Provocation testing

Sting provocation tests are often considered to be the gold standard, although they are less reliable in vespids than in honey bees [35-37, 41, 43]. They are commonly used to assure the efficacy of venom immunotherapy, but are generally considered as unethical in untreated patients with a history of venom anaphylaxis. 

Previous reactors are at high risk for a new reaction. In many cases reported, re-administration of the culprit contrast medium to patients with a previous non-immediate exanthema resulted in a repeat reaction [1]. In some (but not all) cases, a more severe reaction with subsequent RCM exposure has been described. After provocation tests, a re-appearance of the exanthemas after intravenous administration of the culprit contrast medium has been reported in patients with previous contrast medium-induced eruptions [1]. 

The accurate diagnosis of AIA can be established by oral, inhaled, nasal or intravenous placebo-controlled provocations tests with increasing doses of aspirin [10], There is no reliable in vitro test. Oral challenges are most commonly performed, because the oral route mimics natural exposure and the test does not require special equipment, except simple spirometry. The threshold dose of aspirin which provokes a 20% fall in FEVi (positive reaction) will vary with individual patients, depending... 

Results of Skin Test and Provocation Test Procedures... 

Subcutaneous Provocation Testing. When prick and intradermal tests are negative, subcutaneous provocation testing is started using 0.1 ml of the undiluted LA solution followed by 0.2, 0.5, 1.0 and 2.0 ml into the extensor side of the patients upper arm at 30-min intervals. For most of the patients it is possible to find a tolerable LA which is recommended for future applications [33] (table 3). In a long-term followup, Wasserfallen and Frei [32] found in 28 patients undergoing skin and subcutaneous provocative testing that over 3 years in 19 cases re-exposure to a tolerated LA was well tolerated without untoward reaction. 

Aberer W. Bircher A, Romano A, et al Drug provocation testing in the diagnosis of drug hypersensitivity reactions general considerations. Allergy 2003 58 854-863. 

Hein UR, Chantraine-Hess S, Worm M, Zuberbier T, Henz BM Evaluation of systemic provocation tests in patients with suspected allergic and pseudo-allergic drug reactions. Acta Derm Venereol 1999 79 139-142. 

Perform allergy diagnosis (after 3-4 weeks including in vitro diagnosis, skin test and if necessary provocation tests)... 

Perform a provocative test to measure GH, IGF-I, and/or IGFBP-3 levels. 

The importance of PAF in airway hypersensitivity has been confirmed by the protective effect exerted by BN 52021 and related ginkgolides [192] in (i) PAF-induced bronchoconstriction and airway hyperreactivity in both humans and animals (ii) various models of immune anaphylaxis and airway hyperreactivity in animals and, as we shall discuss later (iii) antigen-induced bronchial provocation tests in asthmatic patients. 

Shear MK. (1986). Pathophysiology of panic a review of pharmacologic provocative tests and naturalistic monitoring data. J Clin Psychiatry. 47(suppl) 18-26. 

For some substances, information on some toxicological endpoints is available from clinical and physiological investigations such as provocation tests for detecting allergy, lung function tests, and analyses of biochemical parameters and biomarkers for exposure or effects. 

Four nurses who were sterilizing endoscopes with glutaraldehyde developed symptoms of asthma and rhinitis temporally related to exposures to glutaraldehyde. Three of the four nurses, however, had a prior history of mild seasonal asthma." On specific provocation testing, one patient had an increase in nasal airway resistance, with a dual immediate and late response pattern. Another patient had a delayed 22% decline in FEVi 80 minutes after the final exposure to glutaraldehyde. The occurrence of late reactions suggested that the underlying mechanism involved sensitization rather than an irritant effect." ... 

Humans have developed strong skin reactions when rechallenged with the liquid. Allergic contact dermatitis has been reported in workers handling methacrylate sealants, including methyl methacrylate. In another report, five subjects were shown by bronchial provocation tests to have occupational asthma due to methyl methacrylate or cyanoacrylates. ... 

The only experimental data available on human exposure to airborne diethanolamine come from clinical provocation tests. Diethanolamine-induced occupational asthma was diagnosed following specific bronchial provocation tests in an exposure chamber. The positive reaction was observed in a 39-year-old male metal worker after a 30-min or 45-min inhalation exposure to aerosols from a warmed cutting fluid (40 °C) containing 0.15% diethanolamine and 0.32% triethanolamine, as well as after a 15-min exposure to pure diethanolamine at aerosol concentrations of 0.75 and l.Omg/m (Piipari etal, 1998). 

In pulmonary function laboratories, histamine aerosol has been used as a provocative test of bronchial hyperreactivity. Histamine has no other current clinical applications. 

Severe toxicoderma has been reported with xanthinol nicotinate and confirmed by a provocation test (SEDA-1, 333). Flushing is claimed to be less frequent with xanthinol nicotinate than with nicotinic acid, but has nevertheless been repeatedly observed, and its other adverse effects are likely to be the same as those of nicotinic acid. 

Clonidine stimulates the release of growth hormone and has been used as a provocation test of growth hormone reserve (290). 

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