“…These tests are
useful in pinpointing the offending allergen(s) and making a definitive diagnosis. Skin prick testing (SPT) with aeroallergens common to a particular geographic area
is a widely accepted, safe, convenient and cost effective [37] procedure, and one of the most widely used
diagnostic screening tests [38, 39]. SPT is less useful in conditions
involving generalized eczema, dermographism, in individuals with recent uses of
medications that have significant antihistaminic properties like tricyclic
antidepressants, or undergoing high dose corticosteroid treatment.…”
Section: Allergic Rhinitis [Ar]: Manifestations and Diagnosismentioning
Opinion Statement
A high proportion of suicides visit their medical provider in the month
prior to death, but depression, suicidal thoughts, and substance use are seldom
addressed. For the clinicians routinely treating a substantial patient
population with allergic diseases, there are additional concerns, as allergy has
been linked with both depression and suicidal behavior. While psychotropic
medications may affect diagnosis of allergies, medications used to treat
allergies impact mood and behavior. Thus, we present an overview of the overlap
of allergic rhinitis with depression and suicidal behavior in adults, based on
clinical and epidemiological data, and our research and clinical experience. In
summary, we suggest: 1) inquiring among patients with allergies about personal
and family history of depression, substance use disorders, suicidal ideation and
attempts 2) increased mindfulness regarding the potential effects of allergy
medications on mood and behavior; and 3) for people identified with certain
types of depression or increased suicide risk, a systematic multilevel
collaborative approach. While for practical reasons the majority of patients
with depression will continue to be treated by general or family practitioners,
the allergy-treating provider should always consider integrated care for
bipolar, psychotic or suicidal depression and incomplete remission, or relapsing
and highly recurrent course. While awaiting results of much needed basic and
clinical research to guide clinical approach for patients with comorbid allergic
rhinitis and depression, the simple steps recommended here are expected to
improved clinical outcomes in depression, including, on a large scale, reduced
premature deaths by suicide.
“…These tests are
useful in pinpointing the offending allergen(s) and making a definitive diagnosis. Skin prick testing (SPT) with aeroallergens common to a particular geographic area
is a widely accepted, safe, convenient and cost effective [37] procedure, and one of the most widely used
diagnostic screening tests [38, 39]. SPT is less useful in conditions
involving generalized eczema, dermographism, in individuals with recent uses of
medications that have significant antihistaminic properties like tricyclic
antidepressants, or undergoing high dose corticosteroid treatment.…”
Section: Allergic Rhinitis [Ar]: Manifestations and Diagnosismentioning
Opinion Statement
A high proportion of suicides visit their medical provider in the month
prior to death, but depression, suicidal thoughts, and substance use are seldom
addressed. For the clinicians routinely treating a substantial patient
population with allergic diseases, there are additional concerns, as allergy has
been linked with both depression and suicidal behavior. While psychotropic
medications may affect diagnosis of allergies, medications used to treat
allergies impact mood and behavior. Thus, we present an overview of the overlap
of allergic rhinitis with depression and suicidal behavior in adults, based on
clinical and epidemiological data, and our research and clinical experience. In
summary, we suggest: 1) inquiring among patients with allergies about personal
and family history of depression, substance use disorders, suicidal ideation and
attempts 2) increased mindfulness regarding the potential effects of allergy
medications on mood and behavior; and 3) for people identified with certain
types of depression or increased suicide risk, a systematic multilevel
collaborative approach. While for practical reasons the majority of patients
with depression will continue to be treated by general or family practitioners,
the allergy-treating provider should always consider integrated care for
bipolar, psychotic or suicidal depression and incomplete remission, or relapsing
and highly recurrent course. While awaiting results of much needed basic and
clinical research to guide clinical approach for patients with comorbid allergic
rhinitis and depression, the simple steps recommended here are expected to
improved clinical outcomes in depression, including, on a large scale, reduced
premature deaths by suicide.
“…Considering the fact that only a few percent of allergen molecules will permeate the mucosa [ 76 ], these findings indicate that ratios between levels of allergen molecules and allergen-specific IgE and IgG that occur at sites of allergen incorporation through mucosal surfaces after discharge of allergens by inhaled pollen grains or following allergen-delivery by small inhaled particles, seem to be astoundingly well reflected by serological testing using allergen chips. The same is true for skin prick testing where an average volume of 16 nanoliters enters the skin [ 77 ] which leads to incorporation of around 10–300 pg of allergen, depending on allergen-concentration in the test solution [ 11 , 12 ]. Fig.…”
Section: Allergen Microarrays Can Detect the Induction Of Blocking Anmentioning
Opinion statementAllergen-specific immunotherapy (AIT) is the only treatment of IgE-mediated allergies so far that has a sustained effect on clinical symptoms and can modify the course of the disease. It is an allergen-specific treatment and therefore requires the correct identification of the disease-causing allergens. Furthermore, AIT is a time-consuming treatment for which the efficacy is dependent on several factors. Therefore, diagnostic tests and biomarkers are needed that facilitate (1) selection of the correct allergens according to the patient’s individual sensitization profile and (2) to monitor the effects of AIT. This can provide support for the decision to continue, modify, or discontinue vaccination. One significant mechanism of action of AIT is the induction of allergen-specific antibodies that compete with IgE for the binding to allergen molecules, hence referred to as blocking antibodies. It was shown in several studies that the induction of blocking antibodies by AIT, and their specificity can be measured by allergen microarrays. Inhibition of allergen-specific IgE binding by blocking antibodies can also be determined by microarrays and is associated with changes in clinical parameters or other in vivo and in vitro assays demonstrating efficacy of AIT. Furthermore, allergen microarrays allow determination of IgE sensitizations towards a comprehensive set of allergen molecules and therefore are well suited for identifying the disease-causing allergens for correct prescription of AIT. Thus, diagnostic tests based on microarrayed allergens can be useful in determining the correct prescription of AIT and can be used to monitor efficacy of AIT.
“…14 Another group investigated the importance of the inoculum volume in inducing puncture skin test variation. Antico et al 15 performed 16 puncture skin tests (8 in each forearm) of 15 healthy volunteers (9 men, 6 women, age 64 ± 4 years) with 50% glycerosaline containing Tc99m and a 1-mm acrylic copolymer pyramidaltipped Morrow Brown needle. Using a γ-camera, they measured a mean 0.016-µL inoculum volume delivered to the skin (range 0.42 to 82.25 nanoliters).…”
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