Hypersensitivity to cholecalciferol (vitamin D3) or its active metabolite, calcitriol, is an exceedingly rare clinical phenomenon, with only 2 previously reported cases of suspected immediate hypersensitivity. Diagnosis of delayed drug hypersensitivity reactions is inherently difficult due to the lack of any robust in vitro diagnostic assay, particularly in those patients for whom provocation testing confers an unacceptable risk. In these situations, diagnosis relies on reproducible clinical manifestations following administration of the culprit agent, resolution upon its withdrawal and exclusion of other potential differential diagnoses. Based on these criteria, we propose the first reported case of delayed hypersensitivity to cholecalciferol successfully managed with a desensitisation protocol to pure cholecalciferol.
Calcitriol ; Cholecalciferol ; Diagnosis ; Diagnosis, Differential ; Drug Hypersensitivity ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; In Vitro Techniques

Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other beta-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.
Anti-Bacterial Agents ; Cephalosporins* ; Diagnosis* ; Drug Tolerance ; Hypersensitivity ; Hypersensitivity, Immediate* ; Immunoglobulin E ; Penicillins ; Skin Tests

PURPOSE: IgE was identified by Ishizaka as an antibody that is reacted at Type I hypersensitivity reaction, and has been used in the diagnosis of allergic disease and the differential diagnosis of extrinsic and intrinsic asthma. But there was some confusing in the diagnosis because of the broad range of measured serum IgE. Recently it was reported that serum IgE should be standardized for area and age to give the diagnostic reliability. METHODS: We measured serum IgE in 512 Korean children admitted at Ewha Woman University Mokdong Hospital between March 1991 and March 1994 and studied the relationship between asthma and serum IgE standardized for age in Korean children. RESULTS: 1) The geometric mean of serum IgE in non - allergic children and asthma were increased gradually according to age. The ranges of measured IgE in each group were overlapped in some part. 2) Log IgE increased by age similarly in asthma and non - allergic children, but was higher in asthma children than non - allergic children. Z scores of log IgE in asthma children increased by age, but those in non - allergic children was not changed by age. 3) Log IgE in male was not significantly different to that of female (p>0.05). 4) Incidence of asthma increased by increasing of Z score of log IgE standardized for age(p<0.05). 5) The normal range of serum IgE standardized for age was presented. Asthma was absent in children below the lowest normal IgE level (log IgE-1.5SD). CONCLUSIONS: Serum IgE if standardized by age, would be much valuable for the diagnosis of asthma in children.
Asthma* ; Child* ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Incidence ; Male ; Reference Values

PURPOSE: The purpose of this study is to find out the causative allergens using the prick test and to evaluate the associations between the results of the prick tests and the numerical values of eosinophils and IgE in the patients with allergic conjunctivitis. METHODS: The participants were 42 patients with diagnosis of allergic conjunctivitis on the basis of clinical history and findings of those who reacted positive to the prick test. We measured the numerical values of eosinophils and IgE as the indices of immediate hypersensitivity reaction. RESULTS: 38 out of the 50 allergens used in the prick test were reactive. Dermatophagoides pteronyssinus showed the highest reactivity of 57.1%. The numerical values of eosinophils and IgE were increased above the normal values only in 21.4% and 23.8% of the participants. CONCLUSIONS: It is considered that there is no distinct association between the reactivity of the prick test and the results of the serological test in the patients with diagnosis of allergic conjunctivitis on the basis of clinical history and findings.
Allergens ; Conjunctivitis, Allergic* ; Dermatophagoides pteronyssinus ; Diagnosis ; Eosinophils* ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Reference Values ; Serologic Tests

BACKGROUND AND OBJECTIVES: The diagnosis of the allergic fungal sinusitis (AFS) can be established by demonstrating type I hypersensitivity, nasal polyposis, characteristic CT scans, eosinophilic mucin and a positive fungal stain of mucus. There are certain conditions may also present clinically just like AFS, but in these cases, neither the presence of fungus nor the allergy can be documented. Some authors termed this condition as "AFS-like syndrome". Whether the AFS-like syndrome is a spectrum of AFS or different disease entity remains unclear. The objective of this study was to analyze the clinical features of allergic fungal sinusitis and to compare clinical features of AFS with those of AFS-like syndrome. SUBJECTS AND METHOD: Five patients with AFS and six patients with AFS-like syndromes were analyzed in terms of clinical manifestations, presence of associated diseases, radiologic findings, allergic test, treatment, and treatment outcome. RESULTS: Patients with AFS were younger than those with AFS-like syndrome. All patients of AFS group had histories of allergic disease. Eighty percent of AFS group patients had unilateral lesions, while 18 percent of AFS-like syndrome patients had unilateral lesions. Serum total IgE was more elevated in AFS group. On CT scan, characteristic findings such as heterogeneous soft tissue density, erosion of bony septa, and expansion of sinus wall were more frequently found in AFS group. There was no difference in treatment outcome between two groups. CONCLUSION: These results may suggest that AFS-like syndrome is a different disease entity from AFS.
Diagnosis ; Eosinophils ; Fungi ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Immunoglobulin E ; Mucins ; Mucus ; Sinusitis* ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Cefaclor, a second-generation oral cephalosporin, is known to cause IgE-mediated hypersensitivity. Assays of serum-specific IgE (sIgE) to cefaclor are commercially available via the ImmunoCAP system (Thermo Fisher Scientific). While serum levels of sIgE >0.35 kU/L are considered indicative of an allergy, some patients with cefaclor allergy show low serum IgE levels. This study aimed to evaluate the proper cut-off levels of sIgE in the diagnosis of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS: A total of 269 patients with drug allergy history, who underwent assays of sIgE to cefaclor at Ajou University hospital and Dong-A University Hospital, were reviewed retrospectively. Among them, 193 patients exhibited cefaclor-induced immediate hypersensitivity with certain or probable causality of an adverse drug reaction according to the WHO-UMC (the World Health Organization-the Uppsala Monitoring Centre) algorithm, and 76 controls showed delayed hypersensitivity reactions to non-antibiotics. RESULTS: In total, 126 of the 193 patients (65.3%) experienced anaphylaxis; they had higher serum sIgE levels than patients with immediate hypersensitivity who did not experience anaphylaxis (6.36±12.39 kU/L vs. 4.28±13.61 kU/L, p < 0.001). The best cut-off value for cefaclor-induced immediate hypersensitivity was 0.11 kU/L, with sensitivity of 80.2% and specificity of 81.6%. A cut-off value of 0.44 kU/L showed the best sensitivity (75.4%) and specificity (65.7%) for differentiating anaphylaxis from immediate hypersensitivity reactions. CONCLUSION: Patients with cefaclor anaphylaxis exhibit high serum IgE levels. A cut-off value of 0.11 kU/L of sIgE to cefaclor is proper for identifying patients with cefaclor allergy, and 0.44 kU/L may be useful to detect anaphylaxis.
Anaphylaxis ; Cefaclor* ; Diagnosis ; Drug Hypersensitivity ; Drug-Related Side Effects and Adverse Reactions ; Global Health ; Humans ; Hypersensitivity* ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Retrospective Studies ; Sensitivity and Specificity

Currently, the increasing numbers of vaccine administrations are associated with increased reports of adverse vaccine reactions. Whilst the general adverse reactions including allergic reactions caused by the vaccine itself or the vaccine components, are rare, they can in some circumstances be serious and even fatal. In accordance with many IgE-mediated reactions and immediate-type allergic reactions, the primary allergens are proteins. The proteins most often implicated in vaccine allergies are egg and gelatin, with perhaps rare reactions to yeast or latex. Numerous studies have demonstrated that the injectable influenza vaccine can be safely administered, although with appropriate precautions, to patients with severe egg allergy, as the current influenza vaccines contain small trace amounts of egg protein. If an allergy is suspected, an accurate examination followed by algorithms is vital for correct diagnosis, treatment and decision regarding re-vaccination in patients with immediate-type reactions to vaccines. Facilities and health care professionals should be available to treat immediate hypersensitivity reactions (anaphylaxis) in all settings where vaccines are administered.
Allergens ; Anaphylaxis ; Delivery of Health Care ; Diagnosis ; Egg Hypersensitivity ; Gelatin ; Humans ; Hypersensitivity* ; Hypersensitivity, Immediate ; Influenza Vaccines ; Influenza, Human ; Latex ; Ovum ; Vaccines ; Yeasts

Immediate-type hypersensitivity responses to systemic corticosteroids are rare despite their widespread use. It is still controversial whether the responses rarely occur or are underdiagnosed in clinical settings. Many cases probably remain underdiagnosed because the symptoms often mimic symptoms of underlying diseases. This case report describes a 73-year-old man who had immediate hypersensitivity reactions after intravenous administration of hydrocortisone, which was primarily intended to prevent hypersensitivity reactions to contrast media. Whole body rash with pruritus developed shortly after the steroid injection. Since the patient already experienced rash and itching sense after contrast media and antihistamine injection, we conducted skin testing to figure out which drug triggered the hypersensitivity reactions. Intradermal skin tests revealed a positive response to hydrocortisone sodium succinate, which suggested his hypersensitivity reactions were developed by hydrocortisone. Being a common therapy for allergic reaction, corticosteroids themselves are rarely suspected of causing hypersensitivity reactions. Considering there is no typical symptom or standard diagnostic test, awareness of corticosteroid hypersensitivity reactions is of importance to make the diagnosis.
Administration, Intravenous ; Adrenal Cortex Hormones ; Aged ; Contrast Media ; Diagnosis ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Exanthema ; Humans ; Hydrocortisone* ; Hypersensitivity* ; Hypersensitivity, Immediate ; Intradermal Tests ; Pruritus ; Skin Tests ; Sodium* ; Succinic Acid*

Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.
Adult ; Anaphylaxis ; Basophils ; Chlorpheniramine ; Comorbidity ; Diagnosis ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Female ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Intradermal Tests ; Skin Tests ; Up-Regulation ; Urticaria

BACKGROUND: Banana fruit has been recognized as an important food allergen source. Nowadays banana hypersensitivity had been reported more frequently with various presentations from oral allergy syndrome to anaphylaxis.OBJECTIVE: This study aims to describe the pattern of banana hypersensitivity and the sensitivity of diagnostic test.METHODS: Six patients who experienced banana hypersensitivity were recruited from adult allergy clinic, Ramathibodi Hospital, Mahidol University between 2015–2018. Demographic data, pattern of banana allergy consisted of the onset of reaction, symptoms, severity, cross-reactivity to kiwi, avocado, latex including type and amount of banana were collected. Skin test, serum specific IgE to banana and open-label food challenge test had been applied.RESULTS: All patients experienced multiple episodes of banana anaphylaxis. Regarding the diagnostic investigation, prick-to-prick skin test had higher sensitivity (sensitivity, 100%; 95% confidence interval [CI], 54.07%–100%) than the commercial banana extract (sensitivity, 83.33%; 95% CI, 35.88%–99.58%) and serum specific IgE to banana (sensitivity, 50%; 95% CI, 11.81%–88.19%). The discordance between skin prick test using commercial banana extract and skin test was reported. The cross-reactivity between the species of banana, kiwi, the avocado was documented in all patients. Latex skin prick test and application test were applied with negative results. From the oral food challenge test, a case of banana anaphylaxis patient can tolerate heated banana.CONCLUSION: The various phenotypes of banana hypersensitivity were identified. The prick-to-prick test showed the highest sensitivity for diagnosis of banana allergy. However, component resolved diagnostics might be needed for conclusive diagnosis.
Adult ; Anaphylaxis ; Diagnosis ; Diagnostic Tests, Routine ; Food Hypersensitivity ; Fruit ; Hot Temperature ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Immunoglobulin E ; Latex ; Musa ; Persea ; Phenotype ; Skin ; Skin Tests ; Thailand