Bimodal skin reactivity to histamine in atopic children in Singapore: influence of specific sensitizations

Abstract

Histamine skin prick test (SPT) is used as the 'golden standard' for positive control in in vivo immediate type hypersensitivity testing. The skin reactivity to histamine can, however, be modulated by a bevy of extraneous factors. We aimed to define whether histamine skin reactivity in atopic children in Singapore is influenced by age, ethnic origin, gender, environmental exposure or specific sensitization patterns. A retrospective analysis of children, with specific aeroallergen sensitization (as measured by at least one allergen-specific SPT with a wheal size > 3 mm compared with the negative control) from the outpatient speciality clinic of the KK Children's Hospital, during 06/2002-06/2003. A total of 315 patients were included, 235 (75%) were males, 252 (80%) were Chinese, age mean was 7.7 yr (range: 2-15). Patients were referred to the SPT with a diagnosis of one or more of: allergic rhinitis 287 (91%), asthma 112 (36%) or atopic dermatitis 60 (19%). The mean histamine response showed a bimodal distribution, independent of age, ethnic origin, gender or phenotypical expression of allergic disease. Histamine skin reactivity was higher in atopic patients with polysensitization (mean 5.0 mm vs. 2.9 mm in monosensitized patients, p < 0.001), and in patients with mould sensitization (mean 5.1 mm vs. 3.3 mm in patient not sensitized to moulds, p < 0.001). The presence of passive smoking increased the likelihood of a diminished histamine skin response. Histamine skin response data strongly suggested the presence of two heterogeneous subpopulations. Children with polysensitization and mould sensitization were more likely to show a large significant histamine response, whereas children with passive smoke exposure, showed a diminished skin reactivity to histamine.

Histamine skin reactivity increases with body mass index in Korean children

“…Previous studies have reported that histamine skin reactivity increases with allergic sensitization, along with the number of sensitized allergens [6,10,11,24,26]. Sex, parental allergy history, parental smoking status, allergic sensitization, and number of sensitized allergens were not associated with histamine skin reactivity in multivariate analysis.…”

“…The study questionnaire was distributed, filled out by students and parents, and collected between October 15 and 30, 2010. Skin prick tests and physical examinations were carried out by trained nurses from November 8 to 11,2010. From a total of 687 first and second grade children from six elementary schools, 602 were included in the study.…”

The changing face of food hypersensitivity in an Asian community

“…Although studies have shown that the magnitude of the SPT, for particular food allergens, has a good correlation with challenge‐derived hypersensitivity data [28], this correlation and the respective weal size thresholds have not been validated in Asian children. It seems likely, however, that threshold differences may exist, because we do know that average SPT responses to the histamine‐positive control show significant variations in our population [29], emphasizing the need for such local validation studies.…”

Histamine and Its Relation to Allergens in the Skin Prick Test

“…Studies have shown that age [1,2], immunotherapy [3], habitat [4] and menstrual cycle [5] influence the size of the prick. The more positive allergen skin prick tests, the bigger the histamine wheal [6,7]. In pollen-allergic patients, the sensitivity of the shock organ varies over the year [8], and probably also the skin sensitivity to the offending allergen, but to histamine as well to some degree, shows similar changes [9].…”