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Biomedical subjects

P C Turkeltaub

Publications and source records attributed to P C Turkeltaub.

At least 19 recordsLinked to original sources
PubMed2000

Is allergen skin test reactivity a predictor of mortality? Findings from a national cohort.

BACKGROUND: The importance of atopy on subsequent mortality is controversial. A clearer understanding is important as atopy is increasing worldwide. OBJECTIVE: To determine the influence of allergen skin test reactivity on observed mortality of a national cohort. METHODS: Baseline health status and atopic status (allergen skin testing) was measured as part of the second National Health and Nutrition Examination Survey (NHANES II), a representative sample of the US population, during the years 1976-80. Vital status and cause of death were assessed through December 31, 1992 for all examinees 30 years of age or older at baseline (n = 9252) as part of the NHANES II Mortality Study (NH2MS). The analytic sample contained 8179 men and women after excluding missing data. Allergen skin test reactivity was defined as weal >/= 3 mm to one of eight 1 : 20 (w/v), 50% glycerinated ('No US Standard of Potency') allergens licensed by the FDA: house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial rye grass, and Bermuda grass. Survival analyses were conducted using multivariate adjusted Cox regression models to evaluate the association between atopy and all-cause, cardiovascular, and cancer mortality. RESULTS: There was no association between allergen skin test reactivity and all cause mortality: 30-44 years RR = 1.07 (95% CI 0.63-1.84); 45-59 years RR = 1.10 (0.78-1.55); 60-75 years RR = 1.07 (0.91-1.25). Results were unchanged when cancer or heart disease mortality were examined separately. The presence or absence of allergic symptoms, using the flare to define skin test reactivity, eliminating deaths in the first 5 years of follow-up, or eliminating individuals with pre-existing conditions did not alter the findings. CONCLUSIONS: Atopy, defined by allergen skin test reactivity, with or without symptoms, is not a predictor of subsequent mortality.

Adult↗
PubMed1993

Survey of fatalities from skin testing and immunotherapy 1985-1989.

BACKGROUND: The Committee on Allergen Standardization of the American Academy of Allergy and Immunology (AAAI) began a study of fatalities associated with skin testing and immunotherapy in an effort to identify risk factors and to ascertain whether any additional precautions are required to prevent and treat serious reactions. METHODS: Questionnaire data was obtained from members of the AAAI and the American College of Allergy and Immunology, regarding 17 fatalities associated with immunotherapy for the years 1985 to 1989. In this period, no fatalities were reported with skin testing. The mean age of patients who died was 36.0 years (range: 10 to 77 years), and 69% were female. Of the patients who died, 76% had asthma, and most were reported to have had factors associated with severity (i.e., lability, required steroids, and/or prior hospitalizations). The only patient who had rhinitis alone had cardiovascular disease and was receiving a beta-blocker. High sensitivity by skin test or RAST was reported by 71%, and 36% reported prior systemic reactions. Sixty-five percent of the patients were undergoing build-up therapy. Fatalities involved use of allergen doses between 1:1 million to 1:10 wt/vol. Other factors associated with fatalities were: changing to a new vial of extract, 5; dosing error or inappropriate dose adjustment, 5; allergen season, 5; symptomatic before injection, 4; not waiting after injection, 2; and home injection, 1. Onset of anaphylaxis occurred within 20 minutes in eleven patients, within 20 to 30 minutes in one, and after more than 30 minutes in one. In eleven cases the cause of death was associated with respiratory compromise. These data reinforce the need for special precautions in treating high-risk patients with asthma. The annual fatality rate from administration of allergenic extracts in the United States remains very low: 1 fatality per 2 million doses, but additional educational efforts to further reduce the fatality rate are needed.

Academies and Institutes↗
PubMed1992

The association of individual allergen reactivity with respiratory disease in a national sample: data from the second National Health and Nutrition Examination Survey, 1976-80 (NHANES II).

The independent association of individual allergen reactivity with respiratory disease was evaluated with use of the second National Health and Nutrition Examination Survey, a sample of the U.S. white civilian population, ages 6 to 24 years (n = 4295). Eight, 1:20 wt/vol, 50% glycerol, unstandardized extracts were administered by prick puncture. Allergen reactivity was reported as the percent with a mean erythema diameter 10.5 mm or greater at 20 minutes. Only the prevalence of asthma and allergic rhinitis increased with the increasing number of positive allergen skin tests. The independent association of individual allergen reactivity with respiratory disease was quantified with logistic models that included other allergen reactivity, age, sex, smoking, and region. Asthma was associated with reactivity to house dust (odds ratio, 2.9; 95% confidence interval [CI] 1.7 to 5) and Alternaria (odds ratio, 5.1; 95% CI: 2.9 to 8.9). Allergic rhinitis was associated with reactivity to ragweed (odds ratio, 2.3; 95% CI: 1.5 to 3.3); ryegrass (odds ratio, 2.8; 95% CI: 1.8 to 4.3); house dust (odds ratio, 2.5; 95% CI: 1.6 to 3.9); Alternaria (odds ratio, 2.3; 95% CI: 1.5 to 3.4). Asthma only (without allergic rhinitis) was associated with dust and Alternaria. Allergic rhinitis only (without asthma) was associated with ryegrass, ragweed, and house dust. When both asthma and allergic rhinitis were present, only house dust and Alternaria remained associated. These findings highlight the association of specific allergens with upper and lower respiratory diseases and the interactions among coexisting respiratory diseases.

Adolescent↗
PubMed1992

Age of onset in childhood asthma: data from a national cohort.

There is controversy over the role of age of asthma onset in childhood asthma. Data collected on self-reported physician-diagnosed asthmatic children and young adults aged 6-24 years (N = 352), who participated in the second National Health and Nutritional Examination, 1976-80 (NHANES II), a national sample, were examined to see whether reported age at onset was associated with the future course of the asthma. Three definitions were used for early-onset asthma: asthma beginning before the second birthday, before the third birthday, and before the fourth birthday. Late-onset asthma was defined as asthma beginning on or after the second birthday, the third birthday, and the fourth birthday, respectively. Among 6-14 year olds, late-onset asthmatic subjects as compared with early-onset asthmatic subjects using the three definitions reported more allergic rhinitis OR = 3.79 (95% CI 1.53, 9.41), 3.06 (1.33, 7.07), 2.71 (1.18, 6.22), and were more likely to have at least one positive allergen skin test OR = 2.21 (95% CI 1.02, 4.79), 2.90 (1.29, 6.49), 3.41 (1.50, 7.75). Late-onset asthmatic subjects tended to report that their asthma was active, have more problems during the past 12 months with wheezing, and have lower values for predicted FVC and FEV1. No difference was found in reported chronic rhinitis, sinusitis, other allergies, problems within the last 12 months with cough attacks, or during the past 3 years a period of cough and phlegm lasting more than 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Prevalence of upper and lower respiratory conditions in the US population by social and environmental factors: data from the second National Health and Nutrition Examination Survey, 1976 to 1980 (NHANES II).

Data on respiratory conditions reported by sample persons 12 to 74 years of age in NHANES II were examined. The prevalence of upper respiratory conditions varied little between whites (N = 11,260) and blacks (N = 1,482): allergic rhinitis 9.8% versus 8.1%; chronic rhinitis 20.4% versus 19.2%. Except for "allergic rhinitis only," which was increased in whites, no racial differences were found for any upper respiratory condition, singly or in combination. The prevalence of lower respiratory conditions in whites and blacks were: asthma (A) 6.9% versus 9.2% P less than .05, chronic bronchitis (CB) 1.3% versus 0.8% P less than .05, and chronic cough (CC) 1.1% versus 0.7% P greater than .05. There was no racial difference in the prevalence of overall lower respiratory conditions (A + CC + CB). All upper and lower respiratory conditions peaked in 50 to 74-year-olds except for allergic rhinitis only (without asthma) which peaked in 25 to 49-year-olds. Smokers reported all upper and lower respiratory conditions more often than nonsmokers, except for allergic rhinitis only (without asthma), which was reported less often by smokers. Females reported more allergic rhinitis in any combination, while males reported more asthma only (without allergic rhinitis). Sample persons living below poverty reported increased prevalence of chronic rhinitis, asthma, asthma only (without allergic rhinitis), and either allergic rhinitis or asthma. Residents of urban areas reported increased prevalence of allergic rhinitis and allergic rhinitis only (without asthma) while residents of rural areas reported increased prevalence of asthma only (without allergic rhinitis).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

The association of allergen skin test reactivity and respiratory disease among whites in the US population. Data from the Second National Health and Nutrition Examination Survey, 1976 to 1980.

Data collected on 12- to 74-year-old whites (N = 10,854) during the second National Health and Nutrition Examination Survey, 1976 to 1980, a sample of the US population, were used to determine the association between various respiratory symptoms and the degree of allergen skin test reactivity. Prick-puncture testing using eight unstandardized allergens was performed. Allergen skin test reactivity was classified by means of the mean diameter of the erythema reaction at the 20-minute reading. Nonreactors were the comparison group. The prevalence of allergic rhinitis increased as allergen skin test reactivity increased, with the odds ratio exceeding 8 for the group with two or more positive test results. The prevalence of asthma increased with increasing allergen skin test reactivity only in nonsmokers. The odds ratio for allergic rhinitis with allergen skin test reactivity was higher with outdoor than indoor allergens. The association of allergic rhinitis with allergen skin test reactivity was higher when a physician had previously diagnosed allergic rhinitis. Chronic rhinitis was not associated with allergen skin test reactivity.

Adolescent↗
PubMed1990

The Hymenoptera venom study. III: Safety of venom immunotherapy.

One thousand four hundred ten (44%) of the 3236 subjects in the Hymenoptera venom study accepted venom immunotherapy (VIT). Time to maintenance averaged 95 days, and the largest number achieved maintenance (147 subjects, 10.4%) at day 56. Ninety-two percent of the treated subjects achieved maintenance, and 84% continued therapy, most subjects (91%) until the study was terminated. One hundred seventy-one subjects (12%) experienced 327 treatment systemic reactions (Srs). The incidence of pruritus and angioedema/urticaria was similar with mild, moderate, or severe SRs. The SR severity did not correlate with the severity of the most recent sting before entry into the Hymenoptera-venom study, the most severe historical sting SR, the most severe SR during venom skin tests, the total dose of venom, the degree of skin test reactivity, or the lowest concentration yielding a positive skin test. Most SRs occurred between 1 and 50 micrograms and at maintenance; honeybee or wasp venoms were most likely to produce SR. This study, the largest of its kind with the use of standardized extracts, demonstrates (1) that there was good compliance, (2) that various historical and diagnostic criteria did not predict SRs to VIT, (3) that SRs to VIT were most likely to occur between 1 and 50 micrograms and at maintenance, (4) that honeybee or wasp venoms were most likely to produce an SR, and (5) that VIT is relatively safe.

Animals↗
PubMed1990

Comparative safety and efficacy of short ragweed extracts differing in potency and composition in the treatment of fall hay fever. Use of allergenically bioequivalent doses by parallel line bioassay to evaluate comparative safety and efficacy.

One high potency (HP) and two low potency (LP) commercial whole short ragweed (WSR) extracts were assayed for relative potency (RP) by antigen E (AgE-Amb a 1), RAST inhibition, and parallel line bioassay (PLBA). The RP of the HP extract (300 micrograms AgE) was equal to the reference WSR, but the LP extracts were only approximately 0.01 of the RP of the reference. Each extract was administered to fall hay fever patients with skin sensitivity to WSR (less than or equal to 10(-3) micrograms/ml AgE for sum of erythema = 50 mm) to the maximum tolerated dose, or 0.5 cc of the concentrate, by either a 9- or 40-dose regimen. HP-treated patients had significantly lower symptom scores than untreated controls. No significant difference was noted in the total symptom scores between HP and LP extract-treated patients. Despite approximately 100-fold differences in the RP of HP versus LP extracts, both produced similar frequencies of severe systemic and severe late phase local reactions. Furthermore, when RP of HP and LP extracts were estimated by PLBA, both reached similar peak dosages, similar dosage for IgG WSR antibody response, and comparable IgG WSR antibody levels, indicating that the WSR dose estimates based on RP were bioequivalent. The 9-dose HP regimen produced fewer late phase local and systemic reactions per patient than the 40-dose HP regimen. Most patients experiencing severe systemic reactions were among those most skin sensitive to WSR. The number of systemic reactions per injection was significantly higher at higher WSR doses. One LP extract produced a high incidence of systemic reactions in the initial three injections. With respect to HP, its RP varied approximately 10-fold depending on the skin sensitivity of the patient to heat-stable ragweed allergens, demonstrating that it was compositionally different. However, when the dose of this extract was estimated by RP based on the skin sensitivity of each patient, the peak dose of the extract as well as the doses associated with late phase and systemic reactions were found to be similar to the HP doses. This indicated that immunizing dose estimates of compositionally different WSR extracts based on RP by PLBA were also bioequivalent.

Adult↗
PubMed1989

The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements: data from the second National Health and Nutrition Examination Survey 1976-80 (NHANES II).

A sample (N = 16,204) of the U.S. population, 6 to 74 years of age, was examined in NHANES II with a variety of routine medical procedures, including prick-puncture allergen skin testing (AST), venipuncture, and body measurements. Eight unstandardized extracts licensed by the Food and Drug Administration, a positive and negative control, were used. AST was performed to screen the population for immediate hypersensitivity responses to common aeroallergens. No anaphylactic reactions after AST were observed. One asthmatic reaction occurred during venipuncture. Other adverse reactions (ARs) were limited to syncope, near syncope, and malaise. The rates for any AR were venipuncture, 0.49% (95% confidence interval [CI], 0.38% to 0.60%); AST, 0.04% (95% CI, 0.01%-0.08%); body measures, 0.006% (95% CI, 0 to 0.018%). Sex or fasting status had little effect on the occurrence of AR. The age group 20 to 49 years had the highest occurrence of any AR to venipuncture (0.87%; 95% CI, 0.633% to 1.107%). The risk of prick-puncture AST with eight extracts licensed by the Food and Drug Administration is low and similar to other routine medical procedures.

Adolescent↗
PubMed1989

The Hymenoptera venom study. II: Skin test results and safety of venom skin testing.

Data are summarized in this Hymenoptera venom study (HVS) article on the safety of skin testing with venom extracts. Of the 3236 subjects studied, 89% had experienced an historical sting systemic reaction (SSR). Seventy-four percent of all subjects and 76% of subjects who had experienced an historical SSR had a positive skin test to at least one venom. More subjects tested positive to yellow jacket venom (51.8%) than to any other venom. There were no significant differences of the wheal and erythema sizes associated with different venoms or different historical sting reactions. Forty-five percent of subjects with positive venom skin tests (VST) were positive to wasp, and 89% of these subjects were also positive to at least one of the following venoms: yellow jacket, yellow hornet, or white-faced hornet. Sixty-four of the 3236 subjects studied (2%) had a systemic reaction (SR) during VST; 13 of the SRs (0.4%) were severe. Thirteen of 64 adverse reactions (20%) were possibly vasovagal, and six other subjects (9%) demonstrated no symptoms of immediate-type hypersensitivity. Thus, 45 (1.4%) of the 3236 subjects tested had an SR that was considered to be a reaction of hypersensitivity, of which eight reactions (0.25%) were severe. Allergic SRs are associated with VST but are unusual and are rarely severe.

Animals↗
PubMed1988

The Hymenoptera venom study I, 1979-1982: demographics and history-sting data.

The Hymenoptera venom study, a study based on case histories, skin test results and adverse reactions, immunotherapy and adverse reactions, and treatment efficacy, for 3236 Hymenoptera-allergic subjects, was begun in 1979 after the Food and Drug Administration approval of Hymenoptera venoms. Eighty-four Fellows and Members of the American Academy of Allergy and Immunology participated in the study. All subjects had a history of an adverse reaction to one or more Hymenoptera insects. The mean age was 30 1/2 years (range 1 to 83 years). Male subjects accounted for 61.5% and female subjects, 38.5%; 3.1% were beekeepers and 32.3% were atopic. Demographic data were similar for subgroups. There was an average of 2.7 history stings per subject. At least one systemic reaction (SR) was reported by 2866 subjects (89%); 2219 (69%) experienced an SR after their most recent sting before entry into the study, and 70% had experienced only a single SR. Moderate to severe SRs were equally likely after stings of yellow jacket, white-faced hornet, and yellow hornet (65%), honeybee (67%), or wasp (70%), although historical SRs were reported more often after stings of yellow jacket, white-faced hornet, or yellow hornet (30%) than after honeybee (19%) or wasp (14%) stings. No association was noted between the number of stings per episode and severity of the SR. Fifty-one percent of SRs were reported as occurring within 10 minutes of sting; however, the onset of a moderate to severe SR sometimes occurred at 301 or more minutes after a sting episode. Of 2219 subjects with an SR after their most recent sting before entry into the study, 68% received epinephrine for treatment.

Animals↗
PubMed1987

The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey.

Immediate hypersensitivity skin tests to eight select allergens were performed on a sample (N = 16,204) of the civilian noninstitutional population of the United States, 6 to 74 years of age, in the second National Health and Nutrition Examination Survey (NHANES II). The eight allergens were house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial ryegrass, and Bermuda grass. Skin test reactivity was defined as a mean erythema diameter greater than or equal to 10.5 mm at the 20-minute reading. Overall, 20.2% of the participants reacted to at least one allergen. Peak reactivity occurred in the 12 to 24-year-old age group. Reactivity was higher in blacks versus whites, but the difference did not reach statistical significance (23.2% versus 19.8%; p greater than 0.05). Male participants had an increased prevalence of reactivity versus female participants in whites (22.0% versus 17.6%), but not in blacks (23.2% versus 23.3%). Skin test reactivity increased in both whites and blacks with increasing income and education. The prevalence of skin test reactivity was higher in urban versus rural areas, but the difference was statistically significant only for whites (whites, 21.6% versus 16.4%; blacks, 23.8% versus 18.4%; p greater than 0.05). With logistic regression, the most important predictors of skin test reactivity in whites were age, sex, urban residence, and poverty status. In blacks, the most important predictors were age, urban residence, and poverty status.

Adolescent↗
PubMed1987

Fatalities from immunotherapy (IT) and skin testing (ST)

The Committee on Allergen Standardization of the American Academy of Allergy and Immunology obtained information about 46 fatalities that had occurred during immunotherapy (IT) or skin testing (ST) since 1945. Sufficient information for complete analysis was provided for 30 patients (six for ST and 24 for IT). Of the 30 fatalities, there were 15 male and 15 female fatalities ranging in age from 7 to 70 years (x = 33 years). Known errors of administration accounted for three and possibly an additional three fatalities. Ten fatalities occurred during seasonal exacerbation of the patient's disease, four in patients who had been symptomatic at the time of the injection, two of whom had been receiving beta-adrenergic blockers. Of the 24 fatalities associated with IT, four had experienced previous reactions, 11 manifested a high degree of sensitivity, and four had been injected with newly prepared extracts. Fifteen of the 30 fatalities had received pollen extracts as part of the fatal injection. Of the six fatalities associated with ST, five were due to intradermal testing without prior puncture testing. The signs and symptoms were variable and did not indicate that death was imminent nor predict the cause of death. The time to onset of the reaction was less than 30 minutes in 22/30, more than 30 minutes in 3/30, and not reported in 5/30. The cause of death in 14/16 patients with asthma was respiratory. Epinephrine had been administered to 18, not administered to three, and was either not recorded or unknown in the remaining nine patients. Since seven to 10 million allergen injections are administered yearly, the risk of a fatal reaction is low and may be lessened even further as additional precautions are taken in the selection and treatment of allergic patients and in improved treatment of the anaphylactic reactions.

Adult↗