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The guidelines for construction and approval of international standards and reference reagents of biological substances according to which allergens, like all immunobiological drugs, should be standardized were described. The units of biological (allergic) activity for the first batch of standard are determined in vivo (provocative tests, intradermal tests, skin-prick test, etc.) in sensitized persons. The activity of the first batch of the standard is also studied in parallel by immunoassay methods using inhibition of serum containing allergen-specific IgE. The standard should also be characterized with respect to content of main (major) allergenic proteins, protein profile, and protein structure. Modern requirements for allergen preparations were introduced for the first time in the XIIIth Edition of the State Pharmacopoeia of the Russian Federation.

In 1986 WHO published guidelines for construction and approval of international standards and reference reagents of biological substances, according to which allergens like all immunobiological drugs should be standardized. Standardization of allergens in terms of PNU (used in Russia at the moment) does not reflect the biological activity of drugs. According to the system of biological standardization of allergens used abroad, Units of biological (allergic) activity for the first batches of the standard are determined by in vivo method (provocative tests, intradermal tests, skin prick test, etc.) in the sensitized persons. The activity of the first batch of the estimated standard is studied in parallel by immunoassay methods with the stage of inhibition of specific IgE-containing serum to the test allergen. In addition the standard of the biological activity should be characterized by the content of the main (major) allergenic proteins, protein profile, and protein structure. Taking into account the current requirements for allergen drugs, it is necessary to introduce the system of standardization of the biological activity for allergens in Russia by using both in vivo and in vitro methods. Modern requirements to allergen preparations are introduced for the first time in the XIII edition of the State Pharmacopoeia of the Russian Federation.

Назаров Илья Владимирович – аспирант кафедры факультетской хирургии ГБОУ ВПО Новосибирский государственный медицинский университет МЗ РФ. Адрес: 630091, г. Новосибирск, Красный проспект, д. 52; тел. 8(963)9425448; e-mail: Inazaroff80@mail.ru.Надеев Александр Петрович – доктор медицинских наук, профессор ка-федры патологической анатомии ГБОУ ВПО Новосибирский государственный медицинский университет МЗ РФ. Адрес: 630091, г. Новосибирск, Красный проспект, д. 52; тел. 8(383)2270737, e-mail: nadeevngma@mail.ru. Шутов Юрий Миронович – доктор медицинских наук, профессор кафедры факультетской хирургии ГБОУ ВПО Новосибирский государственный медицин-ский университет МЗ РФ. Адрес: 630091, г. Новосибирск, Красный проспект, д. 52; тел. 8(963)9425448.Аникина Аурика Георгиевна – кандидат медицинских наук, научный сотруд-ник ФГБУ Научный центр клинической и экспериментальной медицины СО РАН, лаборатория структурных основ патогенеза социально значимых заболеваний Адрес: 630117, г. Новосибирск, ул. Тимакова, д. 2; тел. 8(383)3336456; e-mail: aurika.anikina@gmail.com.

Heparin has been widely used for intradialytic anticoagulation since the 1940s. Heparin induced anaphylaxis can be life threatening, mandating early recognition and intervention. However, due to its relative rarity many physicians remain unaware. We report the case of a 70-year-old woman requiring dialysis, who developed recurrent anaphylaxis to intradialytic heparin. We describe a systematic approach to confirm the suspected heparin allergy, which must include an evaluation of predisposing factors, the dialysis equipment and concomitant medications. Further workup for safe alternatives employing skin prick and intradermal tests, as well as provocation tests are discussed.

Vaccination of cattle with a commercial human tuberculosis (TB) vaccine,Mycobacterium bovisbacillus Calmette-Guérin (BCG) Danish, at a dose equivalent to 5 human doses of BCG has protected these animals against TB in field and experimental trials. There is interest in determining whether a 10-fold-lower dose could still protect cattle but not induce a tuberculin intradermal test response. Two groups of calves (n= 9/group) were vaccinated subcutaneously with a lyophilized BCG Danish vaccine containing either 0.5 (1 × 105to 4 × 105CFU) or 5 (1 × 106to 4 × 106CFU) human doses of BCG Danish, with an additional group of 10 calves serving as nonvaccinated controls. Fifteen weeks after vaccination, these animals were challenged intratracheally with 5 × 103CFU of virulentM. bovisand another 15 weeks later were slaughtered and examined for the presence of tuberculous lesions. Vaccination of the calves with either 0.5 or 5 equivalent human doses of BCG Danish induced similar levels of protection against challenge withM. bovis, with both groups showing significant reductions in the pathological and microbiological parameters compared to those for the the control group (P< 0.05). Vaccination with either of the two BCG doses induced similar numbers of animals responding to the tuberculin intradermal test at 11 weeks postvaccination. Vaccination with a 0.5 equivalent human dose of a commercial lyophilized BCG vaccine can protect cattle against challenge withM. bovis.

Die allergologische Abklärung ist bei Verdacht auf eine Allergie auf Beta-Laktam-Antibiotika wichtig, um die Reaktion zu bestätigen und alternative Medikamente zu testen. Da jedoch alle Testmethoden der allergologischen Abklärung (Hautteste und in-vitro-Tests) eine nicht sehr hohe Sensitivität haben, ist eine vorherige umfassende Anamnese sowie die Dokumentation der Symptome und Befunde entscheidend, um eine hohe Aussagekraft der Untersuchung zu ermöglichen und die Indikation zum in vielen Fällen notwendigen Provokationstest stellen zu können. Als wesentliche Voraussetzung muss neben der Klinik der zeitliche Ablauf festgehalten werden, um zwischen einer Sofortreaktion (wenige Stunden nach Substanzeinnahme) und einer Spätreaktion (einige Tage nach Einnahme) unterscheiden zu können. Die Abklärung bis spätestens sechs Monate nach der Reaktion erhöht die Chancen einer erfolgreichen allergologischen Abklärung.

O teste alérgico intradérmico (TID) é uma importante ferramenta no diagnóstico dos alérgenos implicados nas reações de hipersensibilidade mediada por IgE. O objetivo deste estudo foi avaliar o TID em eqüinos não alérgicos com extratos alergênicos de Cynodon dactylon, Lolium multiflorum, Paspalum notatum, Culex sp. e Aedes aegipty, e três concentrações de histamina, em dois volumes diferentes, e baseado nos resultados, verificar a acurácia do TID em eqüinos alérgicos. Foram realizados TID em 17 eqüinos não alérgicos com três concentrações de cada extrato (1:2000v/w, 1:4000v/w e 1:8000v/w) e três concentrações de histamina (0,1mg/ml, 0,05mg/ml e 0,025mg/ml), em dois volumes (0,1 e 0,05ml). Baseado nos resultados obtidos, foram realizados TID em seis eqüinos alérgicos utilizando os extratos na concentração de 1:2000v/w, a histamina na concentração de 0,025mg/ml, em um volume de 0,05ml. Nos eqüinos não alérgicos, nenhuma das três concentrações dos extratos testados nos dois volumes mostrou-se irritativa. Concentrações maiores de histamina provocaram halos maiores e levemente mais túrgidos, e quanto maior o volume injetado, maiores as reações Os TID realizados em eqüinos alérgicos mostraram confiabilidade dos resultados por evidenciar hipersensibilidade individual e não provocar reações irritativas. Em conclusão, as diferentes concentrações dos estratos testados em eqüinos não alérgicos não provocaram reações falso positivas (irritantes). O volume de 0,05ml é mais recomendado para realização dos TID pois as aplicações com 0,1ml produziram reações maiores, prejudicando a sensibilidade do teste. A concentração de 0,025mg/ml da solução de histamina provocou a formação de halos menores, permitindo maior acurácia do cut off no TID. Os extratos alergênicos testados em equinos alérgicos não provoraram reações em todos os animais, o que poderia ser considerado uma reação irritativa. Os equinos alérgicos apresentaram reações positivas diferentes, de acordo com a hipersensibilidade individual, demonstrando sensibilização alérgica verdadeira. The intradermal test (IDT) is an important tool in the diagnosis of allergens involved in IgE-mediated hypersensitivity reactions. The aim of this study was to evaluate the IDT in nonallergic horses with allergenic extracts of Cynodon dactylon, Lolium multiflorum, Paspalum notatum, Culex sp. and Aedes aegypti, and three histamine concentrations, in two different volumes, and based on the results, verify the accuracy of IDT in allergic horses. IDT was performed on 17 nonallergic horses with three concentrations of each extract (1:2000v/w, 1:4000v/h and 18000v/w) and three histamine concentrations (0,1mg/ml, 0,05mg/ml and 0,025mg/ml) in two volumes (0,1 and 0,05ml). Based on the results obtained, IDT was performed in six allergic horses using extracts at the concentration of 1:2000v/w, histamine at a concentration of 0.025mg/ml, in a volume of 0,05ml. In nonallergic horses, none of the three concentrations of the extracts tested in the two volumes were irritant. Larger concentrations of histamine provoked larger and slightly more turgid wheals, and the larger the volume injected, the greater the reactions The IDT performed in allergic horses showed reliability of the results because they demonstrated individual hypersensitivity and did not provoke irritative reactions. In conclusion, the different concentrations of extracts tested in nonallergic horses did not provoke false positive (irritant) reactions. The volume of 0,05ml is more recommended for execution of IDT because the applications with 0,1ml produced larger reactions, impairing the sensitivity of the test. The concentration of 0,025mg/ml of the histamine solution caused the formation of smaller wheals, allowing a better accuracy of the cut off in the IDT. The allergenic extracts tested in allergic horses did not provoke reactions in all the animals, what could be considered an irritative reaction. Allergic horses presented different positive reactions, according to individual hypersensitivity, demonstrating true allergic sensitization.

Background Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food. Case report We report on a Caucasian patient experiencing recurrent severe allergic reactions to several drugs. An extensive diagnostic workup including skin prick tests, intradermal tests (IDT) and a double-blind oral challenge was performed to identify the trigger of anaphylaxis. In the present case hypersensitivity to the additive polyethylene glycol was confirmed by an IDT suggesting an Immunoglobulin E-dependent mechanism as a cause of the reaction. Conclusion Potential life-threatening hypersensitivity reactions to hidden molecules like macrogol may be underdiagnosed. Cases of immediate-type PEG hypersensitivity were reported with increasing frequency. The awareness regarding the allergenic potential of PEG should be raised and a proper product labelling is crucial to prevent PEG mediated hypersensitivity.

Autoimmune progesterone dermatitis (APD) is a rare skin condition with a varying morphology, which appears on a monthly basis during the luteal phase of the menstrual cycle and resolves spontaneously with the endogenous decrease in progesterone during menses. We present the case of 39-year-old multiparous Caucasian woman with generalised, self-limited urticaria in her perimenstrual period. APD was diagnosed in light of the cyclical nature of the symptoms. An intradermal test with the administration of 0.5 mg/mL of medroxyprogesterone acetate showed a positive result. She started using vaginal hormonal contraceptive that paradoxically exacerbate the symptoms, which ceased after the removal of the device. An oral combined contraceptive was initiated instead, with complete resolution of the symptoms. We share the case because of the rarity of the situation, emphasising the importance of a multidisciplinary team for differential diagnosis and patient follow up.

Hydroxyapatite/polyetheretherketone (HA/PEEK) composite materials were prepared via an in situ synthesis process in order to achieve strong bonding between PEEK matrix and hydroxyapatite fillers, and ultimately to improve the mechanical properties of the composites. In the study, the biocompatibility of the synthesized HA/PEEK materials was investigated by acute toxicity test, hemolytic test, sensitization test, pyrogen test, intradermal test, and toxicity assay test on animal tissue and cells for the purpose of examining the possible adverse effects of the residue organic chemicals from the in situ synthesis process. In vivo bioactivity of both lab-synthesized PEEK and HA/PEEK composites with various HA content was also studied. It is found that the in situ synthesized composite materials possess good biocompability without toxicity. Although the bioactivity of the material increases with HA content, the composite material with 5.6 vol % HA exhibits satisfactory bioactivity without compromising its excellent mechanical performance, which hints to a potential use as load-bearing orthopedic material.

Hypersensitivity reactions to tramadol are rare and the drug is commonly considered safe. Here, we report the first case of anaphylaxis to tramadol in a child. We point out the difficulty in reaching a confident diagnosis when testing opioid alkaloid drugs with histamine-releasing properties. Additionally, we showed the importance of a well-performed allergy work-up, especially when testing drugs with low experience and when standardized concentrations have not been tested. Moreover, this case provides insight into the possibility of severe reactions, and even anaphylaxis, to tramadol.

Children with multiple drug allergies are likely to require treatment with one or more of the drugs to which they may have had a reaction, when there is no alternate effective drug available. Detailed review of their history and/or use of appropriate diagnostic studies will help determine the potential safety of readministering the desired drug as well as the method for its readministration, most likely in the form of a drug challenge or desensitization. A practical approach to the diagnosis and treatment of children with multiple drug allergies is described in this review.

Bovine tuberculosis (bTB), caused primarily by Mycobacterium bovis, continues to exert an economic loss, even in countries with active control measures, and is one of zoonotic diseases enable to be transmitted to human. The control and eradication of bTB are mainly based on a test and slaughter policy and/or abattoir surveillance. Various factors including limitation of diagnostic tests have been considered as major constraints to eradication. Single intradermal test (SIT) is the official diagnostic test. New diagnostic methods are needed to be developed, because of limitations of the test. In the present study SIT was compared with single intradermal comparative cervical test (SICCT) and interferon (IFN)-γ assay. There was very low correlation between SIT and SICCT. However, high correlation was shown between SIT and IFN-γ assay while no correlation was observed between SICCT and IFN-γ assay. Therefore, our results suggest the possibility of replacement of SIT with IFN-γ assay for the diagnosis of bovine tuberculosis.

Human and canine atopic dermatitis (AD) share an association with IgE specific to environmental allergens, but few studies have evaluated serum allergen-specific IgE in nonatopic dogs. This study compared serum allergen-specific IgE levels in 30 atopic and 18 nonatopic West Highland white terriers. Atopic dermatitis was confirmed using standard criteria. Nonatopic dogs were over 5 years of age and had no clinical signs or history of AD. Serum allergen-specific IgE levels were measured with Allercept® IgE ELISAs using a 48-allergen Australian panel. Positive reactions were defined as ≥150 ELISA absorbance units. Intradermal tests were performed in 16 atopic dogs, either at the time of or at various times prior to serum collection. In atopic dogs, the most common positive ELISA and intradermal test results were to Dermatophagoides farinae (11 of 30 dogs), but there were no statistically significant correlations between results from the two methods for any allergen. In nonatopic dogs, multiple high-positive ELISA reactions were reported to 45 of 48 allergens, most commonly D. farinae and Tyrophagus putrescentiae (17 of 18 dogs each). Positive ELISA results in nonatopic dogs were statistically significantly higher than those in atopic dogs for 44 of 48 allergens, including two allergens (D. farinae and Dermatophagoides pteronyssinus) commonly regarded as significant in canine AD. In conclusion, positive allergen-specific IgE ELISAs were not specific for canine AD, and high allergen-specific IgE levels were seen in nonatopic dogs. The clinical significance of this and whether it characterizes a protective phenotype is unclear.

To the authors’ knowledge, this is the first report of an allergy to onabotulinumtoxinA. The 43-year-old woman experienced severe itching after injection of Botox and Juvederm. Results of prick and patch testing confirmed a T-cell–mediated allergy to Botox. This case can aid in the evaluation of suspected allergies to Botox. Level of Evidence: 5 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Contact urticaria is a transient, wheal-and-flare response at the site of contact with a substance. We report a case of a military fighter pilot, with a background history of seborrheic dermatitis and steroid-induced facial skin atrophy, who subsequently developed contact urticaria from an oxygen facemask. Skin protection products such as barrier creams were used to try and minimize the provocation of contact urticaria from the oxygen mask whenever he flew, but without success. He was eventually permanently restricted from flying fighter aircraft.

Resume Introduction La vancomycine (V) et la teicoplanine (T), antibiotiques de la famille des glycopeptides prescrits au cours d’infections severes, peuvent induire differents types de toxidermies. Objectif Evaluer l’interet d’explorations allergologiques dans les toxidermies mettant en cause les glycopeptides, a partir d’une serie de huit patients. Patients et methodes Etude retrospective (2000–2007). Six semaines apres la disparition de la toxidermie, des tests cutanes (tests epicutanes, prick-tests et intradermoreactions [IDR]) etaient realises. S’ils etaient negatifs, la reintroduction d’un glycopeptide etait proposee. Resultats La population de l’etude comportait cinq femmes et trois hommes, d’âge moyen 53 ans. Trois d’entre eux avaient presente une reaction a la vancomycine, quatre a la teicoplanine et un aux deux molecules. Les toxidermies etaient reparties en six cas d’exantheme maculopapuleux (EMP), un cas de syndrome d’hypersensibilite ou drug reaction with eosinophilia and systemic symptoms (DRESS) et un cas d’urticaire. Les scores d’imputabilite intrinseque des glycopeptides impliques variaient de I2 a I3. Les tests cutanes par IDR etaient positifs chez quatre des huit patients, avec une reactivite croisee entre T et V dans deux cas. La reintroduction de l’une des deux molecules etait realisee avec une bonne tolerance chez quatre patients. Discussion Ces resultats preliminaires suggerent que les tests cutanes medicamenteux pourraient aider a guider une eventuelle reintroduction d’un glycopeptide chez les patients ayant une suspicion de toxidermie a cette classe d’antibiotiques. Toutefois, la specificite des IDR aux glycopeptides doit etre encore evaluee. Les reactions croisees entre glycopeptides, observees chez deux de nos patients, ont deja ete rapportees dans la litterature mais ne paraissent pas systematiques.

Intradermal tests using a Culicoides nubeculosus extract have proven unreliable for diagnosis of equine insect bite hypersensitivity (IBH) in the Netherlands. The aim of this study was to evaluate the diagnostic value of an extract derived from the Dutch species C. obsoletus and C. pulicaris. Thirteen pairs of horses were tested, each pair consisting of one horse with IBH and the other a healthy control. Each horse was injected intradermally with 0.1 mL of three concentrations of Culicoides whole body extract (1 : 1000 w/v, 1 : 10,000 w/v and 1 : 25,000 w/v), histamine solution (0.01 mg/mL, positive control) and phosphate-buffered saline (negative control). Skin responses were evaluated after 30 min and at 1, 4 and 24 h. At all time points the absolute wheal diameter elicited by Culicoides extract 1 : 1000 w/v was significantly larger (P

Drug skin tests (eg, patch tests, prick tests with delayed readings, intradermal tests [IDT], especially with delayed readings) are used to investigate cutaneous adverse drug reactions (CADR) in delayed hypersensitivity reactions caused by a particular drug. Their value depends on the clinical features of the CADR and on the drug tested. In maculopapular rash (MPR), drug skin tests are of value, beginning with patch tests, and followed: 1) if negative by prick tests (with delayed readings at 24 hours); and, 2) if the injectable form of the drug is available, with IDT with immediate and delayed readings. This article discusses details of the use of patch tests as they apply to patients with various drug reactions. Drug skin tests are useful to study cross-reactivity between suspected drugs. False positive results can occur. The negative predictive value of drug skin tests is approximately 90%.

This article discusses the methodology of rapid readout tests, in particular skin-prick tests, open tests and epidermal tests with readouts at 30 minutes and intradermal tests. These tests are used for a large number of allergens: seasonal environmental airborne allergens, dust mites, household insects, animal allergens, moulds, food allergens, formed agents, occupational allergens, drug allergens, etc. We discuss the risk of cross allergies between allergens. Finally, the skin-prick test is the preferred first-line test because of its ease of use and safety.

Zu den 3 therapeutischen Saulen bei Patienten mit allergischer Rhinitis (AR) zahlt neben Karenzverfahren und medikamentoser Therapie die Hyposensibilisierungstherapie oder spezifische Immuntherapie (SIT). Die Effektivitat der SIT ist abhangig vom spezifischen Allergen, der Qualitat und kumulativer Gesamtdosis der verabreichten Allergenextrakte und dem Applikationsschema. Bei der Cluster-Therapie werden wahrend der Dosissteigerung 2–3 Injektionen je Behandlungstag verabreicht, wodurch das rasche Erreichen der Maximaldosis gewahrleistet wird. Wir untersuchten in dieser Studie 79 erwachsene Patienten (18–59 Jahre, Altersdurchschnitt: 27,4±7,2 Jahre) mit einer Hausstaubmilbenallergie hinsichtlich auftretender Nebenwirkungen des Cluster-Therapieschemas in der Dosissteigerungsphase. Es traten 129 ubersteigerte Lokalreaktionen (≥ Grad 1) auf, entsprechend 10,2% aller Injektionen (69% Grad-1-, 20% Grad-2-, 11% Grad-3- und keine Grad-4-Reaktionen). Systemische Reaktionen gab es 40-mal, entsprechend 3,2% aller Injektionen, hiervon waren 37 (92%) Stadium-1- und 3 (8%) Stadium-2-Reaktionen. Systemische Reaktionen der Stadien 3 und 4 wurden nicht beobachtet. Unter Sicherheitsaspekten ist die Cluster-SIT mit Depotallergenen eine interessante Alternative zu herkommlichen Therapieschemata fur die SIT.

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: Delayed reactions with betalactam antibiotics are a very common reason for consultation and a matter of numerous publications. Objective: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge. To analyse the characteristics of people showing this type of reaction. Methods: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. Results: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. Conclusions: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams.Background: Delayed reactions with betalactam antibiotics are a very common reason for consultation and a matter of numerous publications. Objective: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge. To analyse the characteristics of people showing this type of reaction. Methods: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. Results: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. Conclusions: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams.Background: Delayed reactions with betalactam antibiotics are a very common reason for consultation and a matter of numerous publications. Objective: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge. To analyse the characteristics of people showing this type of reaction. Methods: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. Results: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. Conclusions: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams.

Initially described by Adolfo Lutz in 1908, paracoccidioiodomycosis (PCM) is considered to be the most prevalent endemic systemic mycosis in Brazil and other Latin American countries. Based on data generated by epidemiological surveys employing intradermal tests for paracoccidioidin, the prevalence of

The objective of the study was to evaluate whether allergenic extracts of five house dust and storage mite species standardized for humans might be used for the diagnosis of canine atopic dermatitis (CAD). Extracts of Dermatophagoides pteronyssinus (Pyroglyphidae), D. farinae (Pyroglyphidae), Blomia tropicalis (Glycyphagidae), Lepidoglyphus destructor (Glycyphagidae) and Tyrophagus putrescentiae (Acaridae) were evaluated by intradermal testing in 20 healthy dogs (control) and 25 dogs with allergic dermatitis. A significant difference in the response was observed between the two groups (pO presente trabalho teve como objetivo avaliar se extratos alergênicos de cinco espécies de ácaros da poeira domiciliar e produtos armazenados, padronizados para humanos, podem ser utilizados no diagnóstico da dermatite atópica canina. Extratos de Dermatophagoides pteronyssinus (Pyroglyphidae), D. farinae (Pyroglyphidae), Blomia tropicalis (Glycyphagidae), Lepidoglyphus destructor (Glycyphagidae) e Tyrophagus putrescentiae (Acaridae) foram avaliados através de testes intradérmicos em 45 cães, dos quais 20 normais e 25 com dermatite alérgica. Uma diferença significativa foi observada no padrão de respostas obtidas dos dois grupos (p

The objective of the study was to evaluate whether allergenic extracts of five house dust and storage mite species standardized for humans might be used for the diagnosis of canine atopic dermatitis (CAD). Extracts of Dermatophagoides pteronyssinus (Pyroglyphidae), D. farinae (Pyroglyphidae), Blomia tropicalis (Glycyphagidae), Lepidoglyphus destructor (Glycyphagidae) and Tyrophagus putrescentiae (Acaridae) were evaluated by intradermal testing in 20 healthy dogs (control) and 25 dogs with allergic dermatitis. A significant difference in the response was observed between the two groups (p

Drug skin tests can be helpful in determining the cause of a cutaneous adverse drug reaction (CADR). Patch tests and prick tests can be performed with any commercialized form of a drug. Intradermal tests (IDTs) have a greater value, but their techniques have not been standardized. Moreover, IDTs can be done only if an injectable form of the drug is commercialized and are restricted to patients with nonsevere CADR. Prick tests and IDTs are used in investigating immediate hypersensitivity. Patch tests both with IDTs with delayed readings are helpful for maculopapular rash and generalized or localized eczema. Results obtained with drug skin tests in β-lactam sensitization have been extensively published, but fortunately, during the last few years the value of skin tests in CADR due to other drug classes (e.g., synergistins, platinium salts or radiocontrast medias) was also studied. The analysis of recent literature permits to propose which tests to choose for each clinical feature of CADR and to give the lis...

Canine atopic dermatitis (CAD) is a common dermatosis, defined as a genetic-related disease which predisposes to skin inflammation and pruritus, associated to a IgE-specific response in most of cases. Clinical diagnosis may be later complemented by skin allergy and/or serological tests. The aim of these tests is to identify possible allergens in order to enable the clinicians to select candidate antigens for allergen specific immunotherapy. In the present study 58 CAD positive animals were tested. All were submitted to the intradermal test (IDT) and screened for the presence of antibodies against different antigens using ELISA. The obtained results show a high prevalence of sensitization among the tested dogs to house dust mites and to pollen ofC. dactylon. With this work it was possible to identify the main allergens involved in immunological response of dogs with CAD living in central area of Rio Grande do Sul. RESUMO A dermatite atópica canina (DAC) é uma dermatose comum, definida como doença de cunho genético que predispõe à inflamação e ao prurido cutâneo, associados à resposta IgE específica na maior parte dos casos. O diagnóstico da DAC é clínico e pode ser posteriormente complementado por testes alérgicos cutâneos e/ou sorológicos. O objetivo desses testes é identificar possíveis alérgenos e, com isso, possibilitar ao clínico a seleção de antígenos candidatos para a imunoterapia alérgeno-específica. No presente estudo, foram testados 58 animais diagnosticados para DAC. Todos os animais foram submetidos ao teste cutâneo intradérmico (TID), e amostras de sangue foram coletadas para a realização de testes sorológicos. Os resultados obtidos demonstraram elevada prevalência de sensibilização aos ácaros domiciliares e ao pólen da gramínea C. dactylon nos cães testados. Com este trabalho, foi possível identificar os principais alérgenos envolvidos na resposta imunológica de cães atópicos residentes na região central do Rio Grande do Sul.

Pythiosis is a granulomatous disease of humans and animals caused by an aquatic oomycete named Pythium insidiosum. In Brazil, equine species is the most affected and the highest occurrence of pythiosis is observed in Brazilian Pantanal. Nowadays, in Rio Grande do Sul (RS), in South of Brazil, there has seen an increase in the number of equine pythiosis. Nevertheless, there is no information about seroprevalence in Brazil. Early diagnosis is the key to success in controlling this infection. Currently, immunotherapy with proteic antigens has been studied as a promising alternative of treatment. The intradermal (ID) route to apply proteic antigen is an option to be evaluated, for both early diagnosis and pythiosis treatment, by using proteic antigens of P. insidioum. In this study it was investigated the seroprevalence of equine pythiosis in the RS State and also it was evaluated and compared the use of proteic antigens of P. insidiosum by the ID route in the diagnosis and control of pythiosis in an experimental model (Oryctolagus cuniculus). To determine the prevalence of equine pythiosis in RS it was used 1002 equine serum samples evaluated by indirect ELISA test. Of the total samples tested, 11.1% (111/1002) were seropositive for equine pythiosis. For the diagnosis it was applied 0.1mL (1.7mg) of proteic antigen by ID route in rabbits (O.cuniculus) (n = 15) divided into three groups: negative control (n = 5), with experimental pythiosis (n = 5) and animals previously immunized with the proteic antigen (n = 5). In order to verify and compare the use of proteic antigen of P. insidiosum by ID as an option of treatment it was used ten rabbits with pythiosis. Five rabbits with pythiosis were treated with 0.1mL proteic antigen applied through ID and other five rabbits by subcutaneous (SC) route with 2mL (34mg) (n = 5). The ID test was able to detect cutaneous reactions in 24h and 72h in all animals exposed to P. insidiosum, as well as it demonstrated sensitivity and specificity comparable with the pattern of diagnosis of pythiosis (indirect ELISA). The treatment proteic antigen of P. insidiosum, by ID and SC route, did not observed difference (P> 0.05) in the size of the lesions. However, the clinical cure affect as 40% of rabbits in both groups. Thus, protein antigen of P. insidiosum by ID may be used in therapeutic protocols of pythiosis in rabbits, also this route as a protocol of pythiosis has other advantages such as lower protein concentration and volume of antigen to control pythiosis. However, research is needed for evaluation of ID route for diagnosis and control of pythiosis in naturally affected species. A pitiose é uma doença granulomatosa de humanos e animais, causada pelo oomiceto aquático Pythium insidiosum. A maior ocorrência da enfermidade no Brasil é na espécie equina, especialmente no Pantanal Mato-Grossense, porém no Rio Grande do Sul (RS) observa-se um aumento dos casos da doença. Todavia, não há dados de soroprevalência da pitiose no Brasil. O diagnóstico precoce da enfermidade é fundamental para sucesso no controle da pitiose. Atualmente, a imunoterapia com antígenos proteicos vem sendo estudada como uma alternativa promissora de tratamento. A via intradérmica (ID) é uma opção a ser avaliada tanto para um diagnóstico precoce quanto para o tratamento da pitiose empregando antígenos proteicos de P. insidiosum. Neste estudo investigou-se: a soroprevalência da pitiose equina no estado do RS, bem como avaliou-se e comparou-se o uso de antígenos proteicos de P. insidiosum pela via ID no diagnóstico e controle da pitiose em modelo experimental. Para determinar a soroprevalência da pitiose equina no RS foram utilizadas 1002 amostras de soro equino avaliadas pelo método de ELISA indireto. Do total das amostras testadas, 11,07% (111/1002) foram soropositivas para a pitiose equina. Para o diagnóstico aplicou-se 0,1 mL (1,7mg) de antígeno proteico pela via ID, em coelhos (Oryctolagus cuniculus) (n=15) separados em três grupos: controle negativo (n=5), com pitiose experimental (n=5) e animais previamente imunizados com antígeno proteico (n=5). A fim de verificar e comparar a aplicação do antígeno proteico pela via ID como opção de tratamento utilizaram-se dez coelhos com pitiose. Cinco animais foram tratados com 0,1mL de antígeno proteico aplicado via ID e outros cinco coelhos foram tratados pela via subcutânea (SC) com 2mL (34mg) do antígeno. O teste ID foi capaz de detectar reações cutâneas em 24h e 72h nos animais previamente expostos ao agente, demonstrando sensibilidade e especificidade comparáveis ao teste padrão de diagnóstico da pitiose (ELISA indireto). No tratamento com antígeno proteico pelas vias ID e SC, embora não tenha sido observada diferença (P>0,05) no tamanho das lesões, a cura clínica em 40% dos coelhos de ambos os grupos demonstrou que a via ID pode ser utilizada em protocolos terapêuticos da pitiose em modelo experimental, pois também apresenta outras vantagens como menor concentração e volume de antígeno proteico para o controle da pitiose. No entanto, são necessárias pesquisas para o emprego da via ID no diagnóstico e controle da pitiose nas espécies naturalmente acometidas.

Canine atopic dermatitis (CAD) is a common dermatosis, defined as a genetic-based disease, which predisposes to cutaneous inflammation and pruritus, mediated by class IgE immunoglobulins directed against specific antigens in most cases. Clinical diagnosis may be later complemented by skin allergic and/or serological tests (ELISA). The aim of these tests is to identify possible allergens in order to enable the clinicians to select candidate antigens for allergen specific immunotherapy. This work aimed to identify the sensitization profile of 58 dogs with atopic dermatitis diagnosis. All animals were submitted to intradermic test (IDT) and screened for the presence of antibodies against different allergens using a serologic test. House dust mites are described as the most frequent allergens in all continents. However, the positivity to C. dactylon is not commonly described and may be characteristic for the region. With this work it was possible to identify the main allergens involved in the immunologic response of atopic dogs residing in Rio Grande do Sul, pointing to the importance to include C. dactylon in screening tests for allergy. A dermatite atópica canina (DAC) é uma dermatose comum, definida como uma doença de cunho genético que predispõe à inflamação e ao prurido cutâneo, mediada por imunoglobulinas da classe IgE dirigidas contra antígenos específicos na maior parte dos casos. O diagnóstico da DAC é clínico e pode ser posteriormente complementado por testes alérgicos cutâneos e/ou sorológicos. O objetivo desses testes é identificar possíveis alérgenos e, com isso, possibilitar ao clínico a seleção de antígenos candidatos para a imunoterapia alérgeno-específica. No presente trabalho buscou-se identificar o perfil de sensibilização de 58 cães diagnosticados com dermatite atópica. Todos os animais foram submetidos ao teste intradérmico (TID) e à detecção de anticorpos específicos para diferentes alérgenos através de teste sorológico (ELISA). Os ácaros domiciliares são descritos como os alérgenos mais frequentes em todos os continentes. Entretanto, a positividade ao C. dactylon não é usualmente descrita e pode ser característica da região. Com esse trabalho foi possível identificar os principais alérgenos envolvidos na resposta imunológica de cães atópicos residentes no Rio Grande do Sul, ressaltando-se a importância da inclusão do extrato de C. dactylon em testes alérgicos.

We introduce silicone allergy as a rare cause for cochlear implant extrusion and discuss its management.Retrospective case series and literature review.Tertiary referral centers.Primary eligibility criteria included patients who experienced a delayed extrusion of their cochlear implants with negative wound cultures and had a suspected or a test-proven allergy to silicone components of an implant.Silicone allergy testing, explantation of a cochlear implant containing allergenic silicone materials, reimplantation with a custom-made cochlear implant excluding an allergenic silicone component.Uneventful wound healing and extrusion-free long-term follow-up after the reimplantation with a custom-made cochlear implant excluding an allergenic silicone component.Three known cases of cochlear implant extrusion as a result of silicone allergy have been noted from 1991 through 2004 in three cochlear implant programs in the United States. All three devices extruded, resulting in explantation of the old device and reimplantation with a new custom-made device eliminating the allergenic silicone component. Wound cultures were negative in all cases. All three patients experienced a delayed extrusion of their devices. Two of these patients had a test-proven allergy to the implant's silicone components, whereas the third patient was presumed to have a hypersensitivity solely on the basis of a clinical presentation.We propose that silicone allergy is a rare cause of cochlear implant extrusion. Patients experiencing cochlear implant extrusion, particularly with a delayed onset and negative wound culture results, should be tested for silicone allergy.