Dispositivos únicos ou múltiplos para testes cutâneos alérgicos em crianças?
Single or multiple devices for allergic skin test in children?
Laís Keiko Lopes; Cristine Secco Rosário; Carlos Antônio Riedi; Herberto José Chong Neto; Nelson Augusto Rosário
Resumo
Objetivos: Comparar os resultados obtidos com agulha e Multi-Test II® em testes cutâneos por puntura com diferentes concentrações de histamina e de extrato de Dermatophagoides pteronyssinus e a dor relatada em cada teste. Métodos: Estudo experimental, realizado no complexo Hospital de Clínicas em Curitiba, Paraná. Foram incluídas no estudo 104 crianças com idade entre 6 e 15 anos, com diagnóstico de asma e/ou rinite e/ou dermatite atópica e teste cutâneo alérgico positivo para Dermatophagoides pteronyssinus. Foram realizados testes com agulha hipodérmica descartável BD Precision Glide® 13 x 0,3 e com dispositivo Multi-test II® com histamina 10 mg/mL e 1 mg/ mL, Dermatophagoides pteronyssinus 5000 PNU/mL e 10000 PNU/mL e solução salina. Avaliação da dor foi obtida após cada teste pela escala de faces de dor de Wong-Baker. Resultados: A sensibilidade do teste cutâneo alérgico para os dois dispositivos foi 100% nas concentrações de histamina 10 mg/mL. Com histamina 1 mg/mL o Multi-test II® apresentou maior valor de sensibilidade (S = 86,5%) que a agulha (S = 56,7%). Alto nível de concordância entre os dois dispositivos foi observada com extrato de Dermatophagoides pteronyssinus na concentração de 10000 PNU/mL. Com a concentração de 5000 PNU/mL, o nível de concordância entre os testes foi 69,1% (Kappa = 0,2). A dor foi relatada por 65 (62,5%) crianças com Multi-Test II®, e 48 (46,2%) com agulha (p = 0,01). Conclusão: Houve alta sensibilidade para os dispositivos utilizados. Houve diferenças entre os tamanhos das pápulas nos testes cutâneos alérgicos com os dois dispositivos, porém resultados falso-positivos foram pouco observados. Ambos os dispositivos foram bem tolerados pelas crianças.
Palavras-chave
Abstract
Objectives: To compare results obtained with needle and with Multi-Test II® in skin prick tests with different concentrations of histamine and Dermatophagoides pteronyssinus, and the pain reported by patients with each device. Methods: This experimental study was conducted at Hospital de Clínicas, Curitiba, Brazil. A total of 104 children were included, aged 6 to 15 years and diagnosed with asthma and/or rhinitis and/or atopic dermatitis and showing a positive allergic skin test for Dermatophagoides pteronyssinus. Tests were performed using 13 x 0.3 BD Precision Glide® disposable hypodermic needles and also Multi Test II® with histamine 10 mg/mL and 1 mg/mL, Dermatophagoides pteronyssinus extract 5000 PNU/mL and 10000 PNU/mL, and saline solution. Pain was evaluated after each test using the Wong-Baker FACES Pain Rating Scale. Results: Allergic skin test sensitivity was 100% for the two devices with histamine 10 mg/ mL. With histamine 1 mg/mL, the Multi-test II® showed higher sensitivity (S = 86.5%) than the needle (S = 56.7%). A high level of concordance between the two devices was observed with Dermatophagoides pteronyssinus extract at the 10000 PNU/ mL concentration; with 5000 PNU/mL, the level of concordance was 69.1% (Kappa = 0.2). Pain was reported by 65 (62.5%) children after the use of Multi-Test II® and by 48 (46.2%) after the use of needles (p = 0.01). Conclusion: High sensitivity rates were observed for both single or multiple devices. There were differences in wheal sizes between the two devices, but few falsepositive results were found. Both devices were well tolerated by children.
Keywords
References
1. Chong Neto HJ, Rosário NA. Studying specific IgE: in vivo or in vitro. Allergol et Immunopathol. 2009;37:31-5.
2. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100:1‑148.
3. Bodtger U, Poulsen LK, Malling HJ. Asymptomatic skin sensitization to birch predicts later development of birch pollen allergy in adults: a 3-year follow-up study. J Allergy Clin Immunol. 2003;111:149‑54.
4. Antunes J, Borrego L, Romeira A, Pinto P. Skin prick tests and allergy diagnosis. Allergol Immunopathol. 2009;37:155-64.
5. Demoly P, Bousquet J, Manderscheid JC, Dreborg S, Dhivert H, Michel FB. Precision of skin prick and puncture tests with nine methods. J Allergy Clin Immunol. 1991;88:758-62.
6. Friedman MM, Kaliner M. Ultrastructural changes in human skin mast cells during antigen-induced degranulation in vivo. J Allergy Clin Immunol. 1988;82:998-1005.
7. Sellaturay P, Nasser S, Ewan P. The incidence and features of systemic reaction to skin prick tests. Ann Allergy Asthma Immunol. 2015;115:229-33.
8. Brand PL, Kerstjens HA, Jansen HM, Kauffman HF, de Monchy JG. Interpretation of skin tests to house dust mite and relationship to other allergy parameters in patients with asthma and chronic obstructive pulmonary disease. The Dutch CNSLD Study Group. J Allergy Clin Immunol. 1993;91:560‑70.
9. Oppenheimer J. Skin testing versus in vitro testing in the evaluation of aeroallergy: The great debate. Am J Rhinol Allergy. 2015;29:362‑4.
10. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013;3:3.
11. Ménardo JL, Bousquet J, Rodière M, Astruc J, Michel FB. Skin test reactivity in infancy. J Allergy Clin Immunol. 1985;75:646‑51.
12. Nelson HS, Rosloniec DM, McCall LI, Iklé D. Comparative performance of five commercial prick skin test devices. J Allergy Clin Immunol. 1993;92:750‑6.
13. Nelson HS, Kolehmainen C, Lahr J, Murphy J, Buchmeier A. A comparison of multiheaded devices for allergy skin testing. J Allergy Clin Immunol. 2004;113:1218-9.
14. Carr WW, Martin B, Howard RS, Cox L, Borish L. Comparison of test devices for skin prick testing. J Allergy Clin Immunol. 2005;116:341-6.
15. Tomlinson D, Baeyer T, Stinson JN, Sung L. A Systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;1126:68.
16. Eigenmann PA, Atanaskovic-Markovic M, O'B Hourihane J, Lack G, Lau S, Matricardi PM, et al. Testing children for allergies: why, how, who and when, an updated statement of the European Academy of Allergy and Clinical Immunology (EAACI) Section on Pediatrics and the EAACI Clemens von Pirquet Foundation. Pediatr Allergy Immunol. 2013;24:195‑209.
17. Godinho R, Lanza M, Godinho A, Rodriques A, Assiz TM. Frequência de positividade em teste cutâneo para aeroalérgenos. Rev Bras Otorrinolaringol. 2003;69:824-8.
18. Dutra BM, Rosario Filho NA, Zavadniak AF. Alérgenos inaláveis em Curitiba: uma revisão de sua relevância clínica. Rev bras alerg imunopatol. 2001;24:189-95.
19. Maniglia SF, Tsuru FM, Santos VC, Ueda DM. Sensitization profile to allergens in patients using Multi-Test II. Int Arch Otorhinolaryngol. 2014;18:391-7.
20. Ronchetti R, Haluszka J, Martella S. Skin reactivity to histamine and to allergens in unselected 9-year-old children living in Poland and Italy. Pediatr Allergy Immunol. 2003;14:201-6.
21. Ronchetti R, Pia Villa M, Ciofetta G, Barreto M, Falasca C, Martella S. Changes over 13 years in skin reactivity to histamine in cohorts of children aged 9-13 years. Allergy. 2001;56:436-44.
22. Almeida MM, Gaspar A, Romeira A. Reactividade cutânea inespecífica em estudos populacionais. Rev Port Imuno Alergol. 2001;8:199-204.
23. Tversky JR, Chelladurai Y, McGready J, Hamilton RG. Performance and pain tolerability of current diagnostic allergy skin prick test devices. J Allergy Clin Immunol. 2015;3:888-93.
24. Horsmanheimo L, Harvima IT, Harvima RJ, Ylönen J, Naukkarinen A, Horsmanheimo M. Histamine release in skin monitored with the microdialysis technique does not correlate with the wheal size induced by cow allergen. Br J Dermatol. 1996;134:94-100.
25. Malling HJ. Skin prick testing and the use of histamine references. Allergy. 1984;39:596-601.
26. Nelson HS, Knoetzer J, Bucher B. Effect of distance between sites and region of the body on results of skin prick tests. J Allerg Clin Immnunol. 1996;97:596-601.
27. Piette E, Bourret J, Bousquet P, Demoly P. Prick tests to aeroallergens: is it possible simply to wipe the device between tests? Allergy. 2002;57:940‑2.
28. Kupczyk M, Kuprys I, Gorski P, Kuna P. Not one lancet for multiple SPT. Allergy. 2001;56:256‑7.
Submitted date:
08/20/2017
Accepted date:
01/30/2018
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email