Anhidrotic ectodermal dysplasia (AED) is a rare hereditary disorder with a triad of sparse hair, dental hypoplasia, and anhidrosis. Here we report a case of AED with food allergy and atopic eczema. The patient was a 11-month-old boy admitted to our hospital with pyrexia for 2 weeks. He presented with a history of dry skin, eczema, and food allergy to egg. On clinical examination, his body temperature was 38.8°C, with dry skin and eczema almost all over the body, sparse eyebrows, and scalp hair. Laboratory investigations and physical examination did not show any evidence of infection. Radioallergosorbent test was positive to egg yolk, egg white, ovomucoid, milk, house dust, and house dust mite. As the child did not sweat despite the high fever, we performed the sweat test which revealed a total lack of sweat glands. Genetic examination revealed a mutation of the EDA gene and he was diagnosed as AED. His pyrexia improved upon cooling with ice and fan. His mother had lost 8 teeth and her sweat test demonstrated low sweating, suggestive of her being a carrier of AED. Atopy and immune deficiencies have been shown to have a higher prevalence in patients with AED. Disruption of the skin barrier in patients with AED make them more prone to allergic diseases such as atopic eczema, bronchial asthma, allergic rhinitis and food allergy. Careful assessment of the familial history is essential to differentiate AED when examining patients with pyrexia of unknown origin and comorbid allergic diseases.
Asthma ; Body Temperature ; Child ; Dermatitis, Atopic ; Dust ; Ectodermal Dysplasia ; Eczema ; Egg White ; Egg Yolk ; Eyebrows ; Fever ; Food Hypersensitivity ; Hair ; Humans ; Hypohidrosis ; Ice ; Infant ; Male ; Milk ; Mothers ; Ovomucin ; Ovum ; Physical Examination ; Prevalence ; Pyroglyphidae ; Radioallergosorbent Test ; Rhinitis, Allergic ; Scalp ; Skin ; Sweat ; Sweat Glands ; Sweating ; Tooth

BACKGROUND: The prevalence of allergy among Surabaya school children is currently unknown. OBJECTIVE: To identify the prevalence of the common allergic sensitization and allergic diseases among school children and undergraduate students in suburban of Surabaya by epidemiologic data collection. METHODS: A multistage simple random sampling was done to select 5 primary schools, 8 secondary schools (4 of junior high schools and senior high schools, respectively), and 1 university from 5 districts in Surabaya city. Out of 550 invited respondents, 499 (128 primary school, 221 secondary school, and 150 undergraduate) respondents gave their consent. A complete personal history, allergic symptoms, environmental exposure of common allergens was obtained from interview and the physical examinations were performed. Skin prick test (SPT) was done using 45 different allergen extracts. Total serum IgE and specific IgE radioallergosorbent test levels were measured for respondents with allergic manifestations. RESULTS: There was an increasing SPT positivity among study respondents, from primary school, secondary school, to undergraduate students (21.90%, 28.95%, to 45.30% respectively). Cockroach (42.85%) and fungi/mold spore (42.85%) were the most common allergens in primary school children. House dust mites was the most common allergen in secondary school (63.16%) and undergraduate students (58.82%). Urticaria and rhinitis were the commonest allergic diseases manifestation. History of atopy was positive in 60.79% of the allergic respondents. CONCLUSION: The prevalence of allergic sensitization among school children and undergraduate students in Surabaya suburb areas were increased compared to previous estimates in 1998. While house dust mites are known as important allergens, surprisingly cockroach was the common allergen among the younger school children.
Allergens ; Child ; Cockroaches ; Data Collection ; Developed Countries ; Environmental Exposure ; Epidemiologic Studies ; Humans ; Hypersensitivity ; Immunoglobulin E ; Indonesia ; Physical Examination ; Prevalence ; Pyroglyphidae ; Radioallergosorbent Test ; Rhinitis ; Skin ; Spores ; Surveys and Questionnaires ; Urticaria

The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.
Adult ; Betula* ; Diagnosis ; Erythema ; Food Hypersensitivity ; Humans ; Hypersensitivity* ; Hypersensitivity, Delayed ; Immunoglobulin E ; Immunoglobulins ; Incidence* ; Malus* ; Patch Tests ; Pollen* ; Radioallergosorbent Test ; Rhinitis, Allergic, Seasonal ; Skin

BACKGROUND: Hypersensitivity to penicillin has been studied worldwide, but data regarding patterns of sensitization in Arabian Gulf countries are scarce. OBJECTIVE: To describe the patterns of penicillin hypersensitivity during a 6-year study in Kuwait in terms of demographics, type of the culprit drug, in vivo and in vitro allergy testing. METHODS: One hundred and twenty-four patients referred to the drug allergy clinic for penicillin allergy were fully evaluated by skin prick and intradermal testing. Drug provocation test was done on patients with negative results. RESULTS: A total of 124 patients were evaluated for penicillin allergy. Mean age was 37.8 (standard deviation, 12.7) years, range from 8 to 74 years. Thirty-nine male (31.5%) and 85 female patients (68.5%) were included. Diagnosis of penicillin allergy was confirmed in 46 patients (37.1%). Among the 44 confirmed allergic patients by skin evaluation we had 15 (34.1%) positive skin prick test, and 29 (65.9%) positive intradermal testing. Among patients with positive skin testing, 47.7% were positive to major determinant benzylpenicilloyl poly-L-lysine, 20.4% to minor determinant mixture, 50.0% to penicillin G and 40.9% to ampicillin; 13.6% of patients were positive to amoxicillin by skin prick test. One patient had a positive radioallergosorbent test and one had a positive challenge test. CONCLUSION: Penicillin allergy is a common problem with an incidence of about one third in our study subjects.
Amoxicillin ; Ampicillin ; Demography ; Diagnosis ; Drug Hypersensitivity ; Female ; Humans ; Hypersensitivity ; In Vitro Techniques ; Incidence ; Intradermal Tests ; Kuwait ; Male ; Penicillin G ; Penicillins ; Radioallergosorbent Test ; Skin ; Skin Tests

PURPOSE: To investigate the prevalence rate of sensitization to indoor allergens, especially cat allergen in children with nasal symptoms in Kunpo city. METHODS: This study was a retrospective analysis of our radioallergosorbent test (RAST) database. We included 926 children with nasal symptoms between 3 months and 14 years of age. They underwent RAST which included 5 indoor and 4 food allergens. They were grouped according to age (0 to 3 years, 3 to 6 years, 6 to 9 years, 9 to 15 years). We calculated the prevalence rate of that sensitization according to age groups. RESULTS: Among the patients, 50.4% had the sensitization to at least > or =1 allergen of the RAST. The prevalence rate of sensitization increased according to the age group (P<0.05). The most common indoor allergen was Dermatophagoides farinae (D.f.) (22.6%), followed by cat (22.5%) and Dermatophagoides pteronyssinus (D.p.) (17.4%). Especially in the 0 to 3 age group, cat allergen (22.1%), was the predominant allergen, followed by dog (18.1%) and D.f. (8.7%). Among 926 patients, the rate of cat ownership was only 0.43%. The most common food allergen was pork (15.7%), followed by milk (4.9%) and egg white (3.2%). Pearsons test revealed significant correlation between cat and pork (r=0.563, P=0.000). CONCLUSION: This study shows a high rate of sensitization to cat allergen especially the 0 to 3 age group. It might be caused by exposure to wild cat in the community. We need to design a policy to reduce airborne cat allergen in the community.
Allergens ; Animals ; Cats ; Child ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dogs ; Egg White ; Humans ; Milk ; Ownership ; Prevalence ; Radioallergosorbent Test ; Retrospective Studies

OBJECTIVETo explore the effects of SDS, PBS re-dissolvent solutions on fluorescence values of radioallergosorbent test (RAST) inhibition.

METHODSDermatophagoides pterronyssinus allergen immunoCAP and UniCAP 100 System were used. The Sera Pool consisted of 20 Dermatophagoides pterronyssinus allergic patients sera, their specific IgE fluorescence values were between 12505 and 24776.

RESULTSFluorescence value percentages decreased: 62.9%, 54.1%, 43.5%, 6.7%, 3.7%, 2.6%, 2.2%, and 1.4% respectively, when SDS concentrations were at 2%, 1%, 0.5%, 0.25%, 0.1%, 0.05%, 0.025%, and 0.01%. Fluorescence values decreased more than 5% with SDS concentrations equal to 0.25% or higher. PBS in 0.1 and 0.01 mol/L concentrations decreased fluorescence values 2.9% and 0.9% respectively.

CONCLUSIONSSDS is a commonly used surfactants in allergen extract and re-dissolvent prepared allergen precipitation for RAST inhibition. Thus effects of surfactants (e.g. SDS) upon the RAST inhibition tests must be considered when they were used as re-dissolvent agents to improve protein resolution in RAST inhibition.

Allergens ; Dermatophagoides pteronyssinus ; immunology ; Dose-Response Relationship, Drug ; Fluorescence ; Humans ; Immunoglobulin E ; blood ; immunology ; Phosphates ; administration & dosage ; pharmacology ; Radioallergosorbent Test ; methods ; Sodium Dodecyl Sulfate ; administration & dosage ; pharmacology ; Solutions ; Surface-Active Agents ; administration & dosage ; pharmacology

OBJECTIVETo investigate the mechanism(s) of penicillins allergic reaction.

METHODSThe radioallergosorbent test (RAST) was used to detect 9 specific IgE antibodies, including major antigenic determinants: benzylpenicilloyl (BPO), ampicilloyl (APO), amoxicilloyl (AXO), phenoxomethylpenicilloyl (PVO) and flucloxacilloyl (FLUO), and minor antigenic determinants: benzylpenicillanyl (BPA), amoxicillanyl (AXA), 6-aminopenicillanic (APA) and phenoxomethylpenicillany (PVA), in the sera of 32 penicillin allergic patients. The relationship between specific IgE antibodies and penicillins chemical structures was studied by radioallergosorbent inhibition test.

RESULTSNineteen of 32 patients (59.4%) were RAST positive, among whom, five cases were positive only to one or two antigenic minor determinants, and three cases were positive only to one or three major antigenic determinants. The remaining 11 patients were positive not only to major antigenic determinants but also minor antigenic determinants. In 9 specific IgE antibodies, the positive rate of PVA-IgE was the highest (34.38%), followed by BPO-IgE (31.25%). The positive rate of FLUO-IgE was the lowest (15.63%). Of the total patient group, 53.13% were positive to one or more minor antigenic determinants, while 37.5% (12/32) were positive to one or more major antigenic determinants. The percentage of patients with urticarial reactions who were positive to minor antigenic determinants (63.16%) was significantly higher than observed in the anaphylactic shock group (38.5%, P < 0.05).

CONCLUSIONSThe minor antigenic determinant was important in allergic reaction. The combining sites of the specific IgE antibodies were likely to be the side-chain of drug or the overwhelming drug molecule.

Adolescent ; Adult ; Aged ; Antibodies ; blood ; Drug Hypersensitivity ; immunology ; Epitopes ; immunology ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Penicillins ; immunology ; Radioallergosorbent Test

A case is reported of anaphylactoid reaction to atracurium, used for the induetion of an- esthesia for skin graft in a 36 year old man. The patient had no previous history of any allergic tendency. It is not possible to distinguish between direct pharmacological effects and immune mediated hypersensitivity reactions by clinical observation alone. The mechanism of reaction in this patient was investigated by the leukocyte histamine release test, intradermal test, direct intravenous challenge with other induction agents used during the induction of anesthesia and radioallergosorbent test. The histamine releasing property of atracurium, the distinguishing methods between ana phylactic and anaphylatoid reaction, and the anesthetic management for this kind of reaction are discussed.
Adult ; Anaphylaxis ; Anesthesia ; Atracurium* ; Histamine ; Histamine Release ; Humans ; Hypersensitivity ; Intradermal Tests ; Leukocytes ; Radioallergosorbent Test ; Skin ; Transplants

The authors investigated the radioallergosorbent test (RAST) for the specific IgE and the prick test with hose dust mite in 129 patients with atopic dermatitis(AD) wit4 four or more family numbers. RAST and prick test results were described according to family background of respiratory atopy(RA) and severity of AD. The results are summarized as follows : l. A comparison between the prick test results and RAST reactions gave a concordance of 88%. The prick test was more sensitive than the RAST. 2. The level of specific IgE in patients with personal history(PH) or family history(FH) of RA was significantly increased compared to those in patients with only AD. 3. In patients without PH and FH of RA, the level of specific IgE in patients with FH of AD was significantly increased compared to those in patients without FH of AD. 4. The level of specific IgE did not reflect the severity of AD. From the above results, it could be concluded that type I allergy to house dust mite is not directly related to AD and it occurs predominantly in those patients with AD wha have a predisposition to RA.
Dermatitis, Atopic* ; Dust* ; Humans ; Hydrogen-Ion Concentration ; Hypersensitivity* ; Immunoglobulin E ; Mites ; Pyroglyphidae* ; Radioallergosorbent Test

To characterize the patients whose asthma may be caused by Artemisia pollen extracts, we studied the bronchoprovocation test with Korean Artemisia pollen extracts (1:20 w/v), methacholine bronchial challenge test and wormwood-RAST in 32 asthmatic patients sensitized to Artemisia pollen. Twenty-six(81%) developed a 15% or greater decrease in FEVI after the inhalation of Artemisia pollen extracts and 13 patients showed early responses, 8 dual, and 5 late only. Thirteen(50%) out of 26 positive responders complained of seasonal aggravation of their asthmatic symptoms. Seven(53.8%) of the 13 seasonal type patients, 10(76.9%) of the 13 perennial type and 5(100%) of the 5 negative responders showed concurrent positive responses in the house dust bronchoprovocation test. The bronchial responsiveness to allergen(PD15) was more dependent upon the specific IgE level(bound radioactivity on wormwood-RAST) and multiple regression analysis revealed that the specific IgE level and methacholine PC20 may be contributory to allergen PD15. These results suggested that specific IgE to Artemisia pollen appears to be the major contributor to susceptibility to Artemisia bronchial challenges and this pollen may be considered as one of the important allergenic etiologies of atopic asthma in this country.
Allergens ; Asthma/diagnosis/*etiology ; Bronchial Provocation Tests ; Human ; *Pollen ; Radioallergosorbent Test ; Skin Tests