Skin testing diagnosis

For skin test diagnosis, gelatin solutions are used undiluted (for Gelofusine, Haemaccel, and gelatin solutions 35 mg/ml) in the skin prick test and at dilutions of from 1 in 1,000 to 1 in 10 for intradermal tests. 

If patients have experienced anaphylaxis, the identification of any possible elicitor is important to help avoid further episodes. With skin tests and specific IgE antibodies combined with history, a relevant allergy may be detected. Cellular tests monitoring basophil histamine release or basophil activation may be helpful in some patients who resist diagnosis by standard means [26,31]. 

The p-lactams (penicillins and their derivatives) are the drugs which most frequently cause IgE-mediated anaphylactic reactions. Diagnosis is based on skin tests. To date, the best vaUdated in vitro diagnostic methods are specific IgE and BAT. As for the determination of specific IgE using ImmimoCap (Phadia AB, Uppsala, Sweden), the sensitivity of the technique in the diagnosis of immediate reaction to (3-lactams with positive skin test ranges, according to the study, from 37 to 54% with a specificity of between 83 and 100% [23,24]. 

Perform allergy diagnosis (after 3-4 weeks including in vitro diagnosis, skin test and if necessary provocation tests)... 

Bock, S. A., Buckley, J., Holst, A., and May, C. D. (1977). Proper use of skin tests with food extracts in diagnosis of hjqjersensitivity to food in children. Clin. Allergy 7, 375-383. 

Helbling A, Gayer F, Pichler WJ, Brander KA Mushroom (Basidiomycete) Allergy Diagnosis established by skin test and nasal challenge. J Allergy Clin Immunol 1998 102 853-858. 

Outcome strongly depending from the quality of the extract used. Not aU of these criteria may be present in a patient at a given time because they vary with the activity and stage of the disease [44, 46]. A serologic diagnosis of ABPA can be considered as estahhshed if criteria 6, 7 and 8 are positive [45]. If skin tests are negative, ABPA can he excluded [37]. 

Therapy depends on etiology. In individuals who are suspected of having tuberculosis, diagnosis should make use of a purified protein derivative skin test, chest radiograph, and sputum cultures if necessary. These individuals should be referred for comanagement to their primary physician or to an infectious disease specialist. Though antituberculin agents are systemically administered, the ocular lesions are appropriately treated with topical steroids. In most instances, patients respond to 1% prednisolone acetate every 3 to 4 hours for the first day, subsequently tapered rapidly on the basis of the clinical response. 

This reaction shared the features of a delayed hypersensitivity reaction (exanthematous rash, positive patch test) and of a late phase reaction (CD4+ lymphocjdic infiltrate together with eosinophils). The authors emphasized the importance of skin testing in the diagnosis of delayed skin reactions to contrast media. 

The diagnosis of an allergic reaction to a muscle relaxant is based on clinical features, measurement of histamine and tryptase concentrations in the plasma during the reaction, and subsequent skin testing a few weeks later. However, during general anesthesia isolated sjmptoms can occur, most often hypotension or bronchospasm. Therefore, the clinical features of anaphylaxis may not be recognized as such. 

Ressler C, Mendelson LM. Skin test for diagnosis of penicillin allergy—current status. Ann Allergy 1987 59(3) 167-70. 

Techniques for the diagnosis of anaphylactic sensitivity to hymenoptera (bees, wasps, ants, etc.) stings have been difficult to establish. Studies with commercially available whole body extracts of hymenoptera for skin testing were unable to discriminate between hypersensitive and control subjects. Use of hymenoptera venom skin tests clearly distinguishes between allergic and normal subjects and this venom was made available to the National Institute of Allergy and Infectious Diseases for further uses as a diagnostic material in 1976. ... 

Brockow, K., 8c Romano, A (2008). Skin tests in the diagnosis of drug hypersensitivity reactions. Current Pharmaceutical Design, 14 (27), 2778-2791. 

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