Skin Testing in Predicting Response to Nasal Provocation with Alternaria

Krouse, John H.; Shah, Anand G.; Kerswill, Kristy

doi:10.1097/00005537-200408000-00013

Cited by 33 publications

(56 citation statements)

References 8 publications

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“…In a separate study, Nelson et al, 9 evaluating timothy grass, found that a positive single intradermal skin test response in the presence of a negative SPT result did not indicate the presence of clinically significant sensitivity. The results for molds have not been as convincing, with poor sensitivity and specificity of SPT for Alternaria and modest improvement when further evaluating SPT negative tests with single intradermal tests 42 . There is controversy regarding which classes of antigens may have SPT negative results but clinically significant positive intradermal test results 47 .…”

Section: Discussionmentioning

confidence: 99%

“…The results for molds have not been as convincing, with poor sensitivity and specificity of SPT for Alternaria and modest improvement when further evaluating SPT negative tests with single intradermal tests. 42 There is controversy regarding which classes of antigens may have SPT negative results but clinically significant positive intradermal test results. 47 More work needs to be performed to more clearly determine which antigens deserve further evaluation when SPT results are negative.…”

Section: Discussionmentioning

confidence: 99%

“…Because of concerns about standardization of source materials as well as the significance of skin test results for certain antigen classes, fungal antigens were also reviewed separately. 41,42 Spearman's rank correlation coefficient was used to evaluate correlations between several variables of interest, principally the comparison between the IDT endpoint and the difference score for all antigens, for molds separately, and the size of the histamine and the glycerin/saline wheals. The Wilcoxon signed rank test was used on calculated paired difference scores of interest.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Use of Intradermal Dilutional Testing and Skin Prick Testing: Clinical Relevance and Cost Efficiency

2006

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Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Use of Intradermal Dilutional Testing and Skin Prick Testing: Clinical Relevance and Cost Efficiency

2006

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“…Given the general notion that the levels of IgG indicate the amount of immunologic exposure, these results suggest a direct correlation between the exposure to Alternaria antigens and the severity of the immune reaction as determined by the amount of IL-5 production. Other investigators also found an increase of nasal obstruction after challenge with Alternaria that was independent from an IgE-mediated hypersensitivity [35]. In a recent study, eosinophils from healthy people that were incubated with Alternaria and Penicillium antigens released significant amounts of eosinophil-derived neurotoxin, a marker of eosinophil degranulation [36].…”

Section: Why Do Eosinophils Exist? the Immune Response To Fungimentioning

confidence: 91%

The role of ubiquitous airborne fungi in chronic rhinosinusitis

Ponikau

Sherris

Kephart

et al. 2005

Curr Allergy Asthma Rep

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Chronic rhinosinusitis (CRS) is a confusing disease for both allergists and otorhinolaryngologists, partially due to its poorly understood pathophysiology and partially due to its limited treatment options. Several recent reports now provide evidence for a better understanding of the etiology and the relationship of CRS to airborne fungi, especially to Alternaria. First, the development of novel methods enables detection of certain fungi in mucus from the nasal and paranasal sinus cavities. Second, a non-immunoglobulin E-mediated immunologic mechanism for reactivity of CRS patients to certain common fungi has been described. Third, these fungi are surrounded by eosinophils in vivo, suggesting that they are targeted by eosinophils. Fourth, the preliminary results of studies using antifungal agents to treat patients with CRS are promising. Overall, these recent discoveries provide a logical mechanism for the pathophysiology of CRS, and they also suggest promising avenues for treatment of CRS with antifungal agents.

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“…Subsequently, the production of cytokines crucial to induce an eosinophilic infl ammation, namely interleukin (IL)-13 for the recruitment and IL-5 for the activation and life prolongation of the eosinophils, has been shown to be triggered by fungal antigens in patients with chronic rhinosinusitis [8]. This immune response was independent from the presence or absence of any detectable IgE-mediated allergy, and in striking contrast to its absence in healthy controls [8,9]. Whereas many different species can be recovered from chronic rhinosinusitis patients as well as healthy individuals, only Alternaria species have been shown to consistently induce the immune responses characteristic for chronic rhinosinusitis, which in turn are responsible for the recruitment (IL-13) and activation (IL-5) of eosinophils [8].…”

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confidence: 99%

A 42-year-old woman with chronic rhinosinusitis and allergic mucin

Salazar

Nelson²,

Stone³

2009

Curr Allergy Asthma Rep

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A 42-year-old woman, who is a member of a military parachute team, presents with more than 10 years of nasal congestion, facial pressure, and headaches that she has been self-treating with over-the-counter decongestants. She has a history of polypectomy in 1991 for similar symptoms, but did not have otolaryngology follow-up after the surgery. Following the surgery, she had a 5-year hiatus from parachuting, during which time she was asymptomatic. However, when she returned to parachuting in 1997, she had the gradual return of nasal congestion, facial pressure, and headaches. In addition to her sinus symptoms, the patient has a history of ocular and nasal pruritis and frequent sneezing when she is exposed to grass or dust, most prominent during the summer months. She grew up on a farm in Iowa and had intermittent ocular allergy symptoms when she was bailing hay. She has never had a formal allergy evaluation. The patient has no personal or family history of other atopic disease, such as asthma, atopic dermatitis, or food allergies. Examination revealed an athletic-appearing woman with a protuberance at the superior medial aspect of her right orbit that was evident on external inspection. Her nasal membranes were boggy, and bilateral nasal polyps were visible by rhinoscopy. Sinus CT scan revealed complete opacifi cation of the right frontal sinus with bony erosion posterior. Laboratory evaluation included an elevated IgE of 1870 ng/mL, normal spirometry, and positive skin prick testing to multiple tree pollens, grasses, and weeds. Skin prick testing was negative to Aspergillus fumigatus, Alternaria tenuis, Curvularia specifera, Helminthosporium iter, Mucor racemosus, and Penicillium notatum, but was positive to Cladosporium mix. Intradermal testing to A. fumigatus was positive. Her otolaryngologist identifi ed signifi cant polyp disease during endoscopic sinus surgery in the ethmoid region, obstructing her frontal sinus, as well as thick drainage in the frontal sinus consistent with eosinophilic allergic mucin. Surgical pathology revealed an alternating pattern of mucin and cellular debris rich in eosinophils. Special stains were positive for fungal elements. Culture of the drainage isolated Curvularia species. Expert Commentary: Dr. James T. LiAlthough chronic rhinosinusitis is one of the most common outpatient medical problems, the clinical evidence supporting the diagnosis and management of rhinosinusitis syndromes is rather slim. Nonetheless, patients such as the one presented here deserve our best shot at diagnosis and our best clinical judgment on therapeutic options.The diagnostic considerations of this case include nasal polyposis, chronic rhinosinusitis, allergic rhinitis, and allergic fungal sinusitis. This patient clearly has nasal polyposis based on the previous polypectomy (likely supported by histopathology), physical examination, and endoscopic sinus surgery. The sinus CT fi ndings and the eosinophils noted on surgical pathology support this diagnosis. The protuberance on physical examination and the b...

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Skin Testing in Predicting Response to Nasal Provocation with Alternaria

Cited by 33 publications

References 8 publications

Use of Intradermal Dilutional Testing and Skin Prick Testing: Clinical Relevance and Cost Efficiency

Use of Intradermal Dilutional Testing and Skin Prick Testing: Clinical Relevance and Cost Efficiency

The role of ubiquitous airborne fungi in chronic rhinosinusitis

A 42-year-old woman with chronic rhinosinusitis and allergic mucin

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