Pharmacological influence of antiallergic medication on <i>in vivo</i> allergen testing

Pipkorn, Ulf

doi:10.1111/j.1398-9995.1988.tb00398.x

Cited by 49 publications

(25 citation statements)

References 41 publications

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“…136 Bronchodilators, epinephrine and theophylline do not signifi cantly suppress skin reactivity. 137 In the case of cysteinyl leukotrienes antagonists (e.g. montelukast and zafi rlukast) 138 or EMLA cream 139 , no signifi cant effect on wheal-and-fl are reaction has been described either.…”

Section: Variability Factorsmentioning

confidence: 99%

Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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Skin testing remains an essential diagnostic tool in modern allergy practice. A signifi cant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors. Skin has an important physiological role in the internal balance homeostasis and constitutes a crucial barrier against external aggressions, with well-known immunological properties. 1 It has been used by allergists for decades as an easily assessed laboratory of the immunological status of the individual.The fi rst skin testing technique was developed by Charles H. Blackley in 1865, a Manchester homeopathic physician with allergic rhinitis. He abraded a quarter-inch area of his skin with a lancet and then applied grass pollen grains. 2 The so-called scratch test was later adopted by Schloss for the diagnosis of food allergy in children. 3 Epicutaneous tests can be divided into scratch tests and prick/puncture tests. The fi rst method, proposed by Blackley 2 , implied a linear scratch without drawing blood and could either be performed fi rst, with the extract then dropped on the abraded skin, or be made through a drop of extract. 4 Although it was used extensively in the past, this technique became progressively obsolete due to patient discomfort, poor reproducibility, possible residual lesions and newer and innocuous procedures. 4 Therefore, scratch test is mentioned here for historical purposes only. It was Sir Thomas Lewis who, in 1924, fi rst applied skin prick tests (SPT). 5 Nevertheless, their generalised use in clinical practice only became a reality about 30 years ago, as a result of technique modifi cations proposed by Pepys. 6 For the purpose of this review and for easier comprehension, skin testing will be referred interchangeably as SPT, whatever device is used for its application.In 1966, Ishizaka's work on immunoglobulin E (IgE) and immediate hypersensitivity reactions 7 established the scientifi c corpus to what was done till then on a strictly empiric basis.As written by Dr Walzer in 1974, "the fact that skin testing has not turned out to be a simple and completely reliable technique does not detract from the fact that, when it is intelligently and skilfully performed, it remains the most effective diagnostic procedure in reaginic allergic disorders". 8 The reliability of skin testing and proper documentation of test results are essential in allergy practice. A recent survey to all physician members and fellows of the American College of Allergy, Asthma and Immunology practicing in the

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Section: Variability Factorsmentioning

confidence: 99%

Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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“…Numerous respiratory allergens have been cloned and sequenced - thus accelerating the availability of primary structure data – and expressed as recombinant proteins [1, 2], which provided an excellent basis for the understanding of patients’ IgE cross-reactivity between allergenic molecules.…”

Section: Review Of Advances In Molecular Characteristics Of Respiratomentioning

confidence: 99%

Evolution in the Understanding of Cross-Reactivities of Respiratory Allergens: The Role of Recombinant Allergens

Pauli

2000

Int Arch Allergy Immunol

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The aim of this review is to show the impact of the use of purified and recombinant allergens to discriminate between co- and cross-sensitization to respiratory allergens. The author describes the evolution of diagnostic tests over the last decades; the tests initially allowed the detection of simultaneously positive cutaneous tests and/or simultaneous positivity of specific IgE to different allergen extracts, but they did not differentiate cross-sensitization from co-sensitization. RAST inhibition studies with crude extracts then established cross-reactivity, but did not identify the cross-reactive allergens involved. Later, immunoblot and CRIE inhibition were able to detect multiple cross-reactive allergens and to assess their physicochemical properties. But it is only since purified and recombinant allergens have been used in the different investigations that identification of cross-reactive allergens has been made possible at a molecular level. This historical approach is illustrated by examples selected from some of the main respiratory allergen sources: tree pollen, grass pollen, weed pollen, acarids, cockroaches and mammalians. For each of these allergen sources, the author gives an updated presentation of major and minor cross-reactive allergen molecules and refers to the last decade’s major publications concerning immunochemical investigations carried out in the field of cross-reactive respiratory allergens. Emphasis is placed on the clinical applications for allergic patients: improvement in the accuracy of the diagnosis of sensitization, new concepts of immunotherapy based on genetically engineered hypoallergenic variants of cross-reactive allergens used alone or in combination, evaluation of allergen load with environmental tests using monoclonal antibodies against cross-reactive allergens.

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“…Drugs may alter the response not only of the skin, but of the other target organs of local provocation such as the nose, conjunctiva and bronchus (57). Therefore, any drug that may potentially affect the response should be withheld prior to the provocation test.…”

Section: Interval Between the Withdrawal Of Some Drugs And Allergen Bmentioning

confidence: 99%

“…vi) Sodium cromoglycate inhibits both early and late antigen-induced bronchoconstriction (7,31,54). Sodium cromoglycate should be discontinued 12-24 h before challenge (57). vii) Nedocromil sodium.…”

Section: Mequitazine No Information Is Available About Elimination Omentioning

confidence: 99%

“…New commercially available slow release oral preparations -terbutalin (50) and salbutamol (2) -should be suspended 48 h before challenge. Administration of common inhaled Pj-stimulants should be stopped 8 h before challenge (3,11,57,67), iv) Theophyllines. Slow release oral preparations should be suspended 72 h before challenge, v) Anticholinergic agents.…”

Section: Mequitazine No Information Is Available About Elimination Omentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for the standardization of bronchial provocation tests with allergens

Melillo¹,

Cartier

et al. 1991

Allergy

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Pharmacological influence of antiallergic medication on in vivo allergen testing

Cited by 49 publications

References 41 publications

Skin prick tests and allergy diagnosis

Skin prick tests and allergy diagnosis

Evolution in the Understanding of Cross-Reactivities of Respiratory Allergens: The Role of Recombinant Allergens

Guidelines for the standardization of bronchial provocation tests with allergens

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