Questions and Answers about C. P. S

Frozen foods for skin testing were prepared, stored and used by a simple, practicable, and inexpensive method.The capacity of raw foods to produce immunologically positive skin reactions by the scratch test method was reaffirmed.Storage in the frozen state for several months and thawing immediately before using for one series of tests did not affect the allergenic properties of the material.Raw foods were found to be innocuous to the skin and non-urticariogenic in allergic as well as in non-allergic persons.Raw foods, by the scratch test method, induced true positive reactions of a larger size and in greater numbers than the corresponding commercial extracts in the same series of subjects tested.     

Frozen raw foods as skin-testing materials; further studies of use in cases of allergic disorders

In further studies on the use of frozen raw food as skin-testing material in patients with allergic disorders, the results of previous work were confirmed in a greater number of subjects using a larger number of foods:Tests with frozen raw foods by the scratch method induce true positive reactions of a larger size and in greater frequency than the corresponding commercial extracts by either the scratch or the intracutaneous method. Storage in the frozen state for several years does not affect the antigenic potency of the materials. The frozen preparations have caused no harmful effects in the subjects, are free from irritant properties, and are not urticariogenic.     

FROZEN RAW FOODS AS SKIN-TESTING MATERIALS—Further Studies of Use in Cases of Allergic Disorders

In further studies on the use of frozen raw food as skin-testing material in patients with allergic disorders, the results of previous work were confirmed in a greater number of subjects using a larger number of foods:Tests with frozen raw foods by the scratch method induce true positive reactions of a larger size and in greater frequency than the corresponding commercial extracts by either the scratch or the intracutaneous method.Storage in the frozen state for several years does not affect the antigenic potency of the materials. The frozen preparations have caused no harmful effects in the subjects, are free from irritant properties, and are not urticariogenic.     

FOOD HYPERSENSITIVITY—Correlation of Intradermal Skin Tests with Clinical Allergenicity

A study was made to determine how well the results of skin tests for sensitivity to various foods agreed with observation of clinical reactions to those foods.Test reactions were divided into several categories—negative, and 1, 2, 3 or 4 plus. Then the strong reactions, that is the 3 and 4 plus reactions, the milder reactions and the negative results were studied separately to determine the agreement of results, in each category, with the clinical response. Wide variations were noted. For some foods the agreement was high, for others low. For some foods, the agreement was high in some categories of reaction, low in others. For example, negative results of skin test might match with nonreaction to the food clinically in a high proportion of cases, and 3 or 4 plus reaction to skin test might be in close agreement with the incidence of distress upon ingestion of the food, yet for the same food there might be very poor correlation between mild reaction to skin test and clinical response. This being the case, accuracy of skin tests cannot be determined simply by combining all data on reactions, of whatever degree, and taking the aggregate of agreement in all categories as an index of the validity of the test. Each category of reaction must be considered separately.Combined data and categorized data on accuracy of skin tests for sensitivity to 26 foods were tabulated in the present study.     

Food hypersensitivity; correlation of intradermal skin tests with clinical allergenicity

A study was made to determine how well the results of skin tests for sensitivity to various foods agreed with observation of clinical reactions to those foods. Test reactions were divided into several categories-negative, and 1, 2, 3 or 4 plus. Then the strong reactions, that is the 3 and 4 plus reactions, the milder reactions and the negative results were studied separately to determine the agreement of results, in each category, with the clinical response. Wide variations were noted. For some foods the agreement was high, for others low. For some foods, the agreement was high in some categories of reaction, low in others. For example, negative results of skin test might match with nonreaction to the food clinically in a high proportion of cases, and 3 or 4 plus reaction to skin test might be in close agreement with the incidence of distress upon ingestion of the food, yet for the same food there might be very poor correlation between mild reaction to skin test and clinical response. This being the case, accuracy of skin tests cannot be determined simply by combining all data on reactions, of whatever degree, and taking the aggregate of agreement in all categories as an index of the validity of the test. Each category of reaction must be considered separately.Combined data and categorized data on accuracy of skin tests for sensitivity to 26 foods were tabulated in the present study.     

Measles immunisation in children with allergy to egg.

OBJECTIVE--To examine the occurrence of adverse reactions to measles vaccine given as a single dose to children with egg allergy, and to determine if the administration of single dose to children with a positive result in an intradermal skin prick test with the vaccine is associated with adverse reactions. DESIGN--Review of results of immunisation and prospective study of 96 consecutively presenting children given intradermal skin testing with the vaccine. SETTING--Children''s allergy centre. SUBJECTS--410 children sensitive to egg referred to the allergy unit for advice about measles immunisation. MAIN OUTCOME MEASURES--Nature and severity of reactions associated with the administration of measles vaccine. RESULTS--All children had a positive result in a skin prick test with egg white, and five had a positive result in a skin prick test with vaccine. Of 96 consecutive children, 46 had a positive result in an intradermal test with vaccine. After immunisation with a full dose (0.5 ml) of vaccine adverse reactions were associated with a mild reaction in four children, none of whom required treatment. Only one of the 46 children with a positive result in an intradermal vaccine skin test had a reaction associated with vaccine administration. None of the children with a positive result in a skin prick test with measles vaccine reacted to the vaccine. The rate of minor reactions to the vaccine not requiring treatment was 0.98% (95% confidence interval 0.27% to 2.48%) and serious reactions requiring treatment was 0% (0% to 0.9%). CONCLUSION--Children with IgE mediated allergic reactions to egg protein should be investigated and managed by practitioners with special knowledge in this subject. Measles immunisation should be performed in a setting where any adverse reactions can be dealt with appropriately. Skin tests and measles vaccine and desensitisation are not necessary.     

Allergy to insect stings. IV. Diagnosis by radioallergosorbent test (R.A.S.T.)

Radioallergosorbent tests (RAST(s)) have been developed and assessed for the diagnosis of insect hypersensitivity by using a purified allergen from honeybee venom, phospholipase A, and crude yellow jacket venom. Sera from 193 patients positive both by history and skin test to one of these insects were compared with various groups of control sera. Eighty percent of sera from skin test-positive patients were RAST positive; positive RAST were found in 16% of sera tested from skin test-negative patients. A highly positive RAST correlates well with a positive skin test and clinical sensitivity, but serum IgE is not measurable in many patients with mast cell or basophil bound antibody. Since biologically important reactions of antigen with IgE require that the antibody be cell bound, skin testing would be preferred to RAST if one were limited to a single test for the diagnosis of insect allergy.     

Cell-mediated immunity to Dirofilaria immitis.

Cell-mediated immunity to Dirofilaria immitis (DI) in guinea pigs was confirmed by the migration inhibition test (MIT), the blast transformation test (BTT), the delayed skin reaction, and the skin reaction by passive transfer with sensitized peritoneal exudate (PE) cells. All migration inhibition (MI) positive cases were always associated with positive skin reactions and two cases showed positive skin reactions without MI. The cellular antibody confirmed by MIT first appeared on the 4th day after single sensitization, but DNA synthesis in splenic lymphocytes had already started on the 3rd day in the absence of delayed skin reaction and MI. Then, the role of this cellular antibody in the immune mechanism against DI infection was investigated by the in vitro and in vivo cytotoxicity test using microfilariae (Mf) of this species as a target. The cytotoxic activity significantly increased in the sensitized splenic and PE cells, and in vivo normal PE cells implanted into sensitized animals.     

Experimentation in Lille with the passive hemagglutination test for the detection of Australia antigen. Comparison with other methods]

Among 5347 blood donors sera, the reverse passive hemagglutination test (RPH) enabled to detect 3,55% of HB ag (whereas 2,43% by EID). On the other hand, among 180 patients, the rate of positive reactions was observed to be the same for both techniques, which must be attributed to the presence of higher titer antigens. In the two series all positive reactions found by RPH method were also tested by RIA; this enabled to eliminate a great number (18% and 27%) of false positive reactions, which remain the disadvantage of the method. It must be also noticed that the complement fixation reaction gave the same results as the RIA.     

A simplified screening test for the diagnosis of allergy.

The Quidel allergy screen is a relatively rapid (less than 2 hours) multiallergen dipstick method for detecting specific immunoglobin E antibodies in serum. It was developed to answer the need of primary physician nonspecialists in allergy for a convenient in-office screening test for diagnosing allergy. The new test was evaluated against the benchmark diagnostic skin tests and the radioallergosorbent serologic tests for sensitivity, specificity, accuracy, and technical feasibility in an office setting. It was found that while the Quidel allergy screen lacks the specificity of the standard tests, its overall sensitivity, as defined by the percentage of patients with positive skin reactions who also tested positive with the Quidel screen (68%), its ease of use, and its rapidity warrant its consideration as a screening tool for confirming a possible case of allergy.     

Adverse reactions to foods

Allergic reactions to foods represent a prominent, actual and increasing problem in clinical medicine. Symptoms of food allergy comprise skin reactions (urticaria, angioedema, eczema) respiratory (bronchoconstriction, rhinitis), gastrointestinal (cramping, diarrhea) and cardiovascular symptoms with the maximal manifestation of anaphylactic shock. They can be elicited by minute amounts of allergens. The diagnosis of food allergy is done by history, skin test, in vitro allergy diagnosis and — if necessary — oral provocation tests, if possible placebo-controlled. Avoidance of respective allergens for the allergic patient, however, is often complicated or impossible due to deficits in declaration regulations in many countries. Increasing numbers of cases including fatalities, due to inadvertent intake of food allergens are reported. It is therefore necessary to improve declaration laws and develop methods for allergen detection in foods. Allergens can be detected by serological methods (enzyme immunoassays, in vitro basophil histamine release or in vivo skin test procedures in sensitized individuals). The problem of diagnosis of food allergy is further complicated by cross-reactivity between allergens in foods and aeroallergens (pollen, animal epithelia, latex etc.). Elicitors of pseudo-allergic reactions with similar clinical symptomatology comprise low-molecular-mass chemicals (preservatives, colorings, flavor substances etc.). For some of them (e.g. sulfites) detection assays are available. In some patients classic allergic contact eczema can be elicited systemically after oral intake of low-molecular-mass contact allergens such as nickel sulfate or flavorings such as vanillin in foods. The role of xenobiotic components in foods (e.g. pesticides) is not known at the moment. In order to improve the situation of the food allergic patient, research programs to elucidate the pathophysiology and improve allergen detection strategies have to be implemented together with reinforced declaration regulations on a quantitative basis.     

A novel Candida albicans skin test antigen: efficacy and safety in man

Yeast phase Candida albicans (ATCC No. 10231) was grown in a nonantigenic medium, harvested and lyophilized. Ammonium sulfate fractions of an aqueous extract of the lyophilized cells were evaluated and the fraction yielding the highest specific delayed cutaneous reactivity in sensitized guinea-pigs was used to prepare a C. albicans skin test antigen (CASTA). The safety of the antigen was evaluated by measuring immediate and delayed (0.25, 6, 24, 48 and 72 h) cutaneous reactions in atopic and nonatopic human subjects. The outcome of three repetitive monthly Mantoux skin tests with 0.01-1 microgram antigen doses was used to test for booster effects in 14 subjects and to estimate a safe initial test antigen dose. The utility of a single skin test as a measure of cell-mediated immunity was evaluated in 40 healthy subjects. Reactor rates (greater than or equal to 2 mm, 48 h) of 40% and 85% were detected, respectively, with doses of 0.0316 and 1 microgram. Using a skin test reaction diameter greater than or equal to 5 mm at 48 h, the reactor rate was 50% for the 1-microgram dose. The only adverse reaction (45 mm, 0.25 h) was detected with the 1-microgram dose in an atopic subject who also exhibited exquisite scratch test reaginic hypersensitivity to C. albicans allergen. The prevalence of other adverse reactions to this antigen compared favorably with that to other antigens used for recall antigen testing. These studies suggest the 1-microgram CASTA dose can be used for effective, safe recall antigen skin tests.     

A New Approach in Dispensing Tuberculin PPD and in Performing a Multi-Puncture Tuberculin Test

A simple and low-cost kit for single-dose tuberculin testing is described. For those who perform occasional tuberculin tests only, this kit is proposed as a substitute for the Heaf apparatus used in carrying out a multi-puncture test. No difference in the tuberculin skin reactions could be observed when the needle multi-puncture test was compared with the Heaf test in BCG-sensitized guinea pigs and in 12 volunteers. A comparative study on 37 student nurses, using the needle multi-puncture method and the intracutaneous method (Mantoux test), showed that with the needle multi-puncture method more positive reactors were detected than with the Mantoux test using 1:2000 dilution of OT. However, more positive reactors were obtained with the Mantoux test using 1:100 dilution of OT. It is felt that the singledose kit can be a valuable asset when only few skin tests are performed.     

Skin test to detect resistance of cattle to Rhipicephalus appendiculatus ticks

The evaluation of a skin test to detect acquired resistance to Rhipicephalus appendiculatus Neumann ticks is described. An extract of salivary glands of partially fed female R. appendiculatus was prepared by dissection, sonication and filtration and used for intra-dermal injection. Tests were carried out on twelve calves of known resistance to R. appendiculatus and on twelve naive calves to establish threshold values for positive reactions. Four rabbits naive to ticks were skin tested repeatedly to assess immunogenicity of the test. Reactions to the test at 1 h and at 24 h after injection were significantly correlated with resistance. The correlation was higher with the reactions at 24 h. Rabbits were immunized by the test but the reactions never exceeded the positive threshold. Further development by field testing is recommended.     

Toxoplasmosis II. Studies of Animal Sera Using Complement-Fixation Tests

Serological studies were performed in guinea pigs, a sheep, calf, goat and two pigs experimentally infected with toxoplasmosis. The direct complement-fixation method was effective in detecting antibodies in guinea-pig, goat and sheep sera. The modified complement-fixation technique supplementing complement with normal bovine serum fraction, was required when testing bovine serum. With swine sera best reactions occurred in the indirect complement-fixation test and definite but low grade reactions were produced in the direct test after pro-complementary activity was removed by pH treatment of the sera. Allergic skin reactions were produced in the experimental animals but improvement in the antigen is necessary before the test could be used generally in the field as a diagnostic method for animal toxoplasmosis.     

Endotoxic properties of chemically synthesized lipid A analogs. Studies on six inflammatory reactions in vivo, and one reaction in vitro

Biological activities of two groups of synthesized lipid A analogs, the counterpart of biosynthetic precursor, Lehmann's Ia type, 406, and E. coli lipid A type, 506, as well as their non-phosphorylated, and mono-phosphorylated analogs were investigated. The activities employed included four bone marrow cell reactions in mice, mice skin reaction, leukocytes migration in rabbits' cornea, and hemagglutination. Compound 406 and 506 elicited bone marrow reactions in mice and hemagglutination of mouse RBC, although 406 failed to elicit hemorrhage and necrosis also in mice skin. Compound 406 did not elicit corneal reaction in rabbits. The results suggest that for elicitation of this reaction and mice skin reaction, acyloxyacyl structure is required. Cytotoxicity and thromboplastin production of four bone marrow reactions had been reported by us to be endotoxic reactions, since these had not been elicited by peptidoglycan of Lactobacillus and Staphylococcus (1981) and 300 series synthesized analogs (1984) which did not have endotoxic structures. From these results, it seems that these two marrow reactions and hemagglutination require, as does the limulus test, the lipid A part structure as is present in 406.     

Identification of Chironomus kiiensis allergens, a dominant species of non-biting midges in Korea.

Non-biting midges are known to contain potent inhalant allergens. IgE antibody responses to the crude extract of Chironomus kiiensis adults, a dominant chironomid species in Korea, were examined. With the IgE-ELISA or passive cutaneous anaphylaxis reactions, increased levels of chironomid-specific IgE were detected in the skin test positive human sera, or immunized BALB/c mouse sera with the crude extract adsorbed to alum. IgE-immunoblot analysis showed major IgE-reacting protein band patterns, which reacted with more than 50% of the skin test positive human sera, at 110, 80, 73, 46, 40, 37, 34, and 31 kDa. The reactive band patterns were largely similar between skin test positive humans and immune BALB/c mice. However, the bands of 55, 31, 27, 26, 24, and 23 kDa were found only in sensitized humans, but not in immunized mice.     

Pollen and Mould Allergy in Southern Sardinia (Italy): Comparison of Skin-Test Frequencies and Air Sampling Data

A study was carried out to investigate the influence of atmospheric pollen and fungi in determining allergic diseases by comparing the frequency of skin reactions to air sampling data over a 6-year period.

48% of our population reacted to at least one of the pollen and fungal extracts used. Among pollen, Gramineae gave the most frequent positive reactions, followed by Parietaria, Olea and Compositae. The most common positive skin tests in fungus sensitive patients were by extracts of Alternaria, Cladosporium, Aspergillus and Candida

As for the aerobiological survey, the general trend of pollen and molds was similar during the sampling period. The annual pollen catch did not show remarkable differences during the years sampled, whereas the total fungal spore count was highest in 1988 and 1990.

A comparison between aerobiological and clinical data revealed a good degree of concordance between total pollen counts and positive skin test frequencies for Urticaceae, Gramineae and Oleaceae but not for Compositae (high positive skin reactions and very low counts) and Cupressaceae (high counts and few skin reactions).

A less marked correlation has been found between fungal spore counts and positive skin-test frequencies as compared to pollen. Spores such as Cladosporium, which are present in large number in the air, appear to be less sensitizing, while certain spore types (e.g. Alternaria), seem to be able to sensitize patients in spite of their low atmospheric concentrations.     

16S rRNA-based probes and polymerase chain reaction method to detect Listeria monocytogenes cells added to foods.

A rapid polymerase chain reaction (PCR) method was developed for detection of Listeria monocytogenes in foods. This method used a pair of primers based on a unique region in the 16S rRNA sequence of L. monocytogenes, which were previously reported by us to yield a specific nucleic acid probe. Our method included use of a shorter denaturing time, a shorter annealing time, a rapid transition, and an increase in the number of cycles, resulting in good sensitivity. Just 3 h for PCR plus 1 h for electrophoresis was required. Additional time for DNA isolation and DNA hybridization was not needed. This method detected as few as 2 to 20 CFU of L. monocytogenes in pure cultures and as few as 4 to 40 CFU of L. monocytogenes in inoculated (10(8) CFU), diluted food samples. Seven of eight foods, including four poultry products, gave positive results. Only one food sample, soft cheese, gave interference. An internal probe hybridization test was used to confirm that the PCR products were from L. monocytogenes. A specificity test indicated that this PCR method was positive for all 13 strains of L. monocytogenes tested but negative for the other 6 species of Listeria, including 6 strains of L. innocua, and negative for 17 other gram-positive and gram-negative bacteria tested.     

16S rRNA-based probes and polymerase chain reaction method to detect Listeria monocytogenes cells added to foods.

A rapid polymerase chain reaction (PCR) method was developed for detection of Listeria monocytogenes in foods. This method used a pair of primers based on a unique region in the 16S rRNA sequence of L. monocytogenes, which were previously reported by us to yield a specific nucleic acid probe. Our method included use of a shorter denaturing time, a shorter annealing time, a rapid transition, and an increase in the number of cycles, resulting in good sensitivity. Just 3 h for PCR plus 1 h for electrophoresis was required. Additional time for DNA isolation and DNA hybridization was not needed. This method detected as few as 2 to 20 CFU of L. monocytogenes in pure cultures and as few as 4 to 40 CFU of L. monocytogenes in inoculated (10(8) CFU), diluted food samples. Seven of eight foods, including four poultry products, gave positive results. Only one food sample, soft cheese, gave interference. An internal probe hybridization test was used to confirm that the PCR products were from L. monocytogenes. A specificity test indicated that this PCR method was positive for all 13 strains of L. monocytogenes tested but negative for the other 6 species of Listeria, including 6 strains of L. innocua, and negative for 17 other gram-positive and gram-negative bacteria tested.