Intradermal skin tests development

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. 

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. 

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 ]. 

Immunologic A 46-year-old woman had an IgE-mediated hypersensitivity reaction to transdermal fentanyl and developed generalized erythema and bronchospasm 4 hours after the application of transdermal fentanyl. In preparation for another surgical procedure, skin tests were carried out [90 ]. A prick test for fentanyl was negative, but an intradermal test was positive. There was also cross-reactivity to sufentanil. The delay in response between application and the onset of symptoms was believed to be due to the cutaneous route of administration. 

A 44-year-old woman, who had previously tolerated moxifloxacin, developed pmritus, urticaria, and angioedema 10 minutes after a dose of moxifloxacin [IV j. Skin tests were performed with various quinolones and only the intradermal test with moxifloxacin was positive. She tolerated an oral challenge with... 

An asthmatic patient using inhaled budesonide and salbutamol developed an acute asthma attack. Despite emergency treatment the patient deteriorated, requiring endotracheal intubation and assisted ventilation, and there was no improvement until the glucocorticoid was withdrawn, after which there was steady improvement. Skin prick tests with prednisolone, sodium hemisuccinate, and 6-methylprednisolone-sodium hemisuccinate were positive. Thirty minutes after intradermal 6-methylprednisolone-sodium hemisuccinate 4 mg, the patient developed a dry cough, dyspnea, and wheezing and a 17% fall in FEVi. 

A 5-year-old child with diabetes, Pierre Robin syndrome, cleft palate, allergic rhinitis, recurrent sinusitis, and obstructive sleep apnea, who had previously had skin rashes after penicillin, sulfonamides, and clindamycin, was given soluble and isophane human insulins (131). Three years later she developed local reactions, 2-5 cm areas, 30-120 minutes after injection. Skin-prick tests were negative for the diluent, isophane, and soluble insulin, but intradermal testing was positive with both insulins. Cetirizine and dexamethasone added to the insulin gave temporary relief. She was... 

A 30-year-old woman developed a generalized urticarial reaction immediately after the intravenous administration of aminophylline (4). Skin intradermal testing was positive to ethylenediamine. Rechallenge was positive with intravenous aminophylline but negative with diprophylline, which does not contain ethylenediamine. 

A 4-year-old girl developed angioedema and urticaria 30 minutes after receiving rectal morniflumate. Her signs and sjmptoms resolved in 48 hours. Skin prick and intradermal tests to morniflumate were negative, but rechallenge with rectal administration caused a recurrence (1). 

Ribonucleic acid has been used to enhance immune function in patients with cancer. Of 83 patients who received subcutaneous injections of ribonucleic acid (10 mg every other day) for various skin diseases, three developed an erythematous edematous reaction around the injection sites after the 7th to 15th injections (1). Although patch tests were negative in all three patients, lesions were reproduced after intradermal injection in one patient. 

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