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Background Large local reaction to Hymenoptera stings is usually defined as a swelling >10 cm which lasts longer than 24 hours, sometimes associated with erythema, pruritus and blisters. Currently, the risk of subsequent systemic reactions after re-stings is considered low (2%-15%). Therefore, a diagnostic workup in case of large local reaction is often judged unnecessary, as well as adrenaline auto-injector and venom immunotherapy prescription. The aim of this study was to prospectively evaluate the outcome of re-stings in a real-world setting, in patients with a history of one previous large local reaction. Methods We consecutively enrolled patients who experienced their first large local reaction (as per EAACI definition), treated with antihistamine and steroids. They were followed for field re-stings and assessed for risk of subsequent systemic reactions. Results We enrolled 662 patients. Out of the 225 re-stung subjects, 24% did not experience reactions, 52% reported a second large local reaction and 24% had systemic reactions. The risk of subsequent systemic reactions was higher in case of skin test reactivity to Apis mellifera or Vespula species (OR 2.1 and 3.8, respectively), in particular if positive at 0.001 µg/mL concentration (OR 13.4 and 16.5, respectively). Conclusions Systemic reactions, after a previous large local reaction, occur more frequently than that reported by literature. After analysing the predictive role of large local reactions for systemic reactions, we demonstrated that an accurate diagnostic workup may be considered, particularly skin tests. Further studies in different countries are needed to confirm these results and large local reaction management.

AIM Early diagnosis of tuberculosis infection can significantly contribute to the control of the disease. The aim of the present study was to describe the tuberculin skin test (TST) trends over a 24-year period (1990-2013) and explore the value of universal tuberculosis screening in a low-burden area. METHODS All first graders that underwent TST during the 24-year study period (1990-2013) on the island of Crete, Greece, were retrospectively included in the study. RESULTS A total of 82 402 children (92.3% of Greek nationality; 51.0% male) underwent TST, of whom 335 (0.41%, 95% CI 0.37-0.46) were found to have positive TST while 0.27% of the study population had a TST between 5 and 9 mm. The tuberculin index declined significantly between 1990-1994 and 2010-2013 (0.67 vs 0.26; RR 2.73, 95% CI 1.82-4.09; p

Background Currently, tuberculin skin test (TST) and interferon gamma release assay (IGRA) are used to find the latent tuberculosis infection (LTBI) cases in the candidates of heart transplantation. Therefore, this study aimed to compare TST and IGRA to diagnose LTBI in pediatric heart transplant candidates. Methods This cross-sectional study was performed on 50 children, who were candidates for heart transplantation, of whom 42 cases underwent heart transplantation in Shahid Rajaie Cardiovascular, Medical, and Research center, Tehran, Iran, from 2016 to 2017. Results Participants of the study included 24 male patients (%48) (p-value = 0.67). The mean age of the patients was 8.18 ± 4.27 years (1-16 years). According to the results, IGRA was negative in all patients, and no indeterminate result was reported, while the purified derivative test (PPD) was positive in three (6%) cases. In comparison with QFT, an accuracy of 94% was achieved for TST to diagnose Mycobacterium tuberculosis infection. Conclusions It seems that TST can still be used as an accurate test for screening LTBI in pediatric candidates for heart transplantation.

AIM The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children. METHODS This was a retrospective analysis of all refugee children (

Latent tuberculosis (TB) infection is routinely diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST such as QuantiFERON TB Gold In-Tube (QFT-GIT) have been developed but evidence remains limited on their acceptability among migrant farmworkers. This article examined the acceptability of screening tests among migrant farmworkers working on the Arizona-Mexico border. We conducted a cross-sectional survey of migrant farmworkers via questionnaire. Of 83 participants interviewed, 53 (63.9%) believed that TB was a serious disease that could result in death and 59 (71.1%) considered TB a health concern in their community. Sixty-four participants (77.1%) rated QFT-GIT test as performing better than TST. Our study demonstrates preference for QFT-GIT results over TST, and highlights migrant farmworkers’ considering themselves at risk of TB and TB as a health concern. Policies that create easy access and culturally appropriate, affordable healthcare for this vulnerable population should be encouraged.

Introduction Field studies for allergic rhinitis (AR) commonly have inconsistent allergen concentrations and subject exposure patterns due to varying environmental conditions and subject behaviors. A technical and clinical validation study was conducted for the Allergen BioCube® using timothy grass to confirm uniform allergen concentration and clinically relevant subject symptom responses. Methods Allergen concentrations were verified by laser particle counts. Subjects (N = 14) with positive skin test reactions and no symptoms at screening received four 3-h timothy grass exposures in the BioCube over consecutive days. Subjects evaluated nasal itching, sneezing, rhinorrhea, and nasal congestion while in the BioCube; Total Nasal Symptom Score (TNSS) was computed. Peak Nasal Inspiratory Flow (PNIF), Peak Expiratory Flow Rate (PEFR), sIgE blood tests, and Nasal Inflammation Score (NIS) were assessed. A correlation analysis was conducted for mean sIgE, skin test, and TNSS. Results Uniform timothy grass concentrations were achieved in the BioCube, both spatially and temporally, at all subject positions. Mean TNSS increased substantially from pre-exposure levels (0.36 ± 0.74 to 1.86 ± 2.14) to maximums of 7.07 ± 2.76 at 1.5 h and 6.71 ± 2.70 at 3 h BioCube exposure. Twelve (86%) subjects had TNSS increases ≥6 units. PNIF decreased 12–24% from baseline at 3-h BioCube exposure. NIS increased (baseline = 0) to 3.7 (maximum score = 4). A low/moderate correlation (r = 0.485) occurred between mean sIgE blood levels and mean skin tests; neither sIgE or skin tests correlated with mean TNSS. However, subjects with high skin test scores or positive blood IgE tended to also have higher TNSS. Conclusions The Allergen BioCube achieved technical and clinical validation for uniform timothy grass concentration and clinically meaningful AR sign and symptom responses. The Allergen BioCube can be used to assess the efficacy of therapies for reduction of AR signs and symptoms resulting from grass exposure.

Reactivation of latent tuberculosis following solid organ transplantation has serious consequences for the recipient. The most useful diagnostic test for latent TB is not clear. We conducted a systematic review and meta-analysis to assess the relative test performance of interferon gamma release assays (IGRAs) and the tuberculin skin test (TST) in people undergoing solid organ transplantation. The clinical or radiological risk factors were used as the proxy reference standard. Test performance was expressed as an odd ratio (OR). We identified 24 studies (N = 7811), 12 studies compared IGRAs with TST directly, nine studies evaluated only TST and three studies only IGRAs. Direct comparison between tests and clinical risk factors indicated both tests were strongly associated with the presence of clinical risk factors for TB (TST: OR 3.17; 95%CI 1.55-6.48, IGRA: OR 2.78; 95%CI 1.55-5.01), and radiological evidence of past TB (TST: OR 3.26; 95%CI 1.85-5.73, IGRA: OR 3.85; 95%CI 2.16-6.86). Relative comparison indicated IGRAs positivity was more strongly associated with presence of radiological evidence of TB than TST (relative OR: 3.24; 95%CI 1.10-9.56). While there is no strong evidence in supporting use of IGRAs over TST for diagnosing latent TB, IGRAs positivity is more associated with the presence of radiological evidence of previous TB.

Background Tuberculosis (TB) is an important worldwide ongoing health issue. To be able to control TB, one should not only cure active TB but also identify childhood TB patients who have the possibility to develop active disease in the future. The aim of this study was to compare a century-old tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test, developed as an alternative to TST and which has been claimed to be superior to TST in several ways, in the diagnosis of childhood TB. Methods Fifty-three children with TB between 5 months and 17.5 years of age and 92 healthy children from the same age group with no risk factors for TB were recruited into the study. All children underwent TST and QFT-GIT test and their demographic, clinic and laboratory data were recorded. Data were analyzed using SPSS 14. Results A total of 53 patients were diagnosed with TB. Mean patient age was 8.5 ± 4.3 years (range, 5 months–17.5 years). A total of 41.7% of the patients were female. Sixteen of 53 patients had confirmation on culture. QFT-GIT test was positive in 16 and TST was positive in 15 among 16 children with culture-confirmed TB. The sensitivity of TST and QFT-GIT were 93.8% and 100.0%, and the specificity of TST and QFT-GIT were 100.0% and 97.8%, respectively. With regard to the 53 TB children including those without bacteriological confirmation, QFT-GIT was positive in 33 children, and TST was positive in 44 children. The sensitivity of TST and QFT-GIT was then 83.0% and 62.3%, and the specificity, 100.0% and 97.8%, respectively. Conclusion Although positive QFT-GIT test is very significant for TB, negative results will not exclude TB infection. TST and QFT-GIT used together may provide more efficient results.

SummaryIntroduction The Danish Anaesthesia Allergy Centre (DAAC) investigated 89 adult patients with suspected perioperative cefuroxime-associated hypersensitivity reactions between 2004 and 2013. The goals were to determine whether the time to index reaction after cefuroxime exposure could be used to implicate cefuroxime as the cause of the reactions and explore different test modalities in diagnosing cefuroxime hypersensitivity. Method Skin tests, in vitro tests, and titrated provocations were used to determine cefuroxime hypersensitivity. Patients were deemed cefuroxime positive on the basis of at least two positive tests and/or a positive provocation. Results One or more tests were positive for cefuroxime in 24 of 89 (27.0%) patients. One was only specific IgE positive and was deemed cefuroxime negative. Twenty-three (25.8%) were deemed cefuroxime positive. There were four specific IgE-, 4 histamine release test-, 13 skin test-, and 14 provocation positive patients. There were eight (34.8%) patients who were only provocation positive. Data on time to index reaction after cefuroxime exposure were available for 80 patients (22 in the positive group and 58 in the negative group), 22 of 22 (100%) of positive patients reacted in

Aim The study was carried out on elderly nursing home residents in Taiwan. We assessed whether the serial QuantiFERON-TB Gold (QFT-G) assay and serial tuberculin skin test (TST) were reliable tools to predict or exclude the development of active tuberculosis (TB). Methods This prospective observational cohort study involved non-bacillus Calmette–Guerin-vaccinated 259 elderly nursing home residents free of active TB at baseline. Of these, 147 were eligible for follow up. Participants underwent serial QFT-G and TST at baseline and 2-year follow up, and were monitored for active TB over 5 years. Agreement between QFT-G and TST, incidence rate ratio, positive predictive value, and negative predictive value for progression to active TB were measured. Results During 5-year follow up, three participants developed active TB. The agreement between these two tests was 54.13% (ĸ = 0.167, P = 0.001). The incidence rate ratio was 15.8 (P = 0.016) for the QFT-G-conversion group compared with the TST-positive group at baseline. Positive predictive value for QFT-G conversion groups was 25%. Negative predictive value was 100% for the TST-negative group at baseline. Conclusion In the elderly nursing home residents, QFT-G conversion is a more reliable tool to predict the development of active TB. Meanwhile, TST is a valuable tool for predicting the chance of not developing active TB. Geriatr Gerontol Int 2015; 15: 1179–1184.

Aim The aim of this study was to evaluate the occurrence of active tuberculosis (TB) in patients who received both an interferon-gamma release assay (the QuantiFERON-TB Gold In-Tube test [QFT-GIT]) and tuberculin skin test (TST) in comparison with those who received QFT-GIT or TST alone for the detection of latent TB infection (LTBI). Methods In total, 842 patients who received QFT-GIT or TST and used biologic agents between January 2007 and December 2012 were recruited to determine the usefulness of LTBI screening tests. The incidence of active TB was calculated relative to the LTBI screening method as the number of events per 100 000 person-years exposure. Results TB occurred in two of the patients who complied with an LTBI prophylaxis strategy. The TB incidence in the group that received both QFT-GIT and TST was 151.05 (95% confidence interval [CI] 150.11–151.98)/100 000 person-years, and the incidence was 169.78 (95% CI 168.73–170.84)/100 000 person-years in the group that received only TST. Conclusion TB occurred even in some patients who received LTBI prophylaxis in compliance with national guidelines. The incidence of TB in patients who received either the QFT-GIT plus TST prophylaxis strategy or the TST prophylaxis strategy alone was higher than the annual incidence of the general population of the Republic of Korea. It is not possible to conclude which of the LTBI prophylaxis strategies is superior.

Summary Background Omeprazole is a proton pump inhibitor for the treatment of gastric acid-related disorders. In recent years, reports of dermatitis upon exposure to omeprazole during manufacture have been noted. Objective To present diagnostic findings in workers who reported suspected hypersensitivity reactions resulting from occupational exposure to omeprazole. Methods Ninety-six workers exposed to omeprazole during the manufacturing process underwent investigation by the AstraZeneca Occupational Health Centre (Sodertalje, Sweden) for suspected allergy. All subjects underwent a lymphocyte transformation test (LTT) and a skin test within 6 months of the clinical reaction. Predictive tests on guinea-pigs were conducted to establish omeprazole's sensitizing potential. Results Thirty-one subjects with clinical symptoms had a positive LTT result. Twenty-eight subjects had positive patch test results; of these, 23 also had a positive LTT result (sensitivity of the LTT: 82%). Fifty-six subjects had negative patch test results; 46 of these had a negative LTT result (specificity: 82%). All subjects who underwent prick testing (n = 18) had negative results. Delayed contact hypersensitivity was observed in 18 of 20 test animals. Conclusions These findings confirm the risk of sensitization to omeprazole from occupational exposure. They are of importance for the development of new formulations of omeprazole, or its enantiomers, in light of the potential for inducing skin allergy.

There are studies demonstrating that skin-test sensitivity to penicillins can decrease over time and that allergic patients may lose sensitivity if the responsible compounds are avoided. With regard to subjects with IgE-mediated hypersensitivity to cephalosporins, however, such studies are lacking. We evaluated prospectively in a 5-year follow-up 72 cephalosporin-allergic patients. After the first evaluation, patients were classified into two groups according to their patterns of allergologic-test positivity: to both penicillins and cephalosporins (group A), or only to cephalosporins (group B). Skin tests and serum-specific IgE assays were repeated 1 year later and, in case of persistent positivity, 3 and 5 years after the first allergologic examination. Seven (43.7%) of the 16 subjects of group A and 38 (67.8%) of the 56 patients of group B became negative; one was lost to follow-up. Patients of group B became negative sooner and more frequently than group A subjects.

We read the recent news article on undetected bovine TB with some surprise ( VR , 26 October 2019, vol 185, p 492). While we know that the skin test can miss some infected animals, the simple extrapolations conducted by the Animal Welfare Group (AWG) to estimate the ‘reservoir’ of undisclosed cattle infection are flawed for several reasons. First, the much higher proportion of false positive results that the interferon gamma (IFN-γ) blood test generates (approximately one in 30)1 relative to the comparative tuberculin …

You could be forgiven for thinking that little changes in the management of bovine TB (bTB). At last week’s British Cattle Veterinary Association (BCVA) conference, an experienced cattle vet told a panel discussion on tackling bTB that he was reminded of a similar discussion he’d had 12 years previously. ‘I’ve got a strong case of deja vu,’ he said. ‘It’s so frustrating.’ There is much to support the view that the whole set-up feels more than a little jaded. The standard skin test – the primary screening test for TB in cattle – is old. Vets have been using it since 1948. The rules around using it are old. The feeling that the government isn’t making life easy for vets working to manage the disease is a perpetual gripe. And even the electronic reporting mechanism for test results is unreliable – one vet complained that it …

Background Despite ongoing eradication efforts, bovine tuberculosis (bTB) is endemic in cattle herds in Northern Ireland (NI). This disease has serious implications for the economy, farming and animal welfare. Previous research identified a population of herds which have remained free from bTB infection for 10 years (2004–2014). Understanding the characteristics of these herds may have important implications for eradication efforts, such as spatially targeted interventions. Methods A cluster analysis and a retrospective case–control analysis was conducted to compare bTB- free herds with herds which experienced prolonged infection (ie, bTB breakdowns lasting more than ≥ 365 days). Results Only small, localised clusters of herds which have remained free from bTB were revealed, thus limiting the potential for spatially targeted interventions. The results illustrated the importance of herd size to disease status; over 27 per cent of the bTB-free herds had up to 10 animals. However, the data also showed that there were no inward movements in the year before the bTB skin test in those herds which remained free from bTB. Conclusions Attention should therefore be given to the cattle movement network in NI to better understand the risk associated with cattle purchasing.

Objective To determine if low-risk elderly patients with rheumatoid arthritis (RA) who screen positive for latent tuberculosis (TB) infection prior to anti–tumor necrosis factor (anti-TNF) therapy should be given isoniazid (INH). Methods A Markov model was developed. The base case was a patient age 65 years with RA starting anti-TNF therapy with a positive tuberculin skin test (TST) finding of 5–9 mm, who was born in a country with low TB prevalence and had no other TB risk factors. The decision was 9 months of INH or not. The primary outcome was quality-adjusted life expectancy. Multiple sensitivity analyses were performed. Results No prophylaxis was favored, with a gain of 1.1 quality-adjusted life days, but the decision was sensitive to several variables. Prophylaxis was favored for patients ages 2.5, if the RR with anti-TNF therapy was >5.8, or if the utility associated with INH therapy was >0.98. Prophylaxis was also preferred for patients with a TST result >10 mm and for patients from higher risk countries. If 6 months of INH or 4 months of rifampin were used, prophylaxis was preferred, providing that therapy reduced the risk of TB reactivation by >47% and >27%, respectively. Conclusion Withholding prophylaxis prior to anti-TNF therapy may be reasonable for low-risk elderly RA patients with a TST finding of 5–9 mm, although the decision is sensitive to patient preferences. For patients age 10 mm, prophylaxis is preferred.

Background Although food allergy is an important health problem in Western countries, the prevalence varies among geographic regions. There is limited data on the prevalence of food allergy especially for adolescent age group, and the data from Turkey and Mediterranean region are even scarce. Methods The study is a cross-sectional survey including a questionnaire followed by phone survey with families that have reported food allergy and clinical evaluation of children having a history compatible with food allergy after phone survey. The sample number of students has been calculated 9096 of a total of 210.000 students at the second stage (6th, 7th, and 8th grades) of state elementary schools in the metropolitan counties of Ankara province with the assumption of food allergy prevalence (P) = 1% and a δ value = 0.2 (α

In clinical practice, latent infection with Mycobacterium tuberculosis is defined by the presence of an M. tuberculosis-specific immune response in the absence of active tuberculosis. Targeted testing of individuals from risk groups with the tuberculin skin test or an interferon-γ release assay is currently the best method to identify those with the highest risk for progression to tuberculosis. Positive predictive values of the immunodiagnostic tests are substantially influenced by the type of test, the age of the person who is tested, the prevalence of tuberculosis in the society and the risk group to which the person belongs. As a general rule, testing should only be offered when preventive chemotherapy will be accepted in the case of a positive test result. Preventive chemotherapy can effectively protect individuals at risk from the development of tuberculosis, although at least 3 months of combination therapy or up to 9 months of monotherapy are required, and overall acceptance rate is low. Improvements of the current generation of immunodiagnostic tests could substantially lower the number of individuals that need to be treated to prevent a case of tuberculosis. If shorter treatment regimens were equally effective than those currently recommended, acceptance of preventive chemotherapy could be much improved.

Objective The tuberculin skin test (TST) is an important tool in the diagnosis of tuberculosis infection in children. However, the interpretation of TST may be complicated by prior Bacillus Calmette-Guerin (BCG) vaccination. We evaluated the effect of vaccination with BCG on TST reactivity in first-year pupils attending state schools in Antananarivo. Methods STs were performed on 376 first-year schoolchildren, aged 6 and 7, attending two state primary schools. The relationships between epidemiological information, BCG status (vaccination, BCG scars) and TST reactivity were assessed to compare TST sensitivity between children with and without BCG vaccination and between those with and without a BCG scar. Result The prevalence of positive TST results of ≥5, ≥10 and ≥ 15 mm was 20.2% (76/376), 18.3% (69/376) and 11.4% (43/376), respectively. BCG vaccination was not associated with TST reactivity, whatever the threshold used: ≥5 mm (odds ratio (OR, 1.2; 95% confidence interval (CI), 0.7–2.0); ≥10 mm (OR, 0.9; 95% CI, 0.6–1.7); ≥15 mm (OR, 0.6; 95% CI, 0.3–1.2). Conclusion These results suggest that in Madagascar, a positive TST result indicates TB infection (active or latent) rather than past BCG vaccination. Therefore, high BCG vaccination coverage does not appear to impair the usefulness of the TST as a tool for diagnosing tuberculosis. Objectif: Le test cutane tuberculinique (TCT) est un outil important dans le diagnostic de l’infection tuberculeuse chez les enfants. Cependant, l’interpretation du TCT peut etre compliquee par une vaccination prealable avec le bacille de Calmette-Guerin avant (BCG). Nous avons evalue l’effet de la vaccination par le BCG sur la reactivite au TCT chez les eleves de premiere annee frequentant les ecoles publiques a Antananarivo. Methodes: Le TCT a ete effectue sur 376 ecoliers de premiere annee, âges de 6 et 7 ans, frequentant deux ecoles primaires publiques. Les relations entre l’information epidemiologique, le statut BCG (vaccination, cicatrices du BCG) et la reactivite au TCT ont eteevaluees afin de comparer la sensibilite du TCT entre les enfants avec et ceux sans vaccination BCG et entre ceux avec et ceux sans cicatrice du BCG. Resultat: La prevalence des resultats positifs au TCT de ≥5 mm, ≥10 mm et ≥15 mm etait de 20,2% (76/376), 18,3% (69/376) et 11,4% (43/376), respectivement. La vaccination par le BCG n’a pas ete associee a la reactivite au TCT, quelque soit le seuil utilise: ≥5 mm (odds ratio (OR: 1,2; IC95%: 0,7 - 2,0); ≥10 mm (OR: 0,9; IC95%: 0,6 - 1,7); ≥15 mm (OR: 0,6; IC95%: 0,3 – 1,2). Conclusion: Ces resultats suggerent qu’a Madagascar, un resultat positif au TCT indique une infection tuberculeuse (active ou latente) plutot qu’une vaccination passee par le BCG. Par consequent, une couverture elevee de vaccination par le BCG ne semble pas nuire a l’utilite du TCT comme un outil de diagnostic de la tuberculose. Objetivo: La prueba cutanea de tuberculina (PCT) es una herramienta importante para el diagnostico de la infeccion por tuberculosis en ninos. Sin embargo, la interpretacion de la PCT puede complicarse por una vacunacion previa con el bacilo Calmette-Guerin (BCG). Hemos evaluado el efecto de la vacunacion con BCG sobre la reactividad de la PCT en escolares de primer ano de escuelas publicas en Antananarivo. Metodos: Se realizaron pruebas cutaneas a 376 escolares de primer ano, con edades entre 6 y 7 anos, pertenecientes a dos escuelas primarias publicas. Se evaluo la relacion entre la informacion epidemiologica, el estatus de BCG (vacunacion, cicatrices de BCG) y la reactividad del PCT para comparar la sensibilidad del PCT entre ninos con y sin previa vacunacion con BCG y entre aquellos con y sin cicatrices. Resultados: La prevalencia de resultados de PCT positivos de ≥5 mm, ≥10 mm y ≥ 15 mm fue del 20.2% (76/376), 18.3% (69/376) y 11.4% (43/376), respectivamente. La vacunacion con BCG no estaba asociada con la reactividad del PCT, independientemente del umbral utilizado: ≥5 mm (odds ratio (OR 1.2, IC 95% 0.7–2.0); ≥10 mm (OR 0.9, 95% IC 0.6–1.7); ≥15 mm (OR 0.6, IC 95% 0.3–1.2). Conclusion: Estos resultados sugieren que, en Madagascar, un resultado positivo de PCT indica una infeccion de TB (activa o latente) mas que una vacunacion previa con BCG. Por lo tanto, una alta cobertura de vacunacion con BCG no parece afectar la utilidad de la PCT como herramienta para el diagnostico de la tuberculosis.

To cite this article: Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, Canonica GW, Carlsen KH, Cox L, Haahtela T, Lodrup Carlsen KC, Price D, Samolinski B, Simons FER, Wickman M, Annesi-Maesano I, Baena-Cagnani CE, Bergmann KC, Bindslev-Jensen C, Casale TB, Chiriac A, Cruz AA, Dubakiene R, Durham SR, Fokkens WJ, Gerth-van-Wijk R, Kalayci O, Kowalski ML, Mari A, Mullol J, Nazamova-Baranova L, O'Hehir RE, Ohta K, Panzner P, Passalacqua G, Ring J, Rogala B, Romano A, Ryan D, Schmid-Grendelmeier P, Todo-Bom A, Valenta R, Woehrl S, Yusuf OM, Zuberbier T, Demoly P. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02728.x ABSTRACT: This pocket guide is the result of a consensus reached between members of the Global Allergy and Asthma European Network (GA(2) LEN) and Allergic Rhinitis and its Impact on Asthma (ARIA). The aim of the current pocket guide is to offer a comprehensive set of recommendations on the use of skin prick tests in allergic rhinitis-conjunctivitis and asthma in daily practice. This pocket guide is meant to give simple answers to the most frequent questions raised by practitioners in Europe, including 'practicing allergists', general practitioners and any other physicians with special interest in the management of allergic diseases. It is not a long or detailed scientific review of the topic. However, the recommendations in this pocket guide were compiled following an in-depth review of existing guidelines and publications, including the 1993 European Academy of Allergy and Clinical Immunology position paper, the 2001 ARIA document and the ARIA update 2008 (prepared in collaboration with GA(2) LEN). The recommendations cover skin test methodology and interpretation, allergen extracts to be used, as well as indications in a variety of settings including paediatrics and developing countries.

Background: Though recent reports have indicated a higher prevalence of latent tuberculosis infection (LTBI) in laboratory personnel than in other healthcare workers, these studies included only a limited number of laboratory personnel. Methods: We have thus focused on the laboratory personnel, who had a high level of exposure to specimens from patients with TB. We recruited 173 laboratory personnel and performed QuantiFERON‐TB Gold In‐Tube test (QFT‐G) and tuberculin skin test (TST). Results: QFT‐G was positive in 21.4% of the enrolled laboratory personnel, and TST was positive in 33.3%. The agreement between the two tests was fair (κ = 0.234). In multivariate analyses, household contactwith TBpatients (P = 0.013), the laboratory sections of microbiology (P = 0.045) and chemistry/immunology (P = 0.014) were shown to be significantly associated with positive QFT‐G results. Conclusion: Our data show a high prevalence of TST and QFT‐G positivity in laboratory personnel and emphasize the importance of LTBI screening for laboratory personnel. In BCG‐vaccinated populations with an intermediate incidence setting, QFT‐G seems to be superior to TST as a screening tool for the detection of LTBI. Further study, including results of follow‐up tests will be helpful for confirmation of our findings. J. Clin. Lab. Anal. 25:382–388, 2011. © 2011 Wiley Periodicals, Inc.

Background Skin testing with amoxicillin (AX) is necessary to diagnose immediate hypersensitivity reactions to this β-lactam. A commercial AX (DIA-AX) has recently become available for skin testing. Objective The aim of this study was to compare DIA-AX with the injectable form (INJ-AX) in patients who have well-demonstrated IgE-mediated hypersensitivity to AX. Methods Chemical characterization using high-performance liquid chromatography of both DIA-AX and INJ-AX reagents was performed. Patients diagnosed with an immediate allergic reaction to AX and a positive skin test to INJ-AX (N=55) were re-evaluated within 6 months by performing skin testing with INJ-AX and DIA-AX. Basophil activation test (BAT) and Radioallergosorbent test (RAST) inhibition assay using both reagents were performed in a selected group of patients. Results The chemical analysis indicated that both DIA-AX and INJ-AX contained an AX compound with a purity above 95%. In the re-evaluation, 53 (96.4%) cases maintained skin test positivity to INJ-AX and were also positive to DIA-AX. Comparison of the papule area between the two reagents showed no significant differences between both reagents. BAT was performed in 30 samples and was positive to both compounds in 15 cases; no patient had a positive result to just one reagent. RAST inhibition studies using three individual cases and a pool of positive sera showed that the percentage inhibition detected with DIA-AX and INJ-AX was parallel and almost exactly the same. Conclusions This study shows that DIA-AX is equivalent to INJ-AX in terms of skin test response, as well as with in vitro immunochemical and biological tests. DIA-AX can therefore be used in the diagnosis of immediate hypersensitivity reactions.

Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described.

The aim of the present study was to evaluate the efficacy of a new product (Neuropad repair foam(®)) in promoting skin hydration of the foot in type 2 diabetes. Included in this study were 20 type 2 diabetic patients (10 men, mean age 61·40 ± 2·44 years). Patients applied Neuropad repair foam(®) on the plantar aspect of the right foot twice daily. No agent was applied on the left foot. Patients were examined at baseline, after 7 treatment days and after 14 treatment days. Evaluation of skin dryness was performed by means of the Multi Skin test Corneometer MC 900. In the right foot, skin capacitance was 26·55 ± 4·14 arbitrary units (a.u.) at baseline, 28·90 ± 4·53 a.u. after 7 days of treatment and 32·05 ± 4·54 a.u. after 14 days of treatment. There was a significant increase in skin capacitance from baseline to 7 days of treatment (P < 0·001), from baseline to 14 treatment days (P < 0·001), as well as from 7 to 14 days of treatment (P < 0·001). The same significant (P < 0·001) increases were observed both in men and in women. No changes were noted in the left foot. At baseline, there was no difference in skin capacitance between right and left foot (P = 0·186). However, skin capacitance was significantly higher on the right versus left foot, both after 7 days (P < 0·001) and after 14 days of treatment (P < 0·001). In conclusion, results with the new foam appear encouraging in ameliorating skin dryness in the diabetic foot and further investigation is warranted.

China is a country with high latent tuberculosis infection (LTI) and has a policy of routine BCG vaccination. To monitor tuberculosis (TB) infection, a total of 907 new recruits to the army were interviewed and routinely examined by chest radiographs. They were intradermally injected with purified protein derivative (PPD) and detected with enzyme-linked immunospot (ELISPOT) assay with recombinant CFP-10/ESAT-6 (rCFP-10/ESAT-6) fusion protein, as a stimulus, from December 2009 to February 2010. The prevalence of LTI among new recruits was estimated as 50.2% and 30.7% by PPD skin test and ELISPOT assay, respectively. Of 452 PPD-negative and 455 PPD-positive volunteers, 132 (29.2%) and 146 (32.1%) were ELISPOT positive, respectively. The overall consistency between these two tests was 51.4% (466/907). Although 65.6% of PPD-positive volunteers and 27.8% of ELISPOT-positive volunteers (spot-forming cells; SFC 12.2 ± 21.2) could find the vaccination scars on their arms, 21.3% of PPD-positive volunteers and 35.9% of ELISPOT-positive volunteers (SFC 18.3 ± 34.6) could not. Thus, the TB infection rate in army recruits in China was not as high as previously reported. The results suggest that the ELISPOT technique, we presented, is an accurate method for screening TB infection in China.

P>Background: As oral allergy syndrome (OAS) symptoms to apple are frequent, we aimed to identify low allergenic apple cultivars and to validate the prick-to-prick skin prick test (SPT) as a suitable screening method. Methods: Sixty-eight apple cultivars were tested by SPTs in 33 Dutch adults with OAS, before and during the birch pollen season in 2006 and 2007, respectively. Three cultivars yielding the largest number of negative SPTs (Elise, Santana and Pink Lady (R)) and one reference cultivar (Golden Delicious) were subsequently tested by single-blind oral food challenges (SBFC) just after picking in fall 2007 (fresh) and in spring 2008 (stored), outside the birch pollen season and preceded by SPTs. In spring, Santana was replaced by Modi (R). Results: In fresh apples, OAS symptoms of Elise, as measured by cumulative scores on a Visual Analogue Scale VASt, were significantly lower than those of Santana, Pink Lady and Golden Delicious (P = 0.021; 0.040 and 0.005, respectively). VASt scores of Santana were significantly lower than those of Golden Delicious (P = 0.049). In stored apples, VASt scores of Elise were significantly lower than that of Golden Delicious (P = 0.038). VASt scores of fresh apples did not differ significantly from stored apples, except in Golden Delicious (spring

INTRODUCTION: Pre-transplant screening for LTBI is a complex consideration that varies by institution. Inconsistent performance of IGRA further complicates screening. Data regarding LTBI screening outcomes and test characteristics in large, foreign-born pre-transplant populations within the United States is limited. METHODS: In this retrospective study, patients who received QuantiFERON®-TB Gold (QFT) prior to LT were included. Characteristics of patients were compared by QFT result and predictors of indeterminate results were evaluated. Similar comparisons were performed between patients who developed active TB and those who did not. RESULTS: Of 148 patients screened the rate of positive, indeterminate, and negative testing was 13.5% (20/148), 27% (40/148), and 59% (88/148) respectively. An indeterminate QFT was more likely in patients with a MELD > 25 (OR 16.7, 95% CI: 2.1 – 132.0; p=0.008) and when performed internally compared to by commercial lab (OR 4.1, 95% CI: 1.34 – 12.44, p=0.013). The overall TB incidence was 1102/100,000 transplant cases. No patient who developed active TB had a positive QFT. All were born outside of the US (p=0.06) and had pre-transplantation chest imaging demonstrating granulomatous disease (p=0.006). CONCLUSION: Our experience further highlights the challenges of LTBI screening prior to LT and suggests QFT may be a poor predictor of active TB in higher risk pre-transplant populations. Candidates should be screened as early as possible to optimize QFT performance and local epidemiological data should be used to create institution-specific screening protocols in areas with large populations from TB-endemic regions. Management should consider TB risk factors, QFT, and imaging instead of reliance on QFT testing alone.

Background Skin reactivity to the intradermal injection of autologous serum (autologous serum skin test – ASST) and/or plasma (autologous plasma skin test – APST) is thought to identify chronic urticaria (CU) patients with an autoimmune/autoreactive disease. Immune-mediated inflammation and coagulation are strictly linked, and coagulation activation has been described in CU patients as shown by the elevation of plasma prothrombin fragment F1 + 2 and, in severe cases, of d-dimer as well. Objective The aim of this study was to evaluate whether the coagulation cascade is activated in APST-negative CU patients as it has been described in CU patients with an autoreactive disease. Methods A total of 43 adults with CU (M/F 15/28; mean age 43.5 years; 16 APST-negative patients and 27 APST-positive) and 30 healthy subjects were studied. Prothrombin fragment F1 + 2, d-dimer and C-reactive protein (CRP) plasma levels were measured by ELISA. Results Prothrombin fragment F1 + 2 and d-dimer were elevated in seven of 16 APST-negative CU patients. The activation of the coagulation cascade was associated with disease severity. Men were more prevalent in idiopathic than in autoreactive CU patients (M/F: 10/6 vs. 5/22; P

Background Immune-compromised patients with latent TB infection (LTBI) are at risk for TB reactivation and should receive prophylaxis. Whereas the tuberculin skin test (TST) has limitations particularly in immune-compromised patients. Aims This retrospective study was conducted to determine the incidence of TB infection in adult HSCT recipients whose preventive therapy for LTBI was determined according to the guidance of targeted TST. Patients and methods Five hundred and fifty-eight consecutive HSCT recipients (287 autologous and 271 allogeneic) who survived ≥100 days post-transplantation were included in this analysis. Results Tuberculin skin test results were available in 493 of 558 transplants (88.3%). The incidence of negative TST was 54.5% (269 of 493 patients). One multiple myeloma patient with a history of TB and negative TST result and was not on INH prophylaxis developed reactivation of TB infection. None of the recipients under INH prophylaxis (151 of 558 transplants; 27.1%) and none of the 224 patients with TST ≥5 mm developed TB infection. Discussion Despite the limitations of being a retrospective analysis and variable prophylaxis thresholds of TST, there are some remarkable results of this analysis. We had no TB infection in the allogeneic HSCT recipients. The high incidence of negative TST results may be attributed to the underlying immune-deficiency. TST may not be a reliable guide for predicting TB reactivation risk in hematology patients. Conclusion Tuberculin skin test may have a high rate of false-negative and false-positive results in HSCT recipients. The general guidelines for targeted TST to guide treatment of LTBI may not apply to all regions and situations. More reliable methods are required to predict and treat LTBI in these specific conditions.

It would be logical to look at all the factors, which may have changed to affect this result. There was a small increase in TB reactors in 1975 following the change from human to bovine tuberculin, but otherwise the test used (and in my case the person doing it!) has remained essentially the same since the 1960s. The same skin test has also successfully eliminated TB from other countries in the absence of a wildlife reservoir.

Summary Icelandic horses in Austria are commonly affected by an allergic inflammatory skin disease recurring during the summer seasons, which shares characteristic features with Culicoides hypersensitivity. However, the causative agents have not yet been identified. Therefore, intradermal skin testing (IDST) with a standardised extract of Culicoides variipennis and 21 other allergens relevant within Austria was performed in 81 Icelandic horses. All horses included into the study were treated regularly with ivermectin and had no history of administration of anti-inflammatory drugs. Forty-three of these horses were affected by summer seasonal recurrent dermatitis (SSRD). No history or signs of any other disease were evident in any horse. Pruritic dermatitis due to ectoparasites, bacteria and dermatophytes were ruled out by means of fungal culture, skin scraping and biopsy. Culicoides variipennis antigens evoked a positive cutaneous reaction in 1 of 38 normal and 3 of 43 SSRD horses at the proposed dilution of 1:50,000 or 1:25,000, and in 24 of 38 normal and 13 of 43 SSRD horses at a dilution of 1:10,000. Furthermore, no significant differences in onset or intensity of skin reactions to the 21 other allergens, including pollens, moulds, mites and insects, except deerfly and horsefly, were obvious between the 2 groups. Efficiency (percentage of correct results) for the used antigens in the skin test was 0.47–0.60. Maximal sensitivity was 0.51. Altogether, 38 of 43 SSRD horses and 28 of 38 normal horses were positive 4 h after allergen administration. The divergence between IDST results and manifestation of clinical signs found in this study underlines the difficulties associated with establishing a skin test protocol in horses within a geographic area. Whether the outcome of this study would have been influenced significantly by using Culicoides spp. present in Austria has to be clarified in future research.

BACKGROUND: The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost-effective approach in epidemiological studies. OBJECTIVE: To define the minimal number and the type of skin prick test (SPT) allergens required to identify a patient as sensitized using results of the new Pan-European GA(2)LEN skin prick test study. METHOD: In a large Pan-European multicenter (17 centers in 14 countries) patient based study, a standardized panel of 18 allergens has been prick tested using a standardized procedure. Conditional approach allowed to determine the allergens selection. RESULT: Among the 3034 patients involved, 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, Dermatophagoides pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) allowed to identified more than 95% of sensitized subjects. However, differences were observed between countries, two allergens being sufficient for Switzerland (grass pollen and cat dander) as opposed to nine for France (grass pollen, Dermatophagoides pteronyssinus, olive pollen, cat dander, Blatella, cypress, dog dander, alder and [Artemisia or Alternaria]). According to country, up to 13 allergens were needed to identify all sensitized subjects. CONCLUSION: Eight to ten allergens allowed the identification of the majority of sensitized subjects. For clinical care of individual patients, the whole battery of 18 allergens is needed to appropriately assess sensitization across Europe.

Nineteen Stachybotrys alternans strains isolated from animal feeds, fodder or bedding and from grain for human consumption were tested for their toxin-producing capacity on a mixture of wheat, oats and barley. Ultraviolet light was applied during isolation of the fungi. Nine out of the 19 strains were toxic to white mice in a feeding experiment of two week's duration. Five selected strains were also tested by the rabbit skin test and by the feeding test with guinea pigs. Clinical symptoms and patho-anatomical pictures are described. The reason why S.alternans has been rarely found in grain is discussed.

Summary: Atopic patients with clinical features of dermatophytosis were investigated with respect to skin reactivity to trichophytin antigen preparations (a glycopeptide purified with etylene glycol and commercially available preparation) and to tuberculin (PPD). The overall reactivity was comparable to that of non-atopic patients. A tendency to increased immediate reactions to trichophytin antigens was registered. This tendency was exaggerated in the 25 patients with dermatophytosis verified by culture (10 immediate reactions to purified trichophytin) Non-chronic atopic patients manifested a intact cell-mediated reactivity to the antigens tested. On the other hand, atopic patients with chronic dermatophytosis revealed signs of impaired cell-mediated immunity (CMI) by an almost totol anergy to trichophytin antigen (one positive) and a hyporeactivity to tuberculin (30% positive). It is concluded that some atopic patients seem to posses an intact host defence against dermatophytes and a limited duration of infection while the atopic patients with chronic dermatophytosis expressed signs of depressed CMI as a relative skin anergy to trichophytin as well as to tuberculin. Zusammenfassung: Die Untersuchungen warden an atopischen Patienten durchgefuhrt, die gleichzeitig klinische Zeichen einer Dermatophytose boten. Dabei wurden Hautteste mit einem Trichophytin-Antigen (ein mit Atylenglykol gereinigtes Glykopeptid and ein kommerzielles Praparat) und mit gereinigtem Tuberkulin (PPD) durchgefuhrt. Generell war die Reaktivitat der atopischen Patienten vergleichbar mit der von Nicht-Atopikern. Eine gewisse Tendenz zu vermehrten Soforttypreaktionen gegen Trichophytin wurde jedoch festgestellt. Diese Tendenz war noch deutlicher bei den 25 Patienten mit einer auch kulturell nachgewiesenen Dermatophytose (10 Soforttypreaktionen gegen gereinigtes Trichophytin). Bei den Patienten ohne atopische Erkrankungen lies sich mit den getesteten Antigenen eine unbeeintrachtigte zellulare Reaktivitat feststellen. Im Gegensatz dazu zeigten atopische Patienten mit chronischer Dermatophytose Zeichen einer gestorten zellularen Immunitat, indem hier eine fast totale Anergie gegen Trichophytin-Antigene (einmal positiv) und eine Hyporeaktivitat gegen luberkulin (30% positiv) festzustellen war. Aus den Ergebnissen wird der Schlus gezogen, das einige atopische Patienten uber eine intakte Abwehrleistung gegen Dermatophyten verfugen und nur uber begrenzte Zeit an Dematophytosen erkranken, wahrend die atopischen Patienten mit chronischer Dermato phytose Zeichen emer defizienten zellularen Immunitat erkennen lassen, indem bei ihnen eine relative Hautanergie gegen Trichophytin und Tuberkulin besteht.

Summary: Two hundred horses in a horse farm with a history of infedion with ephtic lymphangitis were examined clinically, mycologically, serologically and by skin test using soluble antigen (‘Histofarch’) prepared from H. farciminosum. 3% of the animals showed clinical manifestations of the disease and 26.5% of the horses had antiiodies demonstrated by Immuno D&sion (ID) and Complement Fmtion Test (CFT). The ‘Histofarcin’ skin test was applied to 40 horses representing serologically negative and positive cases, either apparently healthy, recovered from previous infetion or with clinical manifestations of the disease. All serologically positive cases showed significant increase in skin thickness (8–20 mm) 24 h after iujedion of the antigen, and a maximum increase in skin thickness (50 mm) was recorded after a-72 how. me ‘Histofarcin’ skin test proved to be a reliable and easy test. Zusammenfassung: 200 Pferde einer Pferdefarm, bei denen eine Lymphangitis epizootica vor-lag, den klinisch mykologisch, serologisch und mit einem Hauttest untersucht. Hie& wurde ein losliches Antigen (“Histofarcin”) benutzt, das aus H. farciminosum gewonnen worden war. 3% der mere migten klioische Manifestationen der Erkrankang und 26% hatten mit Hilfe der Immunodiffnsion oder der Komplementbindungsreaktiosreaktion nachweisbare Antikorper. Der “Histofarcin”-Hauttest wnrde bei 40 Pferden durehgefiihrt Diese Pferde waren zum Teil serologisch negativ, z. T. positive. In der Gmppe fanden sich offensichtlich gesunde mere, solche, die yon fruheren Infektionen genesen waren und llere mit klinisch manifester ErkrankMg. Bei allen Pferden mit positiver Serologie fand sich im Hauttest eine Verdidmng der Haut (8–20 mm) 24 Stunden nacb der Injection des Antigens und ein Maximum der Hautverdickung (50 mm) nach 48–72 Stnnden. Der “Histofarrin”-Hanttest emies sicb als verasliche and leicht durchzufuh-rende diagnostische Methode.

Summary: Twenty equine cases of conidiobolomycosis entomophthoromymis were studied between 1981 and 1984 at the Veterinary Medicine School National University. Fourleen presented with external polyps measuring 20 to 35 mm in diameter around the nostrils; in six cases infection was confined to the nasal septum. clinical symptoms consisted of severe dyspnoe pruritus in infected nostrils and blood in the mucous secretions. Conidiobolus coronatus was isolated in culture from biopsies of external polyps submitted to the laboratory and histopathological examination showed an eosinophilic inflammatory reaction with fungal hyphae cut transversally and longitudmally in the centre. Immunodiffusion and skin test as an aid to diagnosis of conidiobolomycosis entomophthoromycosis in horses were found to be successful. Iodine and surgery were used in treatment with variable results. Zusammenfassung: Zwischen 1981 und 1984 mden an der Tierarztlichen Nationalen Hochschule in Costa Rica 20 Falle von Conidiobolomykose Entomophthoromykose bei Pferden beobachtet. 14 Pferde wigten externe Polypen von 20 bis 35 mm Durchmesser in der Umgebung der Nustern. Beisechs Fallen war die Infaktion auf das Nasenseptum beschrankt. Als Symptome wurden schwere Dyspnoe, Pruritus in den infizerten Nustern und Blut in mukosen Sekretionen beobachtet. Conidiobolus coronains konnte kulturell aus Biopsien von den Polypen isoliert werden. Die histologische Untersuchnng zeigte eine eosinophile enlzundliche Reaktion mit Pilzhyphen im Zentrum der Herde. Serologische Untersuchungen Immnnodiffusion und Hauttests waren bei der Diagnose der Conidiobolomykose Entomophthoromykose erfolgreich. Therapieversuche mit Jod und cbimgischer Behandlung fuhrten zu unterschiedlichen Ergebnissen.

We find that the risks of immediate hypersensitivity to grass and mug wort pollens, as measured by a skin test, are positively correlated with the intensity of the first pollen season encountered in infancy. However, only indirect measures of the intensity of the pollen seasons (weather factors and vegetative growth of grasses) were available for the regression analysis performed. The risks were also dependent on the month of birth, maximal risk for both grass nad mugwort pollen sensitivity being associated with birth in April-May. The results support an earlier suggestion that pollen contacts during the first 6 months of life increase the risk of pollen allergy for 20 years or more. We estimate that the elimination of early pollen contacts could have reduced the prevalence of immediate hypersensitivity to grass and mugwort pollens by approximately 20 % each in the age group 0–19 years.

BACKGROUND: Iodinated contrast media cause both immediate and nonimmediate hypersensitivity reactions. The aim of this prospective study was to determine the specificity and sensitivity of skin tests in patients who have experienced such reactions. METHODS: Skin prick, intradermal and patch tests with a series of contrast media were conducted in 220 patients with either immediate or nonimmediate reaction. Positive skin tests were defined according to internationally accepted guidelines. Seventy-one never-exposed subjects and 11 subjects who had tolerated contrast medium exposure, served as negative controls. RESULTS: Skin test specificity was 96-100%. For tests conducted within the time period from 2 to 6 months after the reaction, up to 50% of immediate reactors and up to 47% of nonimmediate reactors were skin test positive. For immediate reactors, the intradermal tests were the most sensitive, whereas delayed intradermal tests in combination with patch tests were needed for optimal sensitivity in nonimmediate reactors. Contrast medium cross-reactivity was more common in the nonimmediate than in the immediate group. Interestingly, 49% of immediate and 52% of nonimmediate symptoms occurred in previously unexposed patients. Many of these patients were skin test positive, indicating that they were already sensitized at the time of first contrast medium exposure. CONCLUSIONS: These data suggest that at least 50% of hypersensitivity reactions to contrast media are caused by an immunological mechanism. Skin testing appears to be a useful tool for diagnosis of contrast medium allergy and may play an important role in selection of a safe product in previous reactors.

Background Effective tuberculosis (TB) control requires accurate diagnostic methods but the tuberculin skin test has serious limitations. Both false-negative and false-positive reactions are common, resulting in the spread of the infection and devastating TB outbreaks. Results of questionnaire surveys concerning TB testing practices in primate housing facilities showed great differences in testing practices. Although there was some uniformity regarding the sites of application, the amounts of tuberculin used and the time intervals for retesting, a great deal of variety was revealed considering the types of tuberculin preparations, the interpretation of tests and the susceptibility of animals. Conclusion Here, we summarize the most common practices as regards TB control and prevention for non-human primates, and attempt to establish a uniform guideline based upon our experience with primate husbandry and care programmes as well as recent developments in the literature. The present guideline represents a consensus recommendation intending to harmonize the existing protocols.

Udgivelsesdato: 2008-Jun-4 Background: The preservative methyldibromo glutaronitrile (MDBGN) has been banned, first from stay-on, and later from rinse-off cosmetics, in the EU countries because of increasing rates of contact allergy. Objectives: To evaluate the frequency of contact allergy to MDBGN among patients patch tested by the Danish Contact Dermatitis Group just before and following regulatory decisions. Patients/Methods: The data set comprised 19 279 consecutive eczema patients patch tested from 2003-2007 with MDBGN 0.3% in petrolatum (pet.) or, in a minority of patients, with Euxyl Ktrade mark 400 1.5% in pet. Results: A significantly decreasing trend in the frequency of positive patch tests to MDBGN was found from 4.6% in 2003 to 2.6% in 2007 (P < 0.001). The decreasing trend was seen for both men and women. A significantly decreasing proportion of cases with a current relevance of contact allergy to MDBGN was also seen from 51.3% in 2003 to 29% in 2007 (P < 0.001). Conclusions: Regulatory interventions have already had a major effect on allergic disease due to MDBGN in Denmark. The same trends are likely to be seen in other EU countries.

Allergic contact dermatitis is now known to be a common problem in pediatric populations, accounting for up to 20% of all dermatitis seen in children. Seminal studies conducted over the past decade have demonstrated a prevalence rate in the range of 25% to 60% of children referred for epicutaneous patch testing. This patch test procedure is generally accepted as the gold standardin vivo technique to diagnose allergic contact dermatitis. However, the overwhelming majority of research studies to date have been conducted on adult populations. Increasingly, pediatric patients are undergoing patch test procedures with techniques that have been standardized and optimized almost exclusively in adults. With this article, we hope to emphasize common misconceptions and pitfalls encountered with this approach. In addition, we hope to stimulate research interest in this field so as to determine the optimum patch test conditions and techniques for children.