether skin-testing is an option for bTB diagnosis in living wild boar. The highest skinfold increase response was detected at the PHA injection site, evidencing that the PHA test could be useful in monitoring cell mediated immunity (CMI) in wild boar populations. A clear ageincreasing trend of the PHA response indicated that age should be taken into account when measuring CMI in wild boar. Origin related differences in the response against mycobacterial antigens could reflect differential exposure to mycobacterial antigens. Skin testing in BCG immunized wild boar showed low sensitivity (43-57%), while the sensitivity was good in the culture positive controls (75-100%), depending on the reading criterion. Specificity improved when the criterion was a response to bPPD larger than 2mm and bPPD response larger than aPPD response (77%). Although a limited sample, our results indicated the potential of skin test as a bTB diagnostic tool in Eurasian wild boar. However, handling of wild boar is dangerous, specificity is low, and more effort is needed in order to define the sensitivity of this technique.

The present work was carried out in a sheep farm of la Sabana de Bogotá, where the purpose of this research was to make a paratuberculosis study in that flock aiming to diagnose by three diagnostic techniques the Mycobacterium avium subsp. paratuberculosis presence. It was used 250 ovine females of San Jorge Experimental Farm – ICA, where a pheces sample were taken from each animal and by Zielh Neelsen’s stain it was stablished the presence of acid fast bacilli. Then, it was made the tuberculinization process (PPD AVIAR® SAGAR B – 0653-034) to the entire population of female sheep and finally, it was carried out a serology test (ELISA Pourquier®). From the stool sample, only 10 was positive where 4 of them were questionable. In the skin test it was found that 16 animals were positive due to a reaction ≥ to 5 mm, however, 3 of them were suspicious due to meterings < to 5 mm. In the ELISA test only 2 animals were positive. In adition, it was followed up a case of an animal that resulted positive to all techniques, also to histophatology and necropsy, confirming the presence of the disease. The findings suggest the need of several tests for a successful diagnose of paratuberculosis with the purpose of set the status and distribution of the disease in the flock., El presente trabajo se llevó a cabo en una granja de ovinos de la Sabana de Bogotá, donde la finalidad de la investigación fue realizar un estudio de la paratuberculosis en dicho rebaño, con el fin de diagnosticar mediante tres técnicas diagnósticas la presencia del Mycobacterium avium subsp. paratuberculosis. Para esto se emplearon 250 hembras ovinas pertenecientes a la Granja Experimental ICA-San Jorge, donde se tomó a cada animal una muestra de materia fecal, y mediante la coloración de Zielh Neelsen se determinó la presencia de bacilos ácido-alcohol resistentes. A continuación, se procedió a aplicar la prueba de intradermorreacción o tuberculinización (PPD Aviar® Sagar B-0653-034) a todas las ovejas y, por último, se realizó una prueba de serología (Elisa Pourquier®). De las muestras de materia fecal, solo diez resultaron positivas, de las cuales, cuatro fueron de carácter dudoso. En la tuberculinización se encontró que dieciséis animales resultaron positivos, debido a que presentaron una reacción ≥ 5 mm, pero tres de ellos fueron sospechosos, ya que en la medición arrojaron valores < 5 mm. En la prueba de Elisa se encontró que dos animales reaccionaron positivamente. Adicionalmente, se realizó un seguimiento de caso a uno de los animales objeto de estudio, que resultó positivo a las pruebas realizadas, a partir del cual, además, por medio de histopatología y necropsia, se logró confirmar la presencia de la enfermedad. Los hallazgos sugieren que para realizar un diagnóstico exitoso de la paratuberculosis, es necesaria la combinación de dos o más técnicas con el fin de determinar la distribución y el estado de la enfermedad en el rebaño.

The present work was carried out in a sheep farm of la Sabana de Bogotá, where the purpose of this research was to make a paratuberculosis study in that flock aiming to diagnose by three diagnostic techniques the Mycobacterium avium subsp. paratuberculosis presence. It was used 250 ovine females of San Jorge Experimental Farm – ICA, where a pheces sample were taken from each animal and by Zielh Neelsen’s stain it was stablished the presence of acid fast bacilli. Then, it was made the tuberculinization process (PPD AVIAR® SAGAR B – 0653-034) to the entire population of female sheep and finally, it was carried out a serology test (ELISA Pourquier®). From the stool sample, only 10 was positive where 4 of them were questionable. In the skin test it was found that 16 animals were positive due to a reaction ≥ to 5 mm, however, 3 of them were suspicious due to meterings < to 5 mm. In the ELISA test only 2 animals were positive. In adition, it was followed up a case of an animal that resulted positive to all techniques, also to histophatology and necropsy, confirming the presence of the disease. The findings suggest the need of several tests for a successful diagnose of paratuberculosis with the purpose of set the status and distribution of the disease in the flock., El presente trabajo se llevó a cabo en una granja de ovinos de la Sabana de Bogotá, donde la finalidad de la investigación fue realizar un estudio de la paratuberculosis en dicho rebaño, con el fin de diagnosticar mediante tres técnicas diagnósticas la presencia del Mycobacterium avium subsp. paratuberculosis. Para esto se emplearon 250 hembras ovinas pertenecientes a la Granja Experimental ICA-San Jorge, donde se tomó a cada animal una muestra de materia fecal, y mediante la coloración de Zielh Neelsen se determinó la presencia de bacilos ácido-alcohol resistentes. A continuación, se procedió a aplicar la prueba de intradermorreacción o tuberculinización (PPD Aviar® Sagar B-0653-034) a todas las ovejas y, por último, se realizó una prueba de serología (Elisa Pourquier®). De las muestras de materia fecal, solo diez resultaron positivas, de las cuales, cuatro fueron de carácter dudoso. En la tuberculinización se encontró que dieciséis animales resultaron positivos, debido a que presentaron una reacción ≥ 5 mm, pero tres de ellos fueron sospechosos, ya que en la medición arrojaron valores < 5 mm. En la prueba de Elisa se encontró que dos animales reaccionaron positivamente. Adicionalmente, se realizó un seguimiento de caso a uno de los animales objeto de estudio, que resultó positivo a las pruebas realizadas, a partir del cual, además, por medio de histopatología y necropsia, se logró confirmar la presencia de la enfermedad. Los hallazgos sugieren que para realizar un diagnóstico exitoso de la paratuberculosis, es necesaria la combinación de dos o más técnicas con el fin de determinar la distribución y el estado de la enfermedad en el rebaño.

Background: Reports of lupine allergy are increasing as its use in food products increases. Lupine allergy might be the consequence of cross-reactivity after sensitization to peanut or other legumes or de novo sensitization. Lupine allergens have not been completely characterized. Objectives: We sought to identify allergens associated with lupine allergy, evaluate potential cross-reactivity with peanut, and determine eliciting doses (EDs) for lupine allergy by using double-blind, placebo-controlled food challenges. Methods: Six patients with a history of allergic reactions to lupine flour were evaluated by using skin prick tests, CAP tests, and double-blind, placebo-controlled food challenges. Three of these patients were also allergic to peanut. Lupine allergens were characterized by means of IgE immunoblotting and peptide sequencing. Results: In all 6 patients the ED for lupine flour was 3 mg or less for subjective symptoms and 300 mg or more for objective symptoms. The low ED and moderate-to-severe historical symptoms indicate significant allergenicity of lupine flour. Two patients allergic to lupine but not to peanut displayed IgE binding predominantly to approximately 66-kd proteins and weak binding to 14- and 24-kd proteins, whereas patients with peanut allergy and lupine allergy showed weak binding to lupine proteins of about 14 to 21 or 66 kd. Inhibition of binding was primarily species specific. Conclusion: Lupine allergy can occur either separately or together with peanut allergy, as demonstrated by 3 patients who are cosensitized to peanut and lupine. Clinical implications: Lupine flour is allergenic and potentially cross-reactive with peanut allergen, thus posing some risk if used as a replacement for soy flour. © 2007 American Academy of Allergy, Asthma & Immunology.