Skin intradermal test

Measurement of plasma tryptase levels immediately (1-4 h) following an episode may be useful to confirm that a histaminoid reaction has occurred. Some four weeks later, intradermal skin tests and specific antibody tests (radioallergosorbent PAST, enzyme-linked immunosorbent ELISA) may help to identify the causative drug, although these tests do produce false-positive and false-negative results. 

She lost consciousness and developed arterial hypotension. She responded to intravenous diphenhydramine and hydrocortisone. Intradermal skin tests were positive for prednisone and negative for methylprednisolone and hydrocortisone. An oral challenge test with prednisone led to flushing, nausea, dizziness, tachycardia, and hypotension and responded to intravenous diphenhydramine and hydrocortisone. Challenge tests with intravenous methylprednisolone and hydrocortisone were negative. 

Park S, Ohya F, Yamashita K, et al Comparison of response to immunotherapy by intradermal skin test and antigen-specific IgE in canine atopy. J Vet Med Sci 2000 62 983-988. 

Positive intradermal skin tests using pure vitamin B12 were seen in 2 out of 1000 individuals tested, although they did not react to an intramuscular injection (B23). 

Table 3. Correlation between intradermal skin test reactivity and absolute levels of allergen-specific IgE in serum of A. fumigatus-sensitized individuals and healthy controls... 

Fig. 3. Intradermal skin test with rAsp f 1 and rAsp f 3 and allergen-specific IgE values. rAsp f 1 or rAsp f 3 allergen solutions were injected into the skin of A. fumigatus-sensitized asthma patients with or without ABPA. Results were grouped according to negative (—) or positive (+) intradermal skin tests and plotted against the allergen-specific IgE values determined hy ELISA. The hatched area represents the cut-off value indicating the level of allergen-specific IgE in serum required for a positive skin test.

The major adverse reactions to the penicillins are hypersensitivity responses. Manifestations of hypersensitivity inclnde nrticaria, angioedema, and anaphylaxis (type 1 reaction) hemolytic anemia (type 11 reaction) interstitial nephritis, vascnlitis, and serum sickness (type 111 reaction) and contact dermatitis or Stevens-Johnson syndrome (type IV reaction). A maculopapular rash occnrs late in the treatment course of 2% to 3% of patients receiving a penicillin drug. Once a patient has had a hypersensitivity response to a penicillin, it is probable, bnt not certain, that a reaction will occur with exposure to the same penicillin or to any other penicillin. Intradermal skin tests can predict whether a patient is at risk for developing a hypersensitivity reaction to the penicillins. If the resnlts are positive, penicillins should generally be avoided. 

Extreme sensitivity to an intradermal skin test (0.003 mg), some 24 hours after a severe skin reaction to the intravenous administration of atracurium, has been described (37). 

In order to prove an underlying allergic disorder, an intradermal skin test with commercial formulations of the platinum compound in different concentrations (for example 0.003-1 mg/ml) can be done (250). 

Other authors have reported the value of the lymphocyte transformation test. Lehner (1971) reported positive results in four patients with suspected allergy to local anaesthetics, in whom the intradermal skin test was negative. 

Brown GL, Kanware BS (1967) Drug rashes in glandular fever. Lancet 2 1418 Budd MA, Parker CW, Norden CW (1964) Evaluation of intradermal skin tests in penicillin hypersensitivity. JAMA 190 203... 

Nicolas et al. (1966) have performed intradermal skin tests in reactors and nonreactors to Lipiphysan and in apparently healthy volunteers. Positive delayed skin... 

ALLERGENS/THER USE ANTACIDS/THER USE ANTIBODY FORMATION/ DRUG EFF ANTIGENANTIBODY REACTIO/DRUG EFF DESENSITIZATION ENGLISH ABSTRACT HUMAN HYPERSENSITIVITY/THERAPY IMMUNIZATION INJECTIONS INTRADERMAL SKIN TESTS... 

Intradermal skin tests are not entirely safe, as has been underlined by the case of a 59-year-old man who died after receiving intradermal ceftriaxone following an allergic reaction 1 month before 5 minutes after injection of an undetermined diluted solution of ceftriaxone into the left forearm he developed severe bronchospasm, dyspnea, restlessness, and generalized pruritus and died despite vigorous treatment [22 ]. 

Fig. 4.2 An intradermal skin test being performed. Note the small blister or bleb formed from the solution injected into the dermis (Photograph courtesy of Dr. Paul A.J. Russo, Department of Clinical Immunology and Allergy, Royal Adelaide Hospital)...

Skin testing with vancomycin and teicoplanin has not been well studied and the procedure remains to be validated with both positive and negative predictive values unknown. Skin test results, and particularly details of drug concentrations used and methodologies employed, are hard to find in the vancomycin-teicoplanin literature on adverse reactions. In a case study of vancomycin anaphylaxis followed by successful desensitization, intradermal skin tests with the drug were positive at a concentration of 0.1 pg/ml. Control subjects showed positive responses at concentrations of 10 pg/ml or greater. A loss of skin test reactivity to vancomycin has been demonstrated in one case study after successful desensitization to the drug. 

Immunologic A patient with a hemopoietic stem cell transplant and a history of an immediate hypersenstivity reaction to mica-fungin was considered for a trial of caspofungin, but a caspofungin intradermal skin test was positive, suggesting cross-reactivity [86" ]. Thus, the cyclic peptide nucleus chemical structure shared by echinocandins may be the site of IgE recognition, and it would be prudent to avoid challenging patients with history of immediate hypersensitivity to one echinocandin with another. 

Gurrently, there is no good clinical mechanism to predict the occurrence of adverse reaction to iodinated contrast. Preliminary intradermal skin testing with contrast agents is not predictive of adverse reactions, may itself be dangerous, and is not recommended [16 ]. 

A well-documented case of severe (lethal) anaphylaxis has recently been reported, confirming similar earlier observations. The authors suggest that intradermal skin tests should be performed if there is any doubt about potential allergy (83 ). 

Hurst DS. Association of otitis media with effusion and allergy as demonstrated hy intradermal skin testing and eosinophil cationic protein levels in both middle ear effusion and mucosal biopsies. Laryngoscope 1996 106 1128-1137. 

---