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Oral Provocation Test (oral + provocation_test)

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Medical Sciences	100%

Selected Abstracts

Multiple fixed drug eruption due to drug combination

CONTACT DERMATITIS, Issue 6 2005
A. Yokoyama
We report the case of a multiple fixed drug eruption (FDE) after taking 1 g of PL® and 100 mg of levofloxacin (Cravit®) at the same time. Patch tests with PL® alone, levofloxacin alone and the combination of PL® and levofloxacin were all negative on the involved and uninvolved sites. Lymphocytic stimulation tests were also negative for PL® alone, levofloxacin alone and the combination of PL® and levofloxacin. Oral provocation tests with PL®alone or levofloxacin alone produced no reactivation. However, we could provoke multiple erythematous plaques on the involved areas by taking a 1/10th dose of the combination of PL® and levofloxacin at the same time. Drug eruption due to a drug combination appears to be very rare. This is the first case of multiple FDE caused by taking PL® -levofloxacin combination. [source]

PPL and MDM skin test: New test kit is helpful in detecting immediate-type allergy to beta-lactams

JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 4 2007
Regina Treudler
Summary Background: The diagnosis of PPL (major determinant) and MDM (minor determinant) sensitization as relevant allergens in beta-lactam allergy has been recently hampered by withdrawal from the market of formerly available test kits. We investigated a new PPL/MDM test kit in the work-up of beta-lactam allergy. Patients and Methods: 15 patients with history of beta-lactam allergy were investigated for specific IgE and received patch, skin prick (SPT) and intracutaneous tests (ICT; immediate and late readings) using the relevant beta-lactams. In addition the new test kit was used for parallel SPT and ICT. Results: 14 women and 1 man (16,73 years) with immediate (n = 7), delayed (n = 7) or unclear (n = 1) reactions to beta-lactams 8,300 months previously (penicillin G/V n = 3, aminopenicillins n = 7, cephalosporins n = 4, unknown n = 2) were tested. In patients with immediate type reactions, n = 2 had specific IgE, n = 4 reacted to the new test kit (n = 3 MDM, all of whom reacted exclusively to this test, n = 1 PPL). Two patients with non-immediate reactions reacted to other beta-lactams. Conclusions: Our data show that the new test kit may be helpful in detecting patients with immediate type allergy to beta-lactams. Without this test, in those three patients reacting exclusively to MDM, and oral provocation test would have been necessary to clarify their allergy. Data from larger groups of patients are needed to determine the sensitivity and specificity of this test kit. [source]

Unnecessary Milk Elimination Diets in Children with Atopic Dermatitis

PEDIATRIC DERMATOLOGY, Issue 1 2007
J.L. Sinagra M.D.
We investigated the percentage of children allergic to cow's milk compared with the rate of milk exclusion diets in a group of patients with atopic dermatitis. We enrolled 206 children (79 girls, 127 boys), mean age 45.8 (4,68) months, affected by atopic dermatitis into our study. All children underwent radioallergosorbent test for casein, alpha-lactalbumin and beta-lactoglobulin, prick test, atopy patch test, and oral provocation test. Children were followed up at 1, 3, 6, and 12 months. Of the 206 patients, 20 were excluded from statistical analysis, leaving 186. Forty-five (24.2%) were on a milk elimination diet and 141 on a normal diet. Four patients on the milk-free diet (8.9%), accounting for 2.2% of all patients, were found to be allergic. In the others, milk reintroduction did not cause the disease to worsen during the follow-up period. No children on a normal diet were found to be allergic. Our results demonstrated an actual prevalence of cow's milk allergy in patients on milk elimination diets (4%) to be significantly lower than the number of patients prescribed such diets (24.2%),confirming that this measure is being applied excessively. [source]

Allergy to peanut oil , clinically relevant?

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2007
J Ring
Abstract The increasing prevalence of food allergies (especially allergy to peanuts) has led to a discussion of how safe topical preparations containing peanut oil are with respect to allergy. The major allergens from peanuts are proteins that have been characterized at a molecular level and cloned. Clinical signs of peanut allergy symptoms can be observed on the skin (urticaria), or in the gastrointestinal and/or respiratory tract culminating in cardiovascular symptoms and anaphylactic reactions. In most cases, symptoms are elicited by oral uptake; rarely, a contact urticaria has been described. In vegetable oils, the contents of protein differ depending on the production process: crude oils contain approximately 100 times more proteins than refined oils. This has clear-cut implications for allergic individuals. Quantitative data are available regarding elicitation of symptoms in allergic individuals with a threshold dose of 0.1,1 mg peanut allergen in oral provocation tests. There are anecdotal reports of adverse reactions after topical use of peanut oils. In one epidemiological trial, an association between topical use of skin care products containing peanut oil and the development of peanut allergy was observed; however, the data reflect a retrospective analysis without specifying skin care products containing peanut oil and also without analysing the quantity of topicals used. In contrast, oral tolerance was prevented and allergic sensitization was enhanced in a mouse model using high concentrations of peanut protein. So far, no reliable data are available regarding doses required to induce sensitization against peanut allergen via the epidermal route. A possible induction of sensitization against peanut proteins through contact with the skin via skin care products and the respective protein concentrations is a matter of speculation. Patients with atopic diseases, namely eczema, need appropriate skin care because of the disturbed skin barrier function. The benefit of avoiding damage to skin barrier functions of atopic individuals by the use of peanut protein-containing skin care products seems to outweigh possible risks of sensitization and/or allergy induction against substances contained in those products containing refined peanut oil. [source]

Anaphylaxis to 5-methoxypsoralen during photochemotherapy

BRITISH JOURNAL OF DERMATOLOGY, Issue 5 2001
F.J. Legat
Photochemotherapy is very effective for the treatment of skin diseases such as psoriasis, as well as for the prophylactic ,hardening' therapy of patients suffering from polymorphic light eruption. The photosensitizers most widely used for oral photochemotherapy are the furocoumarins 8-methoxypsoralen and 5-methoxypsoralen. Beside light-induced phototoxic reactions due to the photosensitizing activity of psoralens, side-effects after the oral intake of psoralens are nausea and vomiting, headaches, anxiety and sleeplessness. We report a rare case of anaphylaxis to 5-methoxypsoralen that developed during prophylactic ,hardening' therapy in a 36-year-old woman suffering from polymorphic light eruption. Anaphylaxis to 5-methoxypsoralen was established by placebo-controlled oral provocation tests. [source]