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Provocation Tests (provocation + test)
Kinds of Provocation Tests Selected AbstractsDevelopment of an imaginal provocation test to evaluate treatment for anger problems in people with intellectual disabilitiesCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2004John L. Taylor Anger and associated aggressive behaviour are significant clinical issues for many people with intellectual disabilities (IDs) that can lead to serious constraints to their liberty, which, in turn, adversely affects their quality of life. There is some evidence to support cognitive,behavioural anger treatment in this client group; however, anger assessment protocols for people with IDs should be diversified. In this regard, a method for anger assessment using imaginal provocation scenes was extended for use with this client population and the context in which treatment takes place. Two studies of the Imaginal Provocation Test (IPT) were conducted: the first with 48 patients examined its internal reliability and concurrent validity with anger psychometric scales; the second investigated whether it was sensitive to change associated with anger treatment in a small outcome study involving men with IDs and histories of offending. The IPT was found to successfully induce anger, be internally reliable, have strong concurrent validity and detect statistically significant changes in anger following anger treatment (N = 9), compared with a routine care waiting-list control group (N = 8). The IPT also had value in highlighting clinical improvements for anger treatment condition participants compared with the control group.,Copyright © 2004 John Wiley & Sons, Ltd. [source] Diagnostic Value of Flecainide Testing in Unmasking SCN5A-Related Brugada SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2006PAOLA G. MEREGALLI M.D. Introduction: Provocation tests with sodium channel blockers are often required to unmask ECG abnormalities in Brugada syndrome (BrS). However, their diagnostic value is only partially established, while life-threatening ventricular arrhythmias during these tests were reported. We aimed to establish sensitivity, specificity, and safety of flecainide testing, and to predict a positive test outcome from the baseline ECG. Methods and Results: We performed 160 tests with flecainide in subjects determined to be at risk for BrS. P wave width, PQ duration, QRS width, S wave amplitude and duration in leads II-III, in addition to ST morphology and J point elevation in V1-V3 were measured before and after flecainide administration. Moreover, leads were positioned over the third intercostal space (V1IC3 -V2IC3). Flecainide tests were considered positive if criteria from the First Consensus Report on BrS were fulfilled. In 64 cases, the test was positive, while 95 were negative (1 test was prematurely interrupted). The sensitivity and specificity, calculated in SCN5A-positive probands and their family members, were 77% and 80%, respectively. Baseline ECGs exhibited significant group differences in P, PQ, and QRS duration, J point elevation (leads V1-V2 and V1IC3 -V2IC3), and S duration in II, but an attempt to predict the outcome of flecainide testing from these baseline ECG parameters failed. No malignant arrhythmias were observed. Conclusion: Flecainide testing is a valid and safe tool to identify SCN5A-related BrS patients. Baseline ECGs do not predict test outcomes, but point to conduction slowing as a core mechanism in BrS. [source] Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletesALLERGY, Issue 10 2007M. Bonini Background:, Asthma is frequently found in athletes, often associated with rhinitis and allergy. Aim:, To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes. Subjects and methods:, Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects. Results:, Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic , nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics , nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values. Conclusions:, Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes. [source] Threshold levels of purified natural Bos d 2 for inducing bronchial airway response in asthmatic patientsCLINICAL & EXPERIMENTAL ALLERGY, Issue 10 2002T. Zeiler Summary Background Provocation tests are invaluable in establishing threshold levels and a causal relationship between atopic asthma and a certain allergen source, especially in relation to work-associated exposure. Purified major allergens open possibilities for a more accurate assessment of sensitization. Objective To determine the threshold dose of purified major bovine dander allergen Bos d 2 in bronchial provocation in comparison with the standard allergen and a set of other parameters of allergy. Method Nine consecutive patients referred to hospital for confirming the bovine origin of their occupational asthma were subjected to bronchial provocation tests with purified natural Bos d 2 and a standard bovine dander allergen. Additional tests included bronchial histamine challenge, measurements of total IgE, specific IgE antibody determinations and skin prick tests (SPT) with both allergens. Results In the provocation tests with Bos d 2, a 15% decrease in the forced expiratory volume in 1 s (FEV1) and/or peak expiratory flow (PEF) values in eight out of nine patients confirmed the predominant role of Bos d 2 in the sensitization. The threshold dose of Bos d 2 varied from 0.1 µg to > 100 µg (median ± median absolute deviation = 4.5 ± 3.9 µg). A positive SPT was induced by a median dose of 13.9 ± 9.8 µg of Bos d 2. Bronchial response to histamine and IgE antibodies against Bos d 2 showed the highest correlations to the provocations results. Conclusions The efficacy of Bos d 2 in bronchial provocation in patients with occupational cattle-associated asthma was confirmed and the range of the threshold level was determined. There were individual variations, but the response in provocation remains the reference method for identification of the cause of occupational atopic asthma. SPT and the measurement of specific IgE antibodies, preferably with purified or recombinant major allergens, increase the accuracy of the diagnosis. [source] Behavioral and cardiovascular effects of 7.5% CO2 in human volunteersDEPRESSION AND ANXIETY, Issue 1 2005Jayne E. Bailey M.Sc. Abstract The study of carbon dioxide (CO2) inhalation in psychiatry has a long and varied history, with recent interest in using inhaled CO2 as an experimental tool to explore the neurobiology and treatment of panic disorder. As a consequence, many studies have examined the panic-like response to the gas either using the single or double breath 35% CO2 inhalation or 5,7% CO2 inhaled for 15,20 min, or rebreathing 5% CO2 for a shorter time. However, this lower dose regime produces little physiological or psychological effects in normal volunteers. For this reason we have studied the effects of a higher concentration of CO2, 7.5%, given over 20 min. Twenty healthy volunteers were recruited to a double blind, placebo-controlled study where air and 7.5% CO2 were inhaled for 20 min. Cardiovascular measures and subjective ratings were obtained. When compared to air, inhaling 7.5% CO2 for 20 min increases systolic blood pressure and heart rate, indicating increased autonomic arousal. It also increases ratings of anxiety and fear and other subjective symptoms associated with an anxiety state. The inhalation of 7.5% CO2 for 20 min is safe for use in healthy volunteers and produces robust subjective and objective effects. It seems promising as an anxiety provocation test that could be beneficial in the study of the effects of anxiety on sustained performance, the discovery of novel anxiolytic agents, and the study of brain circuits and mechanisms of anxiety. Depression and Anxiety 00:000,000, 2005. © 2005 Wiley-Liss, Inc. [source] Estimation of Coronary Flow Velocity Reserve Using Transthoracic Doppler Echocardiography and Cold Pressor Test Might Be Useful for Detecting of Patients with Variant AnginaECHOCARDIOGRAPHY, Issue 4 2010Hui-Jeong Hwang M.D. Purpose: The cold pressor test (CPT) has been used to detect variant angina, but its sensitivity in predicting vasospasm is low. The aim of this study was to determine whether estimates of the coronary flow velocity reserve (CFVR) in the distal left anterior descending coronary artery (dLAD) using transthoracic echocardiography (TTE) and CPT are useful tool to predict variant angina. Methods: 65 patients (mean age = 52 ± 10 years; male:female = 41:24) who had normal coronary artery on angiography and underwent acetylcholine provocation test were enrolled and divided into the spasm group (n = 31) and the no spasm group (n = 34). During CPT, the peak (PDV) and mean diastolic flow velocity (MDV) of the dLAD were estimated using TTE with a high-frequency transducer, and electrocardiography, blood pressures, heart rate, and symptoms were monitored every 30 seconds. CPT%PDV and CPT%MDV were defined as the percentage changes in PDV and MDV during CPT, respectively. Results: CPT%PDV was 4.99 ± 23.62% in the spasm group and 52.75 ± 24.78% in the no spasm group (P < 0.001). CPT%MDV was 6.83 ± 23.81% in the spasm group and 50.22 ± 27.83% in the no spasm group (P < 0.001). CPT%PDV<31.1% had a sensitivity of 93.5% and a specificity of 82.4% in predicting variant angina (95% confidence interval [CI]: 0.939,0.979, P < 0.001). CPT%MDV<30.55% had a sensitivity of 90% and a specificity of 76.5% in predicting variant angina (95% CI: 0.884,0.950, P < 0.001). Conclusion: The measurement of changes in the coronary flow velocity of the dLAD using TTE and CPT might be useful for the estimation of endothelial dysfunction in patients with variant angina. (ECHOCARDIOGRAPHY 2010;27:435-441) [source] PPL and MDM skin test: New test kit is helpful in detecting immediate-type allergy to beta-lactamsJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 4 2007Regina 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] Histamine release test and measurement of antigen‐specific IgE antibody in the diagnosis of allergic conjunctival diseasesJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2001Eiichi Uchio Abstract Although systemic allergic laboratory tests for the quantification of allergen‐specific serum IgE antibody have been widely used, in these tests a high titer of serum specific IgE does not necessarily indicate evidence of allergy. We evaluated the diagnostic value of the glass microfiber‐based histamine release test (HRT) using small amounts of whole blood, in 36 cases of allergic conjunctival diseases: 17 cases of allergic conjunctivitis and 19 of atopic keratoconjunctivitis. The patients were evaluated by HRT, capsulated hydrolic carrier polymer (CAP)‐RAST, and conjunctival provocation test (CPT) against ten allergens. The positive rates for all allergens were higher in CAP‐RAST than in HRT. The mean concordance of HRT with CAP‐RAST results was 0.789. The mean concordance of HRT with CPT was 0.892 and that of CAP‐RAST with CPT was 0.693. A significantly higher concordance was observed in HRT than CAP‐RAST for Japanese cedar and mite antigen. The mean sensitivity, specificity, and efficiency of HRT were higher than those of CAP‐RAST. These results indicate that CAP‐RAST is good for the screening of allergens and that HRT has an advantage in the confirmation of clinical allergens in allergic conjunctival diseases because of its high sensitivity, specificity, efficiency, and higher concordance with CPT. J. Clin. Lab. Anal. 15:71–75, 2001. © 2001 Wiley‐Liss, Inc. [source] Delayed adverse reactions to iodinated radiographic contrast media after coronary angiography: a search for possible risk factorsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2003N. Sakai BSc Summary Objective:, The incidence of and risk factors for delayed adverse events (DAEs) that appear from 1 h to 7 days after injection of radiographic contrast media were investigated in patients who had undergone coronary angiography (CAG). Methods:, DAEs were monitored by questionnaire in 155 patients who received iomeprol. Isosorbide dinitrate was injected in every case. Risk factors for DAEs were analysed by a logistic regression model. Results:, Of 118 patients who returned questionnaires, 54 complained of DAEs, although no severe or fatal reactions occurred. Erythema, rash and nausea were frequent events. Female gender, total dose of isosorbide dinitrate <2 mg, and execution of acetylcholine provocation test were found to be the major risk factors, and the incidence of DAEs increased as the number of risk factors increased. Conclusion:, Care should be taken when CAG is performed on female patients who undergo acetylcholine provocation tests and receive low-dose nitric oxide donor injections. [source] The importance of nasal provocation test in the diagnosis of natural rubber latex allergyALLERGY, Issue 6 2009M. Ünsel Background:, Most studies regarding natural rubber latex (NRL) allergy have concentrated on the prevalance using skin prick test (SPT) and specific IgE assay. The objective of this study is to examine the target organ (skin, nasal mucosa) responses in patients with positive SPT to NRL using the nasal provacation test (NPT) and glove use test (GUT). Methods:, Four thousand four hundred and twenty patients presented to our polyclinic between July 2003 and January 2007 were evaluated. One thousand six hundred and ninety-nine patients had positive SPT to one or more allergens (NRL and other inhaler allergens). Twenty-nine patients with positive SPT to NRL comprised the NRL sensitive group (group 1). Thirty-five randomized patients with positive SPT to an inhaler allergen other than NRL and negative NRL-specific IgE comprised atopic control group (group 2). Thirty healthy individuals who had no allergic diseases and had negative SPT and NRL-specific IgE comprised the healthy control group (group 3). Results:, The lowest NRL allergen concentration leading to NPT positiveness was 0.05 ,g/mL. NPT was negative in groups 2 and 3. NPT was found to have a sensitivity of 96%, specificity of 100%, negative predictive value of 98% and positive predictive value of 100%. GUT was found to have a sensitivity of 81%, specificity of 90%, negative predictive value of 75% and positive predictive value of 93%. Conclusions:, Nasal provocation test was successfully used for the first time in the diagnosis of NRL allergy. NPT is a more sensitive method as compared to GUT. [source] Using the posterior pelvic pain provocation test in pregnant Japanese womenNURSING & HEALTH SCIENCES, Issue 1 2009Fukiko Ando rn Abstract This study investigated the usefulness of the posterior pelvic pain provocation (PPPP) test for differentiating between pelvic pain and low back pain because of the different prognoses and treatment strategies. We recruited 263 Japanese women who were > 36 weeks' gestation and 213 were included. The PPPP test was applied to 154 women with self-reported lumbopelvic pain. The participants were divided into three groups: the PPPP test positive (PPPP+, n = 60) subgroup, PPPP test negative (PPPP,, n = 94) subgroup, and no pain group (n = 59). The disability scores of the PPPP+ subgroup were significantly higher than the scores of the PPPP, subgroup and no pain group. In the PPPP+ subgroup, the intensity of pelvic pain was significantly correlated with the disability scores, but that of low back pain was not. The PPPP test could be carried out by a midwife without side-effects and could detect pregnant women with impaired ability in daily life due to lumbopelvic pain. [source] Unnecessary Milk Elimination Diets in Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 1 2007J.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] Knee pain in the ACL-deficient osteoarthritic knee and its relationship to quality of lifePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2003Michael Hartwick Abstract Background and Purpose Pain during activities of daily living is a common presenting complaint of individuals with knee osteoarthritis and anterior cruciate ligament injury. Knee pain is also associated with a decrease in quality of life for people with osteoarthritis. The purpose of the present study was to examine the dose,response relationship between knee joint forces and painful symptoms, and whether the acute symptoms, were associated with individuals' quality of life. Method This was a cross-sectional cohort correlation study. Seventeen individuals with anterior cruciate ligament (ACL)-deficient knees diagnosed with ipsilateral knee osteoarthritis completed the ACL quality of life questionnaire (ACL-QOL). The subjects also rated pain associated with each of five incremental isometric knee extension tests, proportional to their body weight. Analysis of variance was used to assess the association between pain and normalized torque. Linear regression was used to assess the correlation between the ACL-QOL score and the total pain experienced during the graded test. Results A strong relationship was found between the level of perceived knee pain and the amount of isometric torque produced (Pearson's r = 0.98; p<0.001). There was a statistically significant relationship between pain during the graded isometric test and the ACL-QOL (Pearson's r = ,0.56; p = 0.016). Conclusions Since knee joint compression is a function of active isometric knee extension torque, increased painful symptoms were associated with increased compression forces at the knee joint for these subjects. The relationship between pain provocation and disease-specific quality of life provides evidence for the proposed joint provocation test for this subject population. Weakness caused by osteoarthritis (OA) may, in part, be a negative conditioning response that would need to be overcome in rehabilitation. Copyright © 2003 Whurr Publishers Ltd. [source] Inhaled corticosteroid for persistent cough following upper respiratory tract infectionRESPIROLOGY, Issue 4 2005Prapaporn PORNSURIYASAK Objective: The aim of this study was to determine the clinical effect of inhaled corticosteroid treatment for persistent cough, post upper respiratory tract infection (URTI) in previously healthy individuals, and on bronchial hyperresponsiveness (BHR). Methodology: This was a prospective, randomized, double-blinded, placebo-controlled study conducted at a university hospital. A total of 30 non-asthmatic, non-smoking patients who were >15 years old and who had persistent post-URTI cough for >3 weeks were assessed by a physical examination, CXR and spirometry, and were allocated to receive inhaled budesonide (400 µg/puff, twice daily) or placebo for 4 weeks. If a patient suffered from sinusitis, it was a requirement that it had been well treated. A symptom score (frequency of cough, frequency of coughing bouts, symptoms associated with cough, night-time cough, frequency of taking medications to relieve cough, and number of medications) was recorded at entry, and after 2 and 4 weeks of treatment. A methacholine challenge test was performed at entry and after 4 weeks of treatment. Results: The mean symptom scores for the treatment group (9.4) and the placebo group (9.8) at baseline were not significantly different (P = 0.79), and no differences were found between the groups after week 2 and week 4 of treatment (3.93 and 4.27 vs 2.26 and 2.66, P = 0.29). The mean change in symptom scores from baseline to week 2 and to week 4 of treatment were also not different between groups (5.93 and 5.6 vs 7.00 and 7.58, P = 0.23). No difference between groups was found in the mean changes in FEV1, FVC, and FEF25,75% after 4 weeks of treatment. A positive bronchial provocation test occurred in three patients (10%) but these were borderline. Conclusion: Inhaled corticosteroid is ineffective in treating persistent post-URTI cough in previously healthy individuals. [source] Airway hyperresponsiveness: the usefulness of airway hyperresponsiveness testing in epidemiology, in diagnosing asthma and in the assessment of asthma severityTHE CLINICAL RESPIRATORY JOURNAL, Issue 1 2007Celeste Porsbjerg MD Abstract The present PhD thesis was conducted at the Respiratory Research Unit at the Pulmonary Department L in Bispebjerg Hospital, Copenhagen, Denmark and describes airway hyperresponsiveness in asthma patients in four studies. The first study concerned risk factors for the development of asthma in young adults in a 12-year prospective follow-up study of a random population sample of 291 children and adolescents from Copenhagen, who were followed up from the age of 7,17 years (1986) until the age of 19,29 years (1998). During follow-up, 16.1% developed asthma, and in these subjects, the most important predictor of asthma development was airway hyperresponsiveness to histamine at baseline. Airway hyperresponsiveness is associated with more severe asthma and a poorer prognosis in terms of more exacerbations and less chance of remission of the disease. The second study described the relation between airway hyper-responsiveness to methacholine and the quality of life in 691 asthma patients: In asthma patients with airway hyperresponsiveness to methacholine, the quality of life measured with a validated questionnaire (Junipers Asthma Quality of Life Questionnaire) was significantly reduced compared to asthma patients who did not respond to bronchial provocation with methacholine. Airway hyperresponsiveness is not uncommonly observed in non-asthmatics, and the response to bronchial provocation with methacholine is therefore relatively non-specific. The mannitol test is a relatively new bronchial provocation test that acts indirectly on the smooth airway muscle cells through the release of mediators from inflammatory cells in the airways; the mannitol could consequently be a more specific test compared with methacholine. The third study showed that out of 16 non-asthmatics with airway hyperresponsiveness to methacholine, 15 did not respond to bronchial provocation with mannitol Because of the mechanism of action of mannitol, it seems plausible that the response to mannitol is more closely correlated to airway inflammation in asthma compared with the response to methacholine. The fourth study showed that in 53 adult asthma patients, who did not receive treatment with inhaled steroids, there was a positive correlation between the degree of airway inflammation and the degree of airway responsiveness to mannitol as well as to methacholine. The mannitol does, however, have the advantage of being a faster and simpler test to perform, requiring no additional equipment apart from a spirometer. Conclusions:, Airway hyperresponsiveness in children and in adolescents without asthma predicts asthma development in adulthood. Asthma patients with airway hyperresponsiveness to methacholine have a poorer quality of life as well as more severe disease and a poorer prognosis compared with asthma patients without airway hyperresponsiveness. Bronchial provocation with mannitol as well as with methacholine were useful for evaluating the severity of asthma and the degree of airway inflammation, and accordingly for determining the need for steroid statement. The mannitol test does, however, have practical advantages over the methacholine test that make it preferable for clinical use. [source] 2357: Autonomic nervous system and endothelial peripheral dysfunction in normal tension glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010J WIERZBOWSKA Purpose To define parameters of autonomic nervous system activity and peripheral vascular reactive hyperemia in normal tension glaucoma patients. Methods Ambulatory 24-hour electrocardiogram and blood pressure (BP) monitoring by using Lifecard CF and SpaceLab 90207-30 combined with occlusion provocation test were carried out in 54 NTG patients (44 women, mean age 59.7) and 43 matched control subjects (34 women, mean age 57.0). Heart rate variability (HRV) time and frequency domain parameters [low-frequency (LF), high-frequency (HR) and LF/HF ratio], and blood pressure variability (BPV) were calculated and analyzed for both study groups. Postocclusive hyperemia response parameters (TM - time to peak flow, TH ,half-time hyperaemia, TR ,time to rest flow, BZ-biological zero and MAX , maximum hyperemic response) were compared for patients with a nocturnal fall in mean BP (MPB) of less than 10% (non-dippers), of 10-20% (dippers) and of more than 20% (over-dippers) Results NTG patients demonstrated higher LF and LF/HF values for 24-hour period, day-time and night time than control subjects. There was no difference in BPV between study groups (10.4 ± 1.9 vs. 10.5 ± 2.1, p=0.790). In NTG patients, TH was significantly higher (79.0 ± 80.9 s vs. 51.5 ± 35.3 s, p=0.028) and BZ was significantly lower (2.3 ± 1.0 vs. 3.1 ± 2.0, p=0.009) as compared to the control group. There was statistically significant difference between NTG non-dippers, dippers and over,dippers in the BZ parameter (2.3 ± 0.9 vs. 2.7 ± 1.3 vs. 1.4 ± 0.4 p=0.024). Conclusion NTG patients exhibit abnormal ANS system activity and a different systemic hyperemia response as compared with healthy subjects. [source] Abnormal peripheral vascular response to occlusion provocation in normal tension glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2007J WIERZBOWSKA Purpose: To assess peripheral vascular reactive hyperemia in response to occlusion provocation test, using two-channels laser Doppler probe in patients with normal tension glaucoma (NTG) and normal subjects. Methods: 15 patients with NTG (12 women and 4 men), mean aged 58,9 and 15 control subjects (13 women and 2 men), mean aged 60,6 were subjected to an occlusion test. The experiment comprised following steps: 1/ a 5-minute baseline-period 2/ a 2-minute occlusion of the left hand using a 15 cm wide cuff located directly over the elbow (the pressure in the cuff was 50 mmHg higher than the systolic pressure measured on the arm 3/ a 15- minute final recovery period after occlusion. Finger hyperemia was assessed by two-channels laser-Doppler flowmeter MBF-3d, Moor Instruments, Ltd., continuously during the experiment. For measurements of hyperemia two surface probes were attached to the pulp of the second finger (mean probe) and third finger (basic probe) of the left hand. The following hyperemia parameters were measured: RF (rest flow), BZ (biological zero), TM (time to peak flow), TH (half-time of hyperemia), MAX (maximum of hyperemia) and hyperemia amplitude (MAX-RF)/RF 100% was calculated. Kruskal-Wallis test analysis was used to test the differences between the group of patients and normal subjects for TM1,MXF1 (basic probe) and TM2, MXF2 (mean probe) parameters. Results: In NTG patients, TM1 was significantly higher comparing with healthy subjects whereas MAX was significantly lower as compared to the control group. Conclusions: Occlusion provocation test elicits a different systemic hyperemia response in patients with NTG compared with healthy subjects. [source] Asthma tests in the assessment of military conscriptsCLINICAL & EXPERIMENTAL ALLERGY, Issue 2 2010D. Miedinger Summary Background Respiratory diseases such as asthma may affect individuals' fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms at conscription, objective and reliable tests are needed. Objective To prospectively determine the diagnostic value of the mannitol and methacholine bronchial provocation test (BPT) as well as exhaled nitric oxide in assessing physician-diagnosed asthma in a group of Swiss Armed Forces conscripts. Methods Questionnaire, spirometry, BPT with methacholine and mannitol, exhaled nitric oxide (FeNO) and skin prick testing were conducted in 18,20-year-old male conscripts. Asthma was diagnosed by a military physician not involved in this study according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication. Results Two hundred and eighty four subjects participated in the study. Complete data for the BPT with methacholine, mannitol and measurement of FeNO were available on 235 subjects. Forty-two conscripts (17.9%) had physician-diagnosed asthma. The sensitivity/specificity of mannitol to identify physician-diagnosed asthma was 41%/93% and for methacholine it was 43%/92%. Using a cut-off point of 36.5 p.p.b., FeNO had a similar negative predictive value to rule out physician-diagnosed asthma as BPT with mannitol or methacholine. Conclusion BPT with mannitol has a sensitivity and specificity similar to methacholine for the diagnosis of physician-diagnosed asthma in military conscripts but is less costly to perform without the need to use and maintain a nebulizer. Cite this as: D. Miedinger, N. Mosimann, R. Meier, C. Karli, P. Florek, F. Frey, K. Scherer, C. Surber, B. Villiger, F. Michel and J. D. Leuppi, Clinical & Experimental Allergy, 2010 (40) 224,231. [source] Increased production of cysteinyl leukotrienes and prostaglandin D2 during human anaphylaxisCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2009E. Ono Abstract Background Anaphylaxis is a life-threatening syndrome resulting from the sudden release of mast cell- and basophil-derived mediators into the circulation. However, pathological evidence of the association between inflammatory mediators and human anaphylaxis is insufficient. Objective The aim of this study was to better understand the relationship between in vivo production of inflammatory mediators and the pathogenesis of anaphylaxis. We also sought to evaluate mast cell activation in anaphylaxis. Methods We measured the concentrations of various inflammatory mediators in urine samples, which were collected from 32 anaphylactic patients during the onset of anaphlaxis and during clinical remission, 21 patients with asthma on acute exacerbation and 15 healthy control subjects. Blood and urine specimens were collected from the patients after provocation test. Urinary leukotriene E4 (LTE4), 9,, 11,-prostaglandin F2 (9,, 11,-PGF2), eosinophil-derived neurotoxin (EDN) and leukotriene B4 glucuronide (LTBG) concentrations were determined by enzyme immunoassay, and the activity of plasma platelet-activating factor acetylhydrolase and serum tryptase concentration were measured using commercially available kits. Results Significantly higher concentrations of urinary LTE4 and 9,, 11,-PGF2, which immediately decreased during clinical remission, were observed in the anaphylactic patients than in asthmatic patients on acute exacerbation and healthy control subjects. Concentrations of EDN and LTBG were not significantly different among the anaphylactic patients, asthmatic patients on acute exacerbation and healthy subjects. There was a significant correlation between urinary LTE4 and 9,, 11,-PGF2 concentrations in the anaphylactic patients (r=0.672, P=0.005, n=32). In addition, LTE4 concentration in patients with anaphylactic shock is significantly elevated compared with that in patients without anaphylactic shock. Conclusions This is a report on the significant increase in urinary LTE4 and 9,, 11,-PGF2 concentrations during anaphylaxis. Urinary LTE4 and 9,, 11,-PGF2 concentrations may be a reliable marker of endogenous production of inflammatory mediators associated with anaphylaxis. [source] Allergenicity and cross-reactivity of Senecio pollen: identification of novel allergens using the immunoproteomics approachCLINICAL & EXPERIMENTAL ALLERGY, Issue 6 2008O. Luengo Summary Background The genus Senecio is the largest genus of the family Asteraceae (Compositae). The allergenicity of Senecio has not been assessed previously. Objective The aim of this study was to investigate the allergens of Senecio jacobea pollen and to determine their immunological characteristics and clinical relevance. Methods Fifty patients with rhinoconjunctivitis and a positive skin prick test (SPT) to Senecio were recruited. The clinical relevance of this pollen was assessed by means of a nasal provocation test (NPT). Allergens were characterized by one-dimensional electrophoresis (SDS-PAGE) and two-dimensional gel electrophoresis and immunoblotting. Furthermore, characterization and identification of the allergens were performed by mass spectrometry (MS). In vitro inhibition tests were performed to evaluate cross-reactivity with other pollen. Results Three predominant allergens, both in the intensity of reaction and the frequency of recognition by human-allergic sera, were 59 (60%), 42 (50%) and 31 kDa (50%). The two-dimensional analysis allowed the identification of several allergens. One spot around 42 kDa was identified as a protein homologous to pectate lyase and three other spots were homologous to malate dehydrogenase by MS. S. jacobea proteins showed cross-reactivity with other proteins of the Asteraceae family and also with Parietaria judaica. This was demonstrated by immunoblotting and ELISA inhibition studies. Conclusion S. jacobea constitute a newly discovered allergenic source. It shows cross-reactivity with other members of the Asteraceae plant family as well as with P. judaica. [source] Bilateral nasal allergen provocation monitored with acoustic rhinometry.CLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2005Assessment of both nasal passages, the side reacting with greater congestion: relation to the nasal cycle Summary Background The effect of bilateral nasal provocation on nasal mucosa measured with the use of acoustic rhinometry (AR) can be assessed for both nasal passages or for the side responding with greater congestion. Assessment of changes in nasal congestion during the nasal provocation test (NPT) can be affected by the nasal cycle (NC). The aim of this study was to find out the most accurate method to evaluate changes observed during bilateral nasal provocation. Methods Cross-sectional areas (CSA) at the level of inferior nasal turbinate (CSA-2) were recorded by AR in 26 volunteers with allergic rhinitis during the NC for 5,7 h and subsequently during NPT. The risk of spontaneous total and unilateral CSA-2 decrease was established. Sensitivity of the NPT assessment for the total CSA-2 and for the side responding with greater congestion was evaluated at chosen thresholds. These thresholds were selected in a way that the risk levels of spontaneous decrease of unilateral and total CSA-2 were equal. Results The assessment of the total CSA-2 was found to be more sensitive than the assessment of the side responding with greater congestion. The highest sensitivity and specificity of the test was achieved by using a combination of both assessments. Optimum thresholds of the CSA-2 decrease for assessment at 15 min after provocation, with this method, were 27% and 40% for the side responding with greater congestion and for the total CSA-2, respectively. Conclusions Recognition of the risk of spontaneous unilateral and total CSA-2 decreases enables introduction of combined assessment of bilateral NPT. This assessment seems to be the most accurate method for evaluation of the test results. [source] Development of an imaginal provocation test to evaluate treatment for anger problems in people with intellectual disabilitiesCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2004John L. Taylor Anger and associated aggressive behaviour are significant clinical issues for many people with intellectual disabilities (IDs) that can lead to serious constraints to their liberty, which, in turn, adversely affects their quality of life. There is some evidence to support cognitive,behavioural anger treatment in this client group; however, anger assessment protocols for people with IDs should be diversified. In this regard, a method for anger assessment using imaginal provocation scenes was extended for use with this client population and the context in which treatment takes place. Two studies of the Imaginal Provocation Test (IPT) were conducted: the first with 48 patients examined its internal reliability and concurrent validity with anger psychometric scales; the second investigated whether it was sensitive to change associated with anger treatment in a small outcome study involving men with IDs and histories of offending. The IPT was found to successfully induce anger, be internally reliable, have strong concurrent validity and detect statistically significant changes in anger following anger treatment (N = 9), compared with a routine care waiting-list control group (N = 8). The IPT also had value in highlighting clinical improvements for anger treatment condition participants compared with the control group.,Copyright © 2004 John Wiley & Sons, Ltd. [source] Multiple fixed drug eruption due to drug combinationCONTACT DERMATITIS, Issue 6 2005A. 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] An Outbreak of Respiratory Diseases among Workers at a Water-Damaged Building , A Case ReportINDOOR AIR, Issue 3 2000MARKKU SEURI Abstract We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism. [source] Delayed adverse reactions to iodinated radiographic contrast media after coronary angiography: a search for possible risk factorsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2003N. Sakai BSc Summary Objective:, The incidence of and risk factors for delayed adverse events (DAEs) that appear from 1 h to 7 days after injection of radiographic contrast media were investigated in patients who had undergone coronary angiography (CAG). Methods:, DAEs were monitored by questionnaire in 155 patients who received iomeprol. Isosorbide dinitrate was injected in every case. Risk factors for DAEs were analysed by a logistic regression model. Results:, Of 118 patients who returned questionnaires, 54 complained of DAEs, although no severe or fatal reactions occurred. Erythema, rash and nausea were frequent events. Female gender, total dose of isosorbide dinitrate <2 mg, and execution of acetylcholine provocation test were found to be the major risk factors, and the incidence of DAEs increased as the number of risk factors increased. Conclusion:, Care should be taken when CAG is performed on female patients who undergo acetylcholine provocation tests and receive low-dose nitric oxide donor injections. [source] Allergy to peanut oil , clinically relevant?JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2007J 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] Determining the negative predictive value of provocation tests with beta-lactamsALLERGY, Issue 3 2010P. Demoly To cite this article: Demoly P, Romano A, Botelho C, Bousquet-Rouanet L, Gaeta F, Silva R, Rumi G, Rodrigues Cernadas J, Bousquet PJ. Determining the negative predictive value of provocation tests with beta-lactams. Allergy 2010; 65: 327,332. Abstract Background:, The beta-lactam allergic work-up is mostly standardized. However, the negative predictive value of drug provocation tests is not yet well established. Method:, A historical-prospective multicentre cohort study was conducted in four centres (one in France, one in Portugal, two in Italy) to assess the negative predictive value of provocation tests with beta-lactams in patients initially tested for a suspicion of drug allergy/hypersensitivity. Patients were contacted at least 6 months after the work-up, between 2003 and 2007. A new allergic work-up was proposed to reacting patients. Results:, Among the 457 patients included, 365 (79.9%) were followed up (159 [79.1%] from France, 153 [82.7%] from Italy and 53 [74.6%] from Portugal). Only 118 (25.8%) were re-exposed to the negatively tested beta-lactam. Nine (7.6%) reported a non-immediate (occurring more than 1 h after drug administration) reaction: five urticaria, three exanthema and one undefined cutaneous reaction. None were severe. Only four accepted a re-challenge, negative in two cases and positive in the two others. The negative predictive value was 94.1% (89.8,98.3) (111 out of 118 patients). Conclusion:, Although the negative predictive value of drug provocation tests may not be 100%, none of the false negative patients experienced a life-threatening reaction. This should reassure doctors who might hesitate to prescribe beta-lactams, even in patients with negative allergic work-ups. [source] EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivityALLERGY, Issue 10 2007E. Ni, ankowska-Mogilnicka Abstract:, Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of adverse drug reactions. Majority of them are of the hypersensitivity type. The two frequent clinical presentations of aspirin hypersensitivity are: aspirin-induced bronchial asthma/rhinosinusitis (AIA/R) and aspirin-induced urticaria/angioedema (AIU). The decisive diagnosis is based on provocation tests with aspirin, as the in vitro test does not hold diagnostic value as yet. Detailed protocols of oral, bronchial and nasal aspirin provocation tests are presented. Indications, contraindications for the tests, the rules of drug withdrawal and equipment are reviewed. Patient supervision and interpretations of the tests are proposed. [source] Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletesALLERGY, Issue 10 2007M. Bonini Background:, Asthma is frequently found in athletes, often associated with rhinitis and allergy. Aim:, To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes. Subjects and methods:, Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects. Results:, Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic , nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics , nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values. Conclusions:, Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes. [source] Diagnosis of nonimmediate reactions to ,-lactam antibioticsALLERGY, Issue 11 2004A. Romano Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during , -lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug-specific T-cell clones obtained from the circulating blood and the skin, suggest that a type-IV (cell-mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work-up, the patient's history is fundamental; patch testing is useful, together with delayed-reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug. Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to , -lactams. [source] | |||||||||||||||||||||||||||||||