What is the definition of drug allergies

American Academy of Allergy, Asthma, and Immunology

This academy’s website provides valuable information to assist readers determine the difference between colds, allergies, and sinusitis. A primer guide on sinusitis also provides more specific information about the chronic version of the illness. Additional resources include a «virtual allergist» that helps you to review your symptoms, as well as a database on pollen counts.

American College of Allergy, Asthma, and Immunology (ACAAI)

In addition to providing a comprehensive guide on sinus infections, the ACAAI website also contains a wealth of information on allergies, asthma, and immunology.

What is the definition of drug allergies

The site’s useful tools include a symptom checker, a way to search for an allergist in your area, and a function that allows you to ask an allergist questions about your symptoms.

Asthma and Allergy Foundation of America (AAFA)

For allergy sufferers, the AAFA website contains an easy-to-understand primer on sinusitis. It also provides comprehensive information on various types of allergies, including those with risk factors for sinusitis.

Centers for Disease Control and Prevention (CDC)

The CDC website provides basic information on sinus infections and other respiratory illnesses, such as common colds, bronchitis, ear infections, flu, and sore throat.

It offers guidance on how to get symptom relief for those illnesses, as well as preventative tips on practicing good hand hygiene, and a recommended immunization schedule.

U.S. National Library of Medicine

The U.S. National Library of Medicine is the world’s largest biomedical library. As part of the National Institutes of Health, their website provides the basics on sinus infection. It also contains a number of links to join you with more information on treatments, diagnostic procedures, and related issues.


What are some common uses of the procedure?

Thoracentesis is performed to:

  1. treat symptoms such as shortness of breath and pain
  2. relieve pressure on the lungs
  3. determine the cause of excess fluid in the pleural space.

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What is a Thoracentesis?

Thoracentesis is a minimally invasive procedure used to diagnose and treat pleural effusions, a condition in which there is excess fluid in the pleural space, also called the pleural cavity.

This space exists between the exterior of the lungs and the inside of the chest wall.

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What does the equipment glance like?

In this procedure, ultrasound, CT, or x-ray equipment may be used to guide a needle into the fluid within the pleural space. Thoracentesis is typically performed with ultrasound guidance. Occasionally, CT-guidance will be used.

Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a little hand-held device that resembles a microphone. Some exams may use diverse transducers (with diverse capabilities) during a single exam.

The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.

The technologist applies a little quantity of gel to the area under examination and places the transducer there. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The ultrasound image is immediately visible on a video display screen that looks love a computer monitor. The computer creates the image based on the loudness (amplitude), pitch (frequency) and time it takes for the ultrasound signal to return to the transducer.

It also takes into account what type of body structure and/or tissue the sound is traveling through.

The CT scanner is typically a large, donut-shaped machine with a short tunnel in the middle. You will lie on a narrow examination table that slides in and out of this short tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room. This is where the technologist operates the scanner and monitors your exam in direct visual contact.

The technologist will be capable to hear and talk to you using a speaker and microphone.

A thoracentesis needle is generally several inches endless and the barrel is about as wide as a large paper clip. The needle is hollow so fluid can be aspirated (drawn by suction) through it. In some instances, a little tube is advanced over the needle, and the fluid is removed through the tube after removing the needle.

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In most cases, people with allergies develop mild to moderate symptoms, such as watery eyes, a runny nose or a rash. But sometimes, exposure to an allergen can cause a life-threatening allergic reaction known as anaphylaxis.

This severe reaction happens when an over-release of chemicals puts the person into shock. Allergies to food, insect stings, medications and latex are most frequently associated with anaphylaxis.

A second anaphylactic reaction, known as a biphasic reaction, can happen as endless as 12 hours after the initial reaction.

Call and get to the nearest emergency facility at the first sign of anaphylaxis, even if you own already istered epinephrine, the drug used to treat severe allergic reactions.

Just because an allergic person has never had an anaphylactic reaction in the past to an offending allergen, doesn’t mean that one won’t happen in the future. If you own had an anaphylactic reaction in the past, you are at risk of future reactions.

How to Stay Healthy, Breathe Easier, and Feel Energetic This Winter

Indoor allergies, freezing weather, less sunlight — winter can make it hard to stay well mentally and physically. Discover out how to protect yourself against seasonal allergies, the winter blahs, freezing winds, comfort-eating traps, and fatigue this year.

Learn More About the Ultimate Winter Wellness Guide

Sinusitis can be a confusing thing to treat for anyone.

Because a sinus infection can be so easily confused with a common freezing or an allergy, figuring out the best way to alleviate your symptoms can be difficult.

Even more challenging, a sinus infection can evolve over time from a viral infection to a bacterial infection, or even from a short-term acute infection to a long-term chronic illness.

We own provided for you the best sources of information on sinus infections to assist you rapidly define your ailment and get the best and most efficient treatment possible.


Favorite Resources for Finding a Specialist

American Rhinologic Society

Through research, education, and advocacy, the American Rhinologic Society is devoted to serving patients with nose, sinus, and skull base disorders.

Their website’s thorough coverage of sinus-related issues includes rarer conditions, such as fungal sinusitis, which are often excluded from other informational sites. It also provides a valuable search tool to discover a doctor, as well as links to other medical societies and resources that are useful for patients.

Cleveland Clinic

Their website contains an exhaustive guide on sinusitis and an easy-to-use «Find a Doctor» search tool.

ENThealth

ENThealth provides useful information on how the ear, nose, and throat (ENT) are all connected, along with information about sinusitis and other related illnesses and symptoms, such as rhinitis, deviated septum, and postnasal drip.

As part of the American Academy of Otolaryngology — Head and Neck Surgery, this website is equipped with the ability to assist you discover an ENT specialist in your area.

Allergy Diagnostic Testing

Updated: July
Originally posted: November

Dr. John Oppenheimer
Director of Clinical Research,
Pulmonary and Allergy Associates
Denville, NJ, USA

Prof. Stephen Durham
Department Allergy and Respiratory Medicine,
Imperial College, London, UK

Dr.

Harold Nelson
National Jewish Medical and Research Center
Denver, CO, USA

Dr. Ole D. Wolthers
Clinical Institute, Health, Aarhus University
Asthma and Allergy Clinic, Children’s Clinic Randers
Randers, Denmark

Credit for the first skin testing goes to Charles H. Blackley, who in abraded a quarter-inch area of his skin with a lancet, applied grass pollen on a piece of wet lint, and covered the scarified area with an occlusive bandage. This resulted in intense itching and a extremely large cutaneous response.

Percutaneous skin test ranks first in confirming the presence of IgE-mediated sensitization in the allergist's office.

This should come as no surprise, as it has numerous advantages. Skin testing is minimally invasive, and when it is performed correctly it has excellent reproducibility, is easily quantified, and allows the evaluation of multiple allergens at one session. The results correlates within vivochallenges.in vitrotesting is an alternative, generally a back up tool for diagnosing allergic illness. Skin testing alone or in combination within vitrotesting is relied upon for the evaluation of allergic rhinitis, asthma, eczema, food allergy, insect sting allergy, drug allergy (especially beta-lactam and local anesthetic allergy), occupational disease and anaphylaxis.

However, the reliability of these tests depends on a number of factors. In the case of skin testing, it is significant that the technician performing the skin tests and the clinician ordering or interpreting these tests are aware of the advantages and pitfalls of the type of skin testing, the device used, the location of the tests on the body, the extracts used and the potential for suppression of the skin response by medications used to treat allergies or depression. These issues own been reviewed elsewhere in greater detail.1Forin vitrotesting, it is imperative that quality standards be met.

These include calibration of the assay, training and experience of the technician and the use of quality allergens in the solid phase.2As in any diagnostic test, it is of paramount importance that the clinician consider the positive and negative predictive worth of the tests performed. These tests should always be considered as adjuncts to the medical history and physical exam in formulating the diagnosis in each individual case, bearing in mind that both test types can yield untrue positive or, less commonly, untrue negative results.

Proficiency Testing

Like every other laboratory tests, it is imperative that quality assurance standards be met to ensure that the testing technique produces precise results.

To confirm such standards, it is recommended that every technicians performing skin testing undergo evaluation of their technique.11 Certainly, it would be comforting to know that skin test technicians achieve some degree of consistency in skin test performance. Although there are no formal standards available for skin test proficiency testing, several publications propose some possible criteria. European publications propose a coefficient of variation of less than 20% following repeated skin test control applications, and the Childhood Asthma Management Program study requires that a coefficient of variation of less than 30% be attained with repeated testing with histamine and consistently negative reactions to saline to confirm proficiency in skin testing.

The National Committee for Clinical Laboratory Standards recommends quality control procedures for daily performance ofin vitroallergy testing, with a recommended coefficient of variation of less than or equal to 15%.2Even with such calibration and the increased use of automation,in vitroassays still own flaws.

Williams and colleagues examined the performance of 6 large commercial laboratories on tests of blinded samples of the same sera, both diluted and non-diluted.12They found that only two of the laboratories demonstrated acceptable precision and accuracy.

Methods of Skin Testing

Skin testing may be performed using either the prick/puncture (percutaneous) or intradermal (intracutaneous) technique. Intradermal testing is far more sensitive than prick/puncture testing, which means that it requires about fold less concentrated extracts than those used for prick/puncture testing to achieve a similar response.

Although direct comparisons indicate that intradermal testing is more reproducible than percutaneous testing, there are numerous factors that favor the routine use of percutaneous allergy tests. These include economy of time, patient comfort and patient safety. Percutaneous testing allows the use of extract in 50% glycerin, which provides greater extract stability. Intradermal testing cannot use this diluent, as it may incite a false-positive irritant response. However, the most significant consideration is that results of percutaneous testing correlate better with clinical allergy.

The higher sensitivity of intradermal skin tests does not generally offer added benefit, since the results of skin prick tests performed with potent extracts are of sufficient sensitivity for use in clinical practice.

Two studies reinforce this concept.3,4Each study compared intradermal with skin prick tests by correlating their results with patients' responses to natural exposure to allergen as well as by allergen challenge testing.

In the first study, three groups of patients with seasonal rhinitis were compared. These subjects were classified into 3 groups based on their degree of sensitization to Timothy grass pollen. They were either skin prick test positive, only intradermal test positive, or were negative by both skin prick and intradermal testing. Both nasal allergen provocation testing and symptom scores during the pollen season correlated best with a positive skin prick test (>60% of subjects with positive skin prick tests had symptoms on allergen exposure). The frequency of positive nasal provocation (11%) and symptom scores (21%) in subjects with positive intradermal testing alone were not diverse from subjects who were skin prick test and intradermal test negative.

The authors conclude that under the conditions of this study, the presence of a positive intradermal skin test response to Timothy grass in the presence of a negative skin prick test did not indicate the presence of clinically significant sensitivity to this grass.

In the second study, patients were challenged with cat exposure for one hour.4Both positive skin prick tests andin vitrotests to cat were highly predictive of the development of symptoms upon allergen exposure in the cat challenge room.4Subjects with a negative skin prick test were just as likely to own a positive challenge result if they had a negative intradermal skin test (31%) as subjects with a positive intradermal skin test (24%).

The authors conclude that, at least with regard to cat allergy, major therapeutic decisions, such as environmental control or immunotherapy, should never be based on a positive intradermal skin test alone.

Both of these studies were performed in adults and both relied upon skin testing with relatively potent allergens (Timothy grass and cat). The clinical applicability of these results to less potent allergens, such as dog, or to younger patients (especially infants) is a matter of clinical judgment, because no specific evidence is available for these groups.

Comparing in vivo to in vitro Testing:

The preponderance of comparative studies protest skin tests to be more sensitive thanin vitrotests.

However, the majority of these studies were performed with earlier generationin vitrotests. The newerin vitrotests produce higher test sensitivity and specificity13by using a matrix capsule containing antigen bound to a hydrophilic carrier to produce enhanced specific IgE binding with lower nonspecific IgE binding.2Levels of specific IgE measured by diverse commercial assays are not equivalent, as each assay differs in the composition of allergen reagents, methods of measurement and standardization procedures.

The advantages ofin vitrotesting are largely related to use in patients with extensive dermatoses (e.g., atopic dermatitis), resulting in an inability to act out tests on unaffected skin, or in patients who are unable to discontinue medicines that block the histamine response, i.e., antihistamines or tricyclic antidepressants.

The disadvantages ofin vitrotesting include a potential decrease in sensitivity, added cost, and lack of immediate and visible response. Performing bothin vitroandin vivotests may yield improved sensitivity.15

Recording and Scoring of Skin Test Results

Skin test results are often reported by clinicians in semi-quantitative terms. They may record results only as positive or negative, or express them on a 0 to 4+ scale without any indication of the size of the reactions that these numbers represent.

However, allergy patients may own to change their allergist for numerous reasons, and it is significant that records of prior allergy testing be interpretable by the receiving physician. At the extremely least, a record of skin testing should contain sufficient information to permit another physician to interpret the results and avoid the need to repeat skin testing. Standardized forms own been developed and are available through the American Academy of Allergy Asthma and Immunology website (for an exampleAAAAI's Skin Test and Immunotherapy Forms).

Although the area of the wheal and erythema are the most precise measurements, the longest diameter or two diameters at correct angles to each other correlate with area (r > ).8The importance of performing such measurements is exemplified by the study of McCann and Ownby in which allergists were asked to interpret photographs of skin test reactions.

The scoring and interpretation of the skin test results varied greatly.9The authors of this study reinforce the thought that the most dependable method of reporting a skin test reaction is to measure and record the reaction size. At the extremely minimum, skin test results should be graded 0 to 4+, and the criteria for each grade of reaction clearly stated along with the skin test results.

Various investigators propose diverse criteria for interpreting a skin test response as positive. To assess the reliability of diverse means of interpreting the results of skin prick testing, Vanto and colleagues studied a group of children sensitive to dogs.10A determination of sensitivity to dog was based on a composite score derived from the history, RAST, and bronchial or conjunctival allergen challenges.

Although in this study the overall efficacy was greatest with the histamine reference method (in which the allergy skin test response is compared to a histamine control, with a positive response considered to be a response at least as grand as that of the histamine control), maximal sensitivity was achieved when using a cutoff of a wheal 3 mm. If a clinician wishes to maximize sensitivity, the latter criterion would be most useful; however, adjustment must be made for the device used. Therefore, the criteria for a positive test should be: 1) the larger of a 3 mm mean wheal diameter or 2) equal to or greater than the 99th percentile reaction with that device at negative control sites (see Table 1).

Skin Testing Devices

Whereas intradermal skin tests are always performed using a hypodermic syringe and needle, percutaneous tests may be performed with a variety of devices.

Comparisons of percutaneous devices own been reviewed elsewhere in greater detail.5 Some devices own a single stylus with one or several points, whereas others own multiple heads and permit up to 10 tests to be accomplished with one application. The degree of skin trauma created by these devices for percutaneous testing varies and so may result in differences in the size of positive reactions, and the likelihood of producing a reaction at the site of the negative control.

Thus, they require diverse criteria for what constitutes a positive reaction (see Table 1).

Table 1. Wheal size indicating a positive response to skin tests using various devices.a

a Positive response is defined as a wheal greater than 99% of wheals generated by the istration of saline to the subject's back by the same operator. Adapted from ref.
b HS = Hollister Steir, Greer = Greer laboratories, Lincoln = Lincoln Diagnostics, ALK = ALK America, ALO = Labs of Ohio

"Gold Standard" Confirmation of Allergy

Although there are challenge protocols available in the research setting to confirm allergic rhinitis and asthma, the standard tool available to the clinician is a careful history and physical exam.

Skin testing correlates with results of nasal challenge and with bronchial challenges when allowance is made for nonspecific airway responsiveness.

When evaluating potential food allergy, the clinical history is the initial screening, with skin testing orin vitrotests used to corroborate the history. Oral food challenges represent the "gold standard" for the confirmation of food allergy. These can be performed as open challenges or in a single- or double-blind fashion. Food challenges are not without risk and thus require that appropriate supportive care be available.

Several studies protest that the magnitude of thein vitrotest or the skin test reaction size may be useful in determining the utility of performing a food challenge.16,17One additional advantage of skin testing for food allergies is the ability to act out skin testing with the unused food, "prick-prick" test. Several reports protest that unused foods provide greater sensitivity for certain foods.18, 19This is particularly significant in assessing allergy to fruit; however, useful results own also been demonstrated for other foods, including seafood, peanut, tree nuts, vegetables, milk and eggs.

Molecular-based allergy diagnostic

It is hoped that the predictive worth of allergy diagnostic testing can be improved with the use of molecular-based allergy diagnostics.

This methodology is used to map the allergen sensitization of a patient at the epitope level, using purified natural or recombinant allergenic molecules (components) 20,21Molecular-based allergy diagnostics is available either using singleplex platforms which utilize panels of single allergens together with the corresponding allergen extract or can also be performed using multiplex technology to measure serum IgE antibodies against multiple allergens in a single assay The technique allows for the testing of a large number of allergens using a little quantity of serum (as little as 20 µL; conventional specific IgE tests use 50 µL per allergen).

Currently one multiplex platform is available on the market (the Immuno-Solid phase Allergen Chip (ISAC) platform) 23,24 Though a higher degree of variability in low IgE levels own been found, ISAC results own been similar to those obtained from singleplex platforms 25,26 At low serum IgE levels singleplex platforms may be more sensitive than ISAC and thus this should be considered when interpreting testing using the ISAC. Although more than epitopes own been identified, the clinical relevance of numerous of these is not known. Evidence, however, has been provided for use of several epitopes in clinical practice, such as peanut.

In numerous cases of peanut sensitization detected solely by prick skin testing or by whole allergen specific IgE it is hard to decide whether true allergy exists versus sensitization with no clinical symptoms as a manifestation of cross reactivity to pollen.

In such cases there is excellent evidence for analyzing IgE to the epitopes Ara h 2 (genuine IgE mediated allergy) and Ara h 8 (Bet v 1 (birch pollen) homologue; a marker of cross-reactivity) 27,28 IgE sensitization to Ara h 2 often correlates with positive IgE against Ara h 1 and Ara h 3. If there were IgE antibodies in serum to Ara h 2 and/or Ara h 1/Ara h 3, more than 95% of patients own reported symptoms when ingesting peanuts 29 If there was IgE only to Ara h 2 and not to Ara h 1, 3 or 8, 87% reported symptoms.

Whether there may be a threshold level of serum IgE to Ara h 2 above which peanut allergy may be diagnosed with a sufficient sensitivity and specificity which may forsake the need for oral provocation remains to be prospectively evaluated 30If there was only IgE to Ara h 8 and not to Ara h 1, 2 or 3 only around 18% of patients own reported symptoms, and these were generally extremely mild 29 More serious symptoms cannot be ruled out, however, in Ara h 8 sensitized patients. In the event of itching and swelling in the mouth and throat both Ara h 2 and Ara h 8 should be sure, and, at the same time, assessment of sensitization to birch pollen should be made by analyzing IgE to Bet v 1.

Bet v 1, PR protein is the major allergen in birch pollen and approximately 95% of birch pollen sensitized patients own specific IgE antibodies to Bet v 1 31 Specific IgE to Bet v 1 may also be found in patients with primary sensitization to other tree pollens (e.g.

elm: Aln g 1; hazel pollen: Cor a 1) as well as to foods (hazelnut, apple, soy, peanut (Ara h 8), kiwi, celery). IgE antibodies to Bet v 2 (profilin) and/or Bet v 4 (calcium-binding protein) are markers of cross-reactivity 31 and as opposed to Bet v 1 if increased are indicators that the patient is primarily sensitized to another pollen. IgE to Bet v 2 is a marker of cross-reactivity with numerous pollens and vegetable foods 32 while IgE to Bet v 4 is a marker of cross-reactivity only with other pollen allergens 33

IgE antibodies to Phl p 1 and Phl p 5 are specific markers for sensitization to Phleum pratense (Timothy grass).

Phl p 7 (calcium-binding protein) and Phl p 12 (profilin) are markers of cross-reactivity with fruits and vegetables. Increased IgE to these components and not to Phl p 1 and/or Phl p 5 indicates primary sensitization to a diverse species of grass pollen than Phleum pratense 34 It has been suggested that if relevant symptoms are present in addition to elevated IgE Phl p 1 and p 5 levels immunotherapy with phleum pratense extract would likely be clinically effective because phleum pratense extracts contain mainly Phl p5 and p6 24,35

Molecular-based allergy diagnostics are also likely to be of utility when considering immunotherapy for dust mite allergy.

Der p 1 and Der p 2 are the most significant component markers for sensitization to home dust mites 36as more than % of patients allergic to home dust mites own IgE antibodies to these epitopes. Approximately 10% of patients allergic to home dust mites, however, own increased IgE levels to Der p 10 37 These patients will not benefit from specific immunotherapy since home mite extracts contain mainly Der p 1 and Der p 2 and variable or low amounts of Der p Whether molecular-based allergy diagnostics may increase the effect ratio of immunotherapy of Phleum pratense and houst dust mite allergic patients has not, however, been tested in prospectively planned trials.

Positive IgE to both bee and wasp venom is often due to cross-reactivity between cross-reactive carbohydrate-determining reagents (CCD) 38 shared in these two species.

In the frequently occurring clinical situation of an uncertain history and positive IgE to both allergens, determination of specific molecular epitopes may be of aid. An increase in both Api m 1 and Ves v 5 would indicate a true double sensitization and immunotherapy with both bee and wasp extracts would be indicated 38,39

Understanding the paucity of data, a recent consensus document concluded that molecular-based allergy diagnosis may be considered for investigation of 20

  1. Ferrer M, Sanz ML, Sastre et al. Molecular diagnosis in allergologgy: application of the microarray technique. J Investig Allergol Clin Immunol ;19(suppl 1)
  2. patients with insect allergy (Api m1; Ves v5).
  3. Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC.

    Clin Chem Lab Med ;

  4. Ortolani C, Ispano M., Pastorello EA.,. Ansaloni R, Magri GC Comparison of results of skin prick tests (with unused foods and commercial food extracts) and RAST in patients with oral allergy syndrome Jl Every Clin Immunol ;
  5. McCann WA, Ownby, DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Every Asthma Immunol ;
  6. Martinez A, Asturias JA, Monteseirin J et al. The allergenic relevance of profilin (Ole e 2) from Olea europaea pollen. Allergy ;57(suppl 71)
  7. Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children.

    Clin and Exp Every ;

  8. Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol ,
  9. Pittner G, Vrtala S, Thomas WR et al. Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy ;
  10. Hejl C, Wurtzen PA, Kleine-Tebbe J, Johansen N, Broge L, Ipsen H. Phleum pratense alone is sufficient for allergen-specific immunotherapy against allergy to pooideae grass pollens. Clin Exp Allergy ;
  11. Dreborg S. ed. Skin tests used in type I allergy testing Position paper.

    Allergy ;s

  12. Oppenheimer J. Devices for epicutaneous skin testing. in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p
  13. Constantin C, Quirce S, Poorafshar M et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy ;
  14. Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every
  15. Oppenheimer J, Nelson HS. Skin Testing. Ann Every Asthma Immunol.

    ;S

  16. Nicolaou N, Murray C, Belgrave D et al. Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut alergy. J Allergy Clin Immunol
  17. Meliol G, Bonifazi F, Bonni S, et al. The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms. Clin Biochem ;
  18. Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics ; doi: // Epub Aug 5.
  19. Ownby DR. Computerized measurement of allergen-induced skin reactions.

    J Allergy Clin Immunol , ;

  20. Droste JH, Kerkhof M, de Monchy JGR et al. Association of skin test reactivity, specific IgE, entire IgE, and eosinophils with nasal symptoms in a community-based population study J Every Clin Immunol ;
  21. Sastre J. Molecular diagnosis in allergy. Clin Exper Allergy ;40(10)
  22. Yunginger, J. MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI ;
  23. patients and triggering allergens for specific immunotherapy, specifically
    — grass, (Phl p1, p5, p12)
    — home dust mites, (Der p1, p2, p10)
    — hymenoptera venom (Api m1; Ves v5).
  24. Valenta R, Hayek B, Seiberler S et al.

    Calcium-binding allergens: from plants to man.

    What is the definition of drug allergies

    Int Arch Allergy Immunol ;

  25. Hiller R, Laffer S, Harwanegg C, Huber M, et al. Microarrayed molecules: diagnostic gatekeepers for allergy treatment. FASEB J ;
  26. Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol ;
  27. Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients.

    Allergy. Feb;68(2) doi: /all Epub Dec

  28. Adkinson NF Jr. The radioallergosorbent test in limitations and refinements Jl Every Clin Immunol ;
  29. Nelson HS, Oppenheimer JJ, Buchmeier A, et al. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol ,
  30. Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy ;
  31. Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C.

    The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract ; Jan;1(1) doi: / Epub Dec

  32. Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy ;
  33. Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomysin, in unexposed Orthodox Jews.

    What is the definition of drug allergies

    Clin Exp Allergy ;

  34. selected cases of suspected peanut allergy, birch pollen allergy and associated cross-reactivity (Ara h2, h8 (h1, h3) (Bet v1, v2, v4).
  35. Sampson H Update on food allergy Jl Every Clin Immunol ;
  36. Turkeltaub P. Performance standards for allergen skin testing: An approach to proficiency testing in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p
  37. Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity? Jl Every Clin Immunol ;
  38. MS Dykewicz, JK Lemmon, DL Keaney. Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices.

    Ann Allergy Asthma Immunol ;

  39. Canonica GW, Ansetegui IJ, Pawankar R, et al.

    What is the definition of drug allergies

    A WAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics. WAOJ ;&

  40. Swoboda I, Twaroch T, Valenta R, Grote M. Tree pollen allergens. Clin Allergy Immunol ;
  41. Yoon I-K, Martin BL, Carr WW. A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc ;
  42. De Graaf DC, Aerts M, Danneels E, Devreese B. Bee, wasp and ant venomics pave the way for a component-resolved diagnosis of sting allergy. J Proteomics ;

Rather than classic testing, alternative molecular-based allergy diagnostics should be seen as an adjunct to the traditional whole allergen specific IgE tests. It is significant to remember that numerous patients can still be sufficiently assessed using conventional prick skin testing or specific IgE to whole allergens in the blood in addition to a thorough history and clinical examination 20 The clinical significance of sensitization detected via molecular-based allergy diagnostics should only be used in relation to the clinical history and physical signs.

ISAC testing is likely to be most useful in poly-sensitized patients for evaluation of sensitization to cross-reacting food and airborne allergens. Prospectively planned studies should be undertaken to determine to what extent such extensive panel screening may be helpful in clinical practice. Robust evidence has not yet been provided to prove that molecular-based allergy diagnostics can be utilized in lieu of oral challenge testing in food allergy.

ConclusionDiagnostic testing remains an essential tool for the evaluation of the allergic patient.

Several variables should be controlled to produce more dependable skin test results and improve the predictive values of allergy skin testing. It is also imperative that allergists ensure that the results of skin testing are dependable by conducting proficiency testing. In addition, the results must be properly documented to make them easily understandable by others. Similar standards must be applied toin vitrotesting; as in the case of skin testing, it is imperative that the ordering physician be familiar with the operating characteristics that thein vitrolab employs.

Lastly, it is likely that in the future, molecular based allergy diagnostics will frolic a bigger role in the evaluation of allergic patients.

References

  • Sastre J. Molecular diagnosis in allergy. Clin Exper Allergy ;40(10)
  • Yunginger, J. MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI ;
  • Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time.

    Clin Exp Allergy ;

  • Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity? Jl Every Clin Immunol ;
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  • Pittner G, Vrtala S, Thomas WR et al. Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy ;
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At Carolina Asthma & Allergy Middle, we’re committed to providing the highest quality asthma and allergy care in North and South Carolina. To better serve both states, our Rock Hill location is located near the South Carolina border, making it easily accessible to South Carolina residents in Rock Hill, Fort Mill, and Lake Wylie as well as North Carolina areas such as Pineville.

We own five medical experts on hand at our Rock Hill office, including Natasha Laungani, FNP-C; S.

Nicole Chadha, MD; Roopen R. Patel, MD; Susan I. Hungness, MD; and Glenn W. Errington, MD. Dr. Laungani, who is exclusive to our Rock Hill location, studied at the University of Kentucky and the University of Cincinnati.

What is the definition of drug allergies

Dr. Errington specializes in children over two years ancient and adults. He received certifications through the American Board of Internal Medicine and the American Board of Allergy and Immunology.

You’ll discover our shot room at our Rock Hill office as well, which is open until p.m. on weekdays. This is for our allergy patients dealing with skin allergies, food allergies, insect allergies, and more. Our patients who need allergy treatment or asthma treatment can set up an appointment for any day of the week until 5 p.m.

with one of our specialists. The phone number for our Carolina Asthma & Allergy Middle, including our Rock Hill office, is

Schedule an Appointment

To schedule or update an appointment and general questions, please call

Or Contact Us

Please note: Due to healthcare privacy laws, we cannot answer any questions pertaining to personal health information by e-mail.

Thoracentesis

Thoracentesis uses imaging guidance and a needle to assist diagnose and treat pleural effusions, a condition in which the space between the lungs and the inside of the chest wall contains excess fluid.

It is performed to assist determine the cause of the excess fluid and to ease any shortness of breath or pain by removing the fluid and relieving pressure on the lungs.

Your doctor will instruct you on how to prepare, including any changes to your medication schedule. Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies and medications you’re taking, including herbal supplements and aspirin.

You may be advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners several days prior to your procedure. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

At Carolina Asthma & Allergy Middle, we’re committed to providing the highest quality asthma and allergy care in North and South Carolina. To better serve both states, our Rock Hill location is located near the South Carolina border, making it easily accessible to South Carolina residents in Rock Hill, Fort Mill, and Lake Wylie as well as North Carolina areas such as Pineville.

We own five medical experts on hand at our Rock Hill office, including Natasha Laungani, FNP-C; S.

Nicole Chadha, MD; Roopen R. Patel, MD; Susan I. Hungness, MD; and Glenn W. Errington, MD. Dr. Laungani, who is exclusive to our Rock Hill location, studied at the University of Kentucky and the University of Cincinnati. Dr.

What is the definition of drug allergies

Errington specializes in children over two years ancient and adults. He received certifications through the American Board of Internal Medicine and the American Board of Allergy and Immunology.

You’ll discover our shot room at our Rock Hill office as well, which is open until p.m. on weekdays. This is for our allergy patients dealing with skin allergies, food allergies, insect allergies, and more. Our patients who need allergy treatment or asthma treatment can set up an appointment for any day of the week until 5 p.m. with one of our specialists.

The phone number for our Carolina Asthma & Allergy Middle, including our Rock Hill office, is

Schedule an Appointment

To schedule or update an appointment and general questions, please call

Or Contact Us

Please note: Due to healthcare privacy laws, we cannot answer any questions pertaining to personal health information by e-mail.

Thoracentesis

Thoracentesis uses imaging guidance and a needle to assist diagnose and treat pleural effusions, a condition in which the space between the lungs and the inside of the chest wall contains excess fluid.

It is performed to assist determine the cause of the excess fluid and to ease any shortness of breath or pain by removing the fluid and relieving pressure on the lungs.

Your doctor will instruct you on how to prepare, including any changes to your medication schedule. Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies and medications you’re taking, including herbal supplements and aspirin. You may be advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners several days prior to your procedure.

Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.


How should I prepare?

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

Tell your doctor about every the medications you take, including herbal supplements. List any allergies, especially to local anesthetic, general anesthesia or to contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure.

Tell your doctor about recent illnesses or other medical conditions.

You should tell your physician if you have:

  1. had lung surgery
  2. bleeding problems or take blood thinners, such as aspirin, Lovenox, Arixtra, Fragmin, Innohep, Coumadin, Pradaxa, Xarelto, or Eliquis
  3. lung disease, such as emphysema.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant.

Numerous imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety sheet for more information about pregnancy and x-rays.

You will get specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You may be asked to remove some or every of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

If sedation is required, you will need to own a relative or friend accompany you and drive you home afterward.

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