Skin test reactivity to histamine from infancy to old age

doi:10.1016/0091-6749(87)90292-2

Journal of Allergy and Clinical Immunology

Volume 80, Issue 5, November 1987, Pages 711-716

https://doi.org/10.1016/0091-6749(87)90292-2 Get rights and content

Abstract

The skin test reactivity to allergen and histamine differs according to the age of the patients, but complete data from infancy to old age are still lacking. Three hundred sixty-five subjects (1 to 85 years of age, 33.9% atopic, and 50.1% male patients) were prick tested with threefold dilutions of histamine hydrochloride (1 to 243 mg/ml). There was a significant (p < 0.0001; F test) main effect of age on the skin reactivity to histamine. Age groups were defined and statistical analysis were performed by means of parallel line bioassay. All dose-response curves were linear and parallel. There is a significant increase in the mean wheal size between 4 to 5 and 6 to 9 years of age, 10 to 14 and 15 to 20 years. There was almost no difference between 15 to 20 and 21 to 50 years. No difference was observed between 21 to 30, 31 to 40, and 41 to 50 years, and then, the mean wheal sizes decreased significantly to reach a plateau after the age of 60 years. There was no sex difference, and skin tests with histamine were similar in atopic and nonatopic individuals.

References (23)

JL Ménardo et al.
Skin test reactivity in infancy
J Allergy Clin Immunol
(1985)
PP Van Asperen et al.
Skin test reactivity and clinical allergen sensitivity in infancy
J Allergy Clin Immunol
(1984)
LR Freidhoff et al.
A genetic-epidemiologic study of human immune responsiveness to allergens in an industrial population. II. The association among skin sensitivity, total serum IgE, age, sex, and the reporting of allergies in a stratified random sample
J Allergy Clin Immunol
(1984)
L Tuft et al.
Studies in sensitization as applied to skin test reactions: influence of age upon skin reactivity
J Allergy
(1955)
GH Hagy et al.
Bronchial asthma, allergic rhinitis, and allergy skin tests among college students
J Allergy
(1969)
A Reinberg et al.
Circadian reactivity rhythm of human skin to house dust, penicillin, and histamine
J Allergy
(1969)
J Bousquet et al.
Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. I. In vivo and in vitro parameters after a short course of treatment
J Allergy Clin Immunol
(1985)
P Turkeltaub et al.
A standardized quantitative skin test assay of allergen potency and stability: studies on the allergen dose-response curve and effect of wheal erythema and patient selection on assay results
J Allergy Clin Immunol
(1982)
RA Barbee et al.
Allergen skin test reactivity in a community population sample: correlation with age, histamine skin reactions, and total serum immunoglobulin E
J Allergy Clin Immunol
(1981)
O Osterballe et al.
Cutaneous allergy in a Danish multicentre study
Ugeskr Laeger
(1981)

RA Barbee et al.

Immediate skin test reactivity in a general population sample

Ann Intern Med

(1976)

Cited by (122)

Early Exposure to Cow's Milk Protein Is Associated with a Reduced Risk of Cow's Milk Allergic Outcomes
2019, Journal of Allergy and Clinical Immunology: In Practice
Overall early exposure to allergenic foods in the infant's diet is a new strategy for preventing food allergy to that allergen, but the optimal timing of exposure for different allergens is not known.
We aimed to examine the relationship between exposure to cow's milk protein in the first 3 months of life and risk of cow's milk allergy at age 12 months.
HealthNuts is a longitudinal population-based food allergy study that recruited 5,276 twelve-month-old infants. Skin prick testing to cow's milk was conducted on the second half of the cohort (n = 2,715) and sensitization defined as a wheal ≥2 mm. Cow's milk allergy was defined as a parent-reported reaction to cow's milk consistent with IgE-mediated allergy together with evidence of sensitization. Early exposure to cow's milk protein was captured through parental questionnaire administered at 1 year of age and defined as consumption of cow's milk-based infant formula during the first 3 months of life.
Forty-two percent of infants were exposed to cow's milk in the first 3 months of life (n= 1,977/4,712) and 87% of these infants were also breastfed. Early exposure to cow's milk protein was associated with a reduced risk of cow's milk sensitization (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.23-0.83), parent-reported reactions to cow's milk (aOR 0.44, 95% CI 0.29-0.67), and cow's milk allergy (aOR 0.31, 95% CI 0.10-0.91) at age 12 months. Age at exposure to cow's milk protein was not associated with the risk of other food allergies.
Exposure to cow's milk protein in the first 3 months of life was associated with a reduced risk of cow's milk allergy. These findings are from an observational study and clinical trials are warranted to further assess this association before any recommendations to infant feeding guidelines can be made.
Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens
2017, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Mean wheal size by SPT showed a positive correlation with sIgE levels for all 17 allergens tested (overall correlation r = 0.59). SPT reactivity decreases with age17 and differs by sex.15 In addition, high total IgE levels show more positive CAP results8; therefore, we adjusted for sex, age, and serum total IgE levels.
Skin prick tests (SPTs) and measurements of serum specific immunoglobulin E (sIgE) antibodies are the most commonly used diagnostic tools for confirming sensitization. However, disagreement between the tests has been observed.
To compare SPT and the CAP system for diagnosis of sensitization to common inhalant allergens.
Subjects included 2,635 patients 10 to 90 years old who underwent analyses by SPT and CAP at the Dong-A University Hospital (Busan, Korea) from June 2011 through May 2016. The 2 test results were compared for 17 inhalant allergens.
Agreement between the SPT and sIgE level was 75.3%. Overall agreement was moderate (κ = 0.59), with strong agreement for house dust mites and birch (κ > 0.7) and weak agreement for Tyrophagus putrescentiae and dog (κ < 0.3). When CAP was compared with SPT as the reference, the sensitivity was 75.8% and the specificity was 75.2%. Mean wheal size by SPT showed a positive correlation with sIgE levels (r = 0.59), which decreased with age.
There was a discrepancy between SPT and CAP for diagnosing allergic sensitization among inhalant allergens. The allergic sensitization and correlation between the tests decreased with age. Cautious interpretation of the clinical relevance of allergen sensitization based on SPT and CAP results is required, especially in older patients.
Association of atopy phenotypes with new development of asthma and bronchial hyperresponsiveness in school-aged children
2017, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Nevertheless, the effect of the sensitization to specific allergens on the development of allergic diseases may involve various factors, such as exposure duration, intensity of sensitization, and exposure to specific allergens. Although the summed wheal diameters have also been associated with atopy,40,41 there were no significant differences in the summed wheal diameters across the atopy phenotypes with regard to indoor and outdoor allergens in our current study (Fig 4). Thus, the types of sensitized allergens, rather than summated wheal diameters, may be more important predictors of the prognosis in individuals with specific sensitization patterns.
Although previous studies have investigated the association between atopy phenotypes and allergic diseases, atopy characterizations in association with the development of allergic diseases remain poorly understood.
To identify atopy phenotypes in school-age children and to evaluate the association between atopy phenotypes and allergic diseases.
We enrolled 616 children with atopy defined as 1 or more positive allergen responses on skin prick tests and 665 children without atopy from the Children's Health and Environmental Research (CHEER) study. All children were followed up for 4 years at 2-year intervals. Atopy phenotypes were classified using latent class analysis.
Four atopy phenotypes were characterized: later sensitization to indoor allergens (cluster 1); multiple early sensitization (cluster 2); early sensitization to outdoor allergens, especially Alternaria, and later sensitization to indoor allergens, including Aspergillus (cluster 3); and early sensitization to indoor allergens and later sensitization to outdoor allergens (cluster 4). New cases of asthma during follow-up were increased in clusters 2 and 3 (adjusted odds ratio [aOR], 2.76 and 4.25, respectively). The risk of new-onset bronchial hyperresponsiveness was highest in cluster 3 (aOR, 5.03). Clusters 2 and 4 had an increased risk of allergic rhinitis (aOR, 7.21 and 2.37, respectively).
Identification of atopy phenotypes facilitates prediction of the development of asthma and bronchial hyperresponsiveness in school-age children. Our study suggests prevention of additional sensitization is required to modify the progression of allergic diseases.
Food Challenge and Community-Reported Reaction Profiles in Food-Allergic Children Aged 1 and 4 Years: A Population-Based Study
2017, Journal of Allergy and Clinical Immunology: In Practice
Oral food challenge is the main tool for diagnosing food allergy, but there is little data on the reaction profiles of young children undergoing challenges, nor how these reactions compare to reactions on accidental ingestion in the community.
To compare reaction profiles from food challenges and parent-reported reactions on accidental ingestion, and assess predictors of severe reactions.
HealthNuts is a longitudinal population-based cohort study of 5276 1-year-old infants. Infants underwent skin prick tests and those with identifiable wheals were offered food challenges. Food challenges were repeated at age 4 years in those with previous food allergy or reporting new food allergies. Community-reported reactions were ascertained from parent questionnaires.
Food challenges were undertaken in 916 children at age 1 year and 357 children at age 4 years (a total of 2047 peanut, egg, or sesame challenges). Urticaria was the most common sign in positive challenges at both ages (age 1 year, 88.7%, and age 4 years, 71.2%) although angioedema was significantly more common at age 4 years (40.1%) than at age 1 year (12.9%). Anaphylaxis was equally uncommon at both ages (2.1% and 2.8% of positive challenges at ages 1 and 4 years, respectively) but more common for peanut than for egg (4.5% and 1.2% of positive challenges at ages 1 and 4 years, respectively). The patterns of presenting signs reported during community reactions were similar to those observed in formal food challenges. Serum food-specific IgE levels of 15 kU/L or more were associated with moderate to severe reactions but skin prick test was not.
There was a shift from the most common presenting reaction of urticaria during food challenges toward more angioedema in older children. Serum food-specific IgE levels were associated with reaction severity.
Determination of nonirritating concentrations of antibiotics for intradermal skin tests in Korean adults
2017, Journal of Allergy and Clinical Immunology: In Practice
Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement
2016, World Allergy Organization Journal
One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation.
Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures.
Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended.
This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.

View all citing articles on Scopus

^∗: From the Clinique des Maladies Respiratoires, Hopital l'Aiguelongue, Montpellier.

^∗∗: From the Département de l'Information Médicale, Unité de Recherche Clinique, Hopital La Peyronie, Montpellier, France.

View full text

Article preview

Journal of Allergy and Clinical Immunology

Abstract

References (23)

Skin test reactivity in infancy

J Allergy Clin Immunol

Skin test reactivity and clinical allergen sensitivity in infancy

J Allergy Clin Immunol

A genetic-epidemiologic study of human immune responsiveness to allergens in an industrial population. II. The association among skin sensitivity, total serum IgE, age, sex, and the reporting of allergies in a stratified random sample

J Allergy Clin Immunol

Studies in sensitization as applied to skin test reactions: influence of age upon skin reactivity

J Allergy

Bronchial asthma, allergic rhinitis, and allergy skin tests among college students

J Allergy

Circadian reactivity rhythm of human skin to house dust, penicillin, and histamine

J Allergy

Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. I. In vivo and in vitro parameters after a short course of treatment

J Allergy Clin Immunol

A standardized quantitative skin test assay of allergen potency and stability: studies on the allergen dose-response curve and effect of wheal erythema and patient selection on assay results

J Allergy Clin Immunol

Allergen skin test reactivity in a community population sample: correlation with age, histamine skin reactions, and total serum immunoglobulin E

J Allergy Clin Immunol

Cutaneous allergy in a Danish multicentre study

Ugeskr Laeger

Immediate skin test reactivity in a general population sample

Ann Intern Med

Cited by (122)

Early Exposure to Cow's Milk Protein Is Associated with a Reduced Risk of Cow's Milk Allergic Outcomes

Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens

Association of atopy phenotypes with new development of asthma and bronchial hyperresponsiveness in school-aged children

Food Challenge and Community-Reported Reaction Profiles in Food-Allergic Children Aged 1 and 4 Years: A Population-Based Study

Determination of nonirritating concentrations of antibiotics for intradermal skin tests in Korean adults

Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

Original articleSkin test reactivity to histamine from infancy to old age

Abstract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy

J Allergy

J Allergy

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Cutaneous allergy in a Danish multicentre study

Ugeskr Laeger

Immediate skin test reactivity in a general population sample

Ann Intern Med

Original article
Skin test reactivity to histamine from infancy to old age