Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics

권재우,김윤정,양민석,송우정,김세훈,조상헌,장윤석 대한의학회 2019 Journal of Korean medical science Vol.34 No.50

Background: The relationship between cephalosporin hypersensitivity and a history of β-lactam hypersensitivity is unclear. We evaluated the usefulness of routine intradermal cefazolin skin testing and its relationship with the history of β-lactam hypersensitivity. Methods: The electronic medical records of patients who underwent intradermal cefazolin (0.3 mg/mL) skin testing without negative controls from January 2010 to January 2011 at Seoul National University Bundang Hospital were evaluated. The history of β-lactam hypersensitivity of the patients was taken. Immediate adverse reactions after cefazolin injection were evaluated by searching the electronic medical records for key words and reviewing consultation documents of allergy specialists or dermatologists. The medical records of the patients were reviewed by an allergist. Results: There were 13,153 cases of cefazolin skin testing over the 13-month study period. Among the 12,969 cases with negative skin test results, 8 had immediate hypersensitivity related to cefazolin (0.06%). The negative predictive value of cefazolin skin testing alone wa 99.94%. The overall positivity rate of cefazolin skin tests was 1.4% (184/13,153). Of the cases with a history of allergy to β-lactams, 15% (6/40) showed a positive cefazolin skin test result compared to only 1.36% (178/13,113) of cases with no such history (P < 0.001) including som false-positive tests. Conclusion: The results suggest that routine screening involving cefazolin skin testing without negative controls is not useful for all patients, but could be helpful for those with a history of β-lactam hypersensitivity, although a large prospective study is needed to confirm this.

약물알레르기 검사의 시행과 해석: 전문가 의견서

양민석 ( Min-suk Yang ),반가영 ( Ga-young Ban ),김민혜 ( Min-hye Kim ),임경환 ( Kyung-hwan Lim ),권혁수 ( Hyouk-soo Kwon ),송우정 ( Woo-jung Song ),정재우 ( Jae-Woo Jung ),이정민 ( Jeongmin Lee ),서동인 ( Dong In Suh ),권재우 ( Ja 대한천식알레르기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.5

Diagnostic methods for drug allergy include the patient’s history, in vivo skin test, in vitro laboratory test, and provocation test. How-ever, the history is often not reliable, procedures for in vivo and in vitro tests are not standardized, and provocation tests are some-times harmful to patients. Generally, skin prick and intradermal tests are useful for immediate reactions; in contrast, patch test and delayed reading of both skin prick and intradermal tests are helpful for delayed reactions. A drug provocation test is the gold stan-dard for both responses, and it is necessary to be aware of exact indications and contraindications with appropriate drugs, doses, and intervals. To date, several methods have been developed to detect culprit agents for drug hypersensitivity reactions, but they are neither completely well validated nor standardized. Based on this awareness and necessity, the Korean Academy of Asthma, Al-lergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature, and then developed the consensus report on the procedures and applications of diagnostic tests for drug allergy. (Allergy Asthma Respir Dis 2017;5:239-247)

Flare Up Reaction During Provocation Test to Glatiramer Acetate in a Patient With Allergy to Interferon Beta1a

Paola Lucia Minciullo,Gioacchino Calapai,Sebastiano Gangemi 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.5

Glatiramer acetate (GA) is a synthetic amino acid polymer, used for relapsing-remitting multiple sclerosis. The most common adverse effect of GA isa skin reaction at the injection site with a probable IgE-mediated mechanism. We report a case of a 45-year-old woman with multiple sclerosis andurticaria to interferon-β1a, who underwent a challenge test to GA. She presented itching wheals at the intradermal sites. A month later the patientrepeated the test and presented the same reactions of the first test. The next day she continued the test with subcutaneous injections. One hour latershe presented a flare up of the reactions appeared during the previous 2 tests. No reactions appeared at the subcutaneous injection sites. Thepatient also presented dyspnea. Flare-up reactions are characterized by the reactivation of previously positive reactions to intradermal or skin teststriggered by patch testing and after systemic provocation with an allergen. The phenomenon is not common to drugs. The mechanisms involved inthis reaction seem to be heterogeneous and are not completely understood. To our knowledge this is the first case of allergic reaction to GA manifestedas a flare-up reaction during challenge test.

EMLA 크림이 ampicillin sodium 항생제 피내반응검사에 미치는 효과

김진(Kim, Jin),강희영(Kang, Hee-Young) 기본간호학회 2011 기본간호학회지 Vol.18 No.1

Purpose: The purpose of this study was to identify the effects of EMLA cream (eutectic mixture of local anesthetics, lidocaine and prilocaine) on pain during ampicillin sodium intradermal (ID) skin test, and also to assess skin reaction after the skin test. Methods: Forty-three nurse-volunteers had skin tests with 0.01ml-0.05ml ampicillin sodium antibiotics. Skin tests were done on each forearm to compare the pain level of the skin test site after application of EMLA cream with the pain level when no EMLA cream was applied. EMLA cream was applied at the ID skin test site with an occlusive dressing for one hour. Pain was evaluated using a visual analogue scale and pain sensation using the short form McGill Pain Questionnaire. The transverse diameter of the wheal and redness was read right after and at 15 minutes after the skin test. The results were compared using independent t-tests. Results: Pain score and sensation with EMLA cream treatment were significantly lower than when EMLA cream was not applied. There was no difference in skin reactions; reading of the skin test was not affected by EMLA cream. Conclusions: EMLA cream was found to be an effective local anesthetic to relieve the pain of clients having ampicillin sodium antibiotics ID skin tests.

Evaluation of multiple allergen simultaneous (sIgE) testing compared to intradermal testing in the etiological diagnosis of atopic dermatitis in horses

Piotr Wilkołek,Marcin Szczepanik,Wiesław Sitkowski,Beata Rodzik,Michał Pluta,Iwona Taszkun,Marcin Gołyński 대한수의학회 2019 Journal of Veterinary Science Vol.20 No.6

Although intradermal testing (IDT) is commonly used in the etiological diagnosis of allergies, in vitro testing for specific IgE (sIgE) is an attractive alternative. Currently, new laboratory techniques in veterinary allergological practice, including multiple allergen simultaneous tests (MASTs), gradually supersede in vivo tests. Both, serological (sIgE) and IDTs in fourteen atopic Malopolski horses were performed. Correlation and agreement between test results were evaluated. ROCReceiver operating characteristic analysis showed that sIgE to Acarus siro had the best diagnostic performance (Area under the ROC curve [AUC] = 0.969), followed by Dermatophagoides pteronyssinus (AUC = 0.844), Dermatophagoides farinae (AUC = 0.813) and Tyrophagus putrescentiae (AUC = 0.803). A significant positive correlation between IDT and MAST was found for A. siro (rS = 0.870; Pp = 0.00005), and D. farinae (rS = 0.657; Pp = 0.011). There was significant moderate agreement for 2 of 5 allergens, A. siro (κ = 0.569) and D. farinae (κ = 0.485) in semiquantitative assessment and significant fair to substantial agreement for 3 of 5 allergens, D. pteronyssinus (κ = 0.689), A. siro (κ = 0.569), D. farinae (κ = 0.432) in dichotomic assessment. Sensitivity ranged from 44% to 89%, depending on the allergen, while specificity was significantly higher for all allergens in MAST (60%–100%); the mean accuracy was 73% (manufacturer cut-off) and 77.4% (optimal cut-off) based on the Youden index. Compared with IDT, serological MAST showed good detection performance for 60 % allergen sIgE in dichotomic assessment with substantial diagnostic capability, but careful clinical interpretation is needed for some allergens.

문신 색소에 대한 육아종성 반응

이건복(Kun Bock Lee),이종육(Jong Yuk Yi),김형옥(Hyung Ok Kim),김정원(Chung Won Kim) 대한피부과학회 1988 대한피부과학회지 Vol.26 No.4

A 48-year-old woman, who had had tattoo on her eyebrows, was seen with pruitic erythematous indurated plaques on the tattooing sites. The skin react ion was begun to observe about 4 weeks after getting tattoo. Skin biopsy specimens from the indurated lesions showed granulomatous reactions. Intradermal tests by means of multiple pricks and patch test were done on her low back with the same tattoo dye and also 4 others available in Korea. Serial punch biopsy specimens were obtained from the sites of intradermal test at 2nd, 7th, 28th, and 56th day after intradermal test. Granulomatous reactions were found in the spiecimens taken at the 28th and 56th day.

Anaphylactic shock caused by an intradermal skin test-negative antibiotic during general anesthesia -A case report-

김규남,김동원,신영훈,오송이 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Anaphylaxis during the perioperative period is rare, but it still causes severe cardiovascular and respiratory collapse that can be fatal. In particular, when using antibiotics that have a high risk of hypersensitivity reactions, it is important to establish that intradermal skin tests are negative before using antibiotics. We report a case of anaphylactic shock occurring during general anesthesia after using an intradermal skin test-negative antibiotic. Regrettably, negative results of intradermal skin tests before using antibiotics do not completely eliminate the risk of anaphylaxis. Therefore, anesthesiologists should be prepared for anaphylaxis to occur at any point during the perioperative period.

Anaphylaxis to Chlorpheniramine Maleate and Literature Review

최용원,정민재,김혜원,정보영,박천욱 대한피부과학회 2019 Annals of Dermatology Vol.31 No.4

Chlorpheniramine maleate is commonly used antihistamine. Since antihistamines are the main therapeutic agents for symptomatic treatment of urticaria, anaphylaxis to antihistamines may lead to errors in diagnosis and treatment. We report a case of anaphylaxis induced by chlorpheniramine maleate confirmed by intradermal test. A 35-year-old female experienced history of anaphylaxis after intramuscular injection of chlorpheniramine maleate. Skin prick test was negative, but intradermal test was positive. Patient also experienced mild dizziness after intradermal test and refused to perform any further evaluation such as oral challenge test. Anaphylaxis for chlorpheniramine maleate is very rare but should be considered.

ELISA법을 이용한 경남지부 간흡충 진단 결과분석

엄기선 한국건강관리협회 1998 건협 Report Vol.1 No.-

Anaphylaxis to Chlorpheniramine Maleate and Literature Review

( Yong Won Choi ),( Min Je Jung ),( Hye One Kim ),( Bo Young Chung ),( Chun Wook Park ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.4

Chlorpheniramine maleate is commonly used antihistamine. Since antihistamines are the main therapeutic agents for symptomatic treatment of urticaria, anaphylaxis to antihistamines may lead to errors in diagnosis and treatment. We report a case of anaphylaxis induced by chlorpheniramine maleate confirmed by intradermal test. A 35-year-old female experienced history of anaphylaxis after intramuscular injection of chlorpheniramine maleate. Skin prick test was negative, but intradermal test was positive. Patient also experienced mild dizziness after intradermal test and refused to perform any further evaluation such as oral challenge test. Anaphylaxis for chlorpheniramine maleate is very rare but should be considered. (Ann Dermatol 31(4) 438∼441, 2019)