scholarly journals Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

2012 ◽  
Vol 140 (3-4) ◽  
pp. 233-235 ◽  
Author(s):  
Marina Atanaskovic-Markovic ◽  
Marija Gavrovic-Jankulovic ◽  
Srdja Jankovic ◽  
Gordan Blagojevic ◽  
Tanja Cirkovic-Velickovic ◽  
...  
Keyword(s):  
Allergic Reaction ◽  
Anaphylactic Reaction ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Clinical Findings ◽  
Skin Tests ◽  
Type I ◽  
Positive Skin ◽  
Uncommon Case ◽  
Type I Hypersensitivity

Introduction. In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. Case Outline. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT) was positive. Conclusion. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of cross-reactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.

scholarly journals Allergy to cephalosporin antibiotics in children

2003 ◽  
Vol 131 (3-4) ◽  
pp. 127-130 ◽  
Author(s):  
Marina Atanaskovic-Markovic ◽  
Branimir Nestorovic
Keyword(s):  
Allergic Reaction ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Allergic Reactions ◽  
First Line ◽  
Positive Skin ◽  
Cephalosporin Antibiotics ◽  
The Cross ◽  
Single Blind ◽  
Common Infections

A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children?s Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2 % to 17 %, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1 % to 14.5 %, and among cephalosporins is 0 % to 11.7 %.

THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽  
1959 ◽  
Vol 24 (6) ◽  
pp. 1009-1015
Author(s):  
Richard L. London ◽  
Jerome Glaser
Keyword(s):  
Skin Test ◽  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Etiologic Factor ◽  
Initial Reaction ◽  
Age Group ◽  
Positive Skin ◽  
Clinical Sensitivity ◽  
Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

scholarly journals Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Manzo Suzuki ◽  
Hajime Kawase ◽  
Azusa Ogita ◽  
Hiroyasu Bito
Keyword(s):  
General Anesthesia ◽  
Skin Testing ◽  
Blocking Agent ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Intradermal Test ◽  
Skin Tests ◽  
Prick Test ◽  
Causative Drug ◽  
Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

scholarly journals Increased IgE Deposition in Appendicular Tissue Specimens Is Compatible with a Type I Hypersensitivity Reaction in Acute Appendicitis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Nuno Carvalho ◽  
André Barros ◽  
Hélder Coelho ◽  
Ana Cóias ◽  
Pedro Botelho ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Hypersensitivity Reaction ◽  
Allergic Reaction ◽  
Standard Procedure ◽  
Control Group ◽  
Common Disease ◽  
Type I ◽  
Tissue Destruction ◽  
Gangrenous Appendicitis ◽  
Type I Hypersensitivity

Background. IgE mediates type I hypersensitivity reaction and can be found in the mucosa of organs affected by allergy. Acute appendicitis (AA) is a common disease, but its etiology remains poorly understood. Here, we investigated IgE deposition in histological sections of AA samples to test the hypothesis that an allergic reaction may substantially contribute to the pathophysiology of AA. Materials and Methods. In a retrospective study, we assessed the presence of IgE in appendicular specimens of histologically confirmed appendicitis and in the control group, comprised of negative appendicitis and incidental appendectomies, using a monoclonal antibody against human IgE. Samples from 134 appendectomies were included: 38 phlegmonous and 27 gangrenous appendicitis from the study group and 52 incidental appendectomies and 17 negative appendicitis from the control group. The slides were visualized by light microscopy, and a standard procedure was used to manually count the positive IgE staining cells. Results. IgE staining was present in the cells of all but 5 appendicular specimens. We found a significantly increased number of IgE-positive cells in phlegmonous AA ( median = 28 ) when compared to incidental appendectomy ( median = 17 ) ( p = 0.005 ; p < 0.0001 when adjusted for age and gender). No difference was found for gangrenous appendicitis. Discussion. The presence of IgE supports the contribution of an allergic reaction for the pathophysiology of phlegmonous appendicitis. The reduced number of IgE staining cells in gangrenous appendicitis can be due to tissue destruction, or, as been claimed by others, gangrenous appendicitis is a distinct entity, with different etiology. Conclusion. In this study, phlegmonous appendicitis had the highest number of IgE-positive appendicular cells. These findings suggest that an allergic reaction can contribute to the pathophysiology of AA, opening a novel possibility for preventive measures in a disease that typically requires surgery.

scholarly journals Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy

2014 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Manish D Shah ◽  
Sarah K Wise ◽  
Melissa R Rotella ◽  
Avani P Ingley ◽  
Michael M Johns
Keyword(s):  
Retrospective Review ◽  
Skin Testing ◽  
Causal Link ◽  
Skin Tests ◽  
Insufficient Evidence ◽  
Positive Skin ◽  
Nasal Symptoms ◽  
Significant Difference ◽  
Inhalant Allergy ◽  
Allergy Skin Testing

ABSTRACT Background The effect of environmental allergy on laryngeal and pharyngeal complaints is not well understood. The goal of this study was to determine the prevalence of laryngeal and pharyngeal symptoms in patients with environmental inhalant allergy. Methods A retrospective review was conducted of all patients undergoing allergy skin testing between 2006 and 2009. Patients with positive skin tests were included and were classified as ‘mild’ or ‘extensive’ reactors based on skin testing results. Data regarding laryngeal and pharyngeal complaints, as well as ocular and nasal symptoms, had been systematically documented for all patients. The prevalence of these complaints was calculated in each group of reactors and overall. Results The prevalence of laryngeal and pharyngeal complaints was 42.0% overall, 45.5% among the mild reactors, and 39.3% in the extensive reactors. No patients complained of hoarseness or were felt to have dysphonia. There was no statistically significant difference between the mild and extensive reactors (p = 0.78). The prevalence of ocular and/or nasal symptoms was 96.0, 90.9 and 100%, respectively. Conclusion The prevalence of laryngeal and pharyngeal complaints in allergy sufferers was low in this study. Given the conflicting literature on this topic, there is insufficient evidence to establish a causal link between environmental allergy and laryngeal and pharyngeal symptoms. How to cite this article Shah MD, Wise SK, Rotella MR, Ingley AP, Johns MM. Prevalence of Laryngeal and Pharyngeal Symptoms in Patients with Environmental Allergy. Int J Phonosurg Laryngol 2014;4(1):1-4.

Skin testing in allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 366-368
Author(s):  
Gayatri Patel ◽  
Carol Saltoun
Keyword(s):  
Skin Test ◽  
Immunoglobulin E ◽  
Clinical Symptoms ◽  
Skin Testing ◽  
Smooth Muscle Contraction ◽  
Skin Tests ◽  
Test Reaction ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Clinical Sensitivity

Skin tests are used in addition to a directed history and physical examination to exclude or confirm immunoglobulin E (IgE) mediated diseases, such as allergic rhinitis, asthma, and anaphylaxis, to aeroallergens, foods, insect venoms, and certain drugs. There are two types of skin testing used in clinical practice: percutaneous testing (prick or puncture) and intracutaneous testing (intradermal). Prick testing involves introducing a needle into the upper layers of the skin through a drop of allergen extract that has been placed on the skin and gently lifting the epidermis up. Various devices are available for prick testing. Intracutaneous (intradermal) testing involves injecting a small amount of allergen into the dermis. The release of preformed histamine from mast cells causes increased vascular permeability via smooth-muscle contraction and development of a wheal; inflammatory mediators initiate a neural reflex, which causes vasodilatation, which leads to erythema (the flare). Prick testing methods are the initial technique for detecting the presence of IgE. These may correlate better with clinical sensitivity and are more specific but less sensitive than intradermal testing. Sites of skin testing include the back and the volar aspect of the arm. By skin testing on the arm, the patient can witness the emergence and often sense the pruritus of the skin test reaction. Because more patients are sensitized (have IgE antibodies and positive skin test reactions) than have corresponding symptoms, the diagnosis of allergy can be made only by correlating skin testing results with the presence of clinical symptoms.

Skin Tests in the Diagnosis of Allergic Conditions

1981 ◽  
Vol 2 (10) ◽  
pp. 327-332
Author(s):  
Lillian P. Kravis
Keyword(s):  
Skin Test ◽  
Skin Testing ◽  
Clinical History ◽  
Skin Tests ◽  
Food Allergies ◽  
Type I ◽  
Test Results ◽  
Type Iv ◽  
Transfer Testing ◽  
Allergic Disorders

Allergic disorders may be classified into four main categories of immunologic hypersensitivity reactions: type I, immediate or anaphylactic; type II, cytotoxic; type III, involving immune complexes; and type IV, delayed or cell mediated. Type I reactions are those most commonly encountered in clinical allergy. They may be well defined by skin testing, provided the patients to be tested are carefully selected and the tests are applied properly and interpreted critically. Major indications for direct skin testing are: (1) to separate atopic from nonatopic patients; (2) to help in identifying specific allergens in atopic persons; and (3) to reassess the allergic profile in patients receiving immunotherapy. Other indications for skin-testing, of more limited applicability, include: (1) screening for hypersensitivity to vaccines; (2) testing for reactivity to drugs (and particularly penicillin); (3) testing for immediate and delayed reactions in such conditions as bronchopulmonary aspergillosis; and (4) in evaluation of patients with reactions to insect stings. Skin-testing has limited usefulness in early infancy, in chronic urticaria, in the investigation of food allergies, in atopic dermatitis not accompanied by other manifestations of atopy, or in allergic reactions to drugs other than penicillin. A checklist to be consulted prior to performing or interpreting skin tests should include: (1) assurance of the potency of the extract used in testing; (2) knowledge of the nonspecific irritant properties of any extracts used for testing; (3) history of administration of antihistamine drugs or epinephrine prior to testing; and (4) the correlation of skin test results with clinical history. The help of a qualified allergist should be sought if: (1) skin test results are at variance with the historical data; or (2) systemic reactions are induced by skin testing; or (3) the patient fails to respond to the therapy dictated by the skin test results. Alternatives or supplements to skin-testing include RAST testing and measurement of histamine release from sensitized leukocytes. These have rendered passive transfer testing (PK or Prausnitz-Küstner) substantially obsolete. Direct allergy skin testing remains the most sensitive, most specific, and most reliable method presently available to the physician for investigation of IgE-mediated allergic disorders.

Skin Testing for Penicillin Allergy: Its Limited Value

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 309-309
Author(s):  
Renee K. Bergner
Keyword(s):  
American Academy ◽  
Skin Testing ◽  
Skin Tests ◽  
Penicillin G ◽  
Study Group ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
American Academy Of Pediatrics ◽  
History Of ◽  
Therapeutic Administration

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2

CROSS-REACTING ALLERGENS IN NATURAL RUBBER LATEX AND AVOCADO

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 324-324
Author(s):  
Martin Sachs
Keyword(s):  
Natural Rubber ◽  
Natural Rubber Latex ◽  
Cross Reactivity ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Rubber Latex ◽  
Type I Hypersensitivity

There is considerable cross-reactivity between natural rubber latex and avocado. This cross-reactivity explains the type I hypersensitivity reactions to natural rubber latex and avocado in patients with a preexisting allergy to either allergen.

scholarly journals Successful Desensitization of a Patient with Aplastic Anemia to Antithymocyte Globulin

2015 ◽  
Vol 6 (1) ◽  
pp. ar.2015.6.0110 ◽  
Author(s):  
Stephanie A. Wolanin ◽  
Jeffrey G. Demain ◽  
Eric A. Meier
Keyword(s):  
Aplastic Anemia ◽  
Skin Test ◽  
Antithymocyte Globulin ◽  
Skin Testing ◽  
Serum Sickness ◽  
Literature Discussion ◽  
Type I ◽  
Life Threatening ◽  
Delayed Reactions ◽  
Type I Hypersensitivity

Antithymocyte globulin (ATG) is a polyclonal gamma immunoglobulin derived from either rabbit or equine serum that serves as therapy for aplastic anemia; however, ATG causes serum sickness in up to 70% and anaphylaxis in up to 5% of recipients. Intradermal (ID) skin testing has been the primary technique used to evaluate for a preexisting Gell and Coombs type I hypersensitivity reaction to ATG. There are no data reporting the predictive value of delayed reactions to ID testing on the risk of serum sickness. This study was designed to establish the importance of epicutaneous and ID skin testing before the administration of ATG through a case report and literature discussion. We report a patient with severe aplastic anemia that was successfully desensitized to ATG after a negative epicutaneous skin test and positive ID skin test. The patient had neither systemic nor localized reactions during the desensitization. Desensitization to ATG in patients with positive epicutaneous skin testing has been shown to be associated with serious and potentially life-threatening complications and should only be considered when the benefits outweigh the risks. Epicutaneous skin testing should be considered in conjunction with ID skin testing when screening for potential sensitivity to ATG. Because of the serious risk of anaphylaxis, desensitization should be performed in an intensive care unit setting in conjunction with a physician familiar with drug desensitization and the management of anaphylaxis.

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