Robust automated reading of the skin prick test via 3D imaging and parametric surface fitting

The conventional reading of the skin prick test (SPT) for diagnosing allergies is prone to inter- and intra-observer variations. Drawing the contours of the skin wheals from the SPT and scanning them for computer processing is cumbersome. However, 3D scanning technology promises the best results in terms of accuracy, fast acquisition, and processing. In this work, we present a wide-field 3D imaging system for the 3D reconstruction of the SPT, and we propose an automated method for the measurement of the skin wheals. The automated measurement is based on pyramidal decomposition and parametric 3D surface fitting for estimating the sizes of the wheals directly. We proposed two parametric models for the diameter estimation. Model 1 is based on an inverted Elliptical Paraboloid function, and model 2 on a super-Gaussian function. The accuracy of the 3D imaging system was evaluated with validation objects obtaining transversal and depth accuracies within ± 0.1 mm and ± 0.01 mm, respectively. We tested the method on 80 SPTs conducted in volunteer subjects, which resulted in 61 detected wheals. We analyzed the accuracy of the models against manual reference measurements from a physician and obtained that the parametric model 2 on average yields diameters closer to the reference measurements (model 1: -0.398 mm vs. model 2: -0.339 mm) with narrower 95% limits of agreement (model 1: [-1.58, 0.78] mm vs. model 2: [-1.39, 0.71] mm) in a Bland-Altman analysis. In one subject, we tested the reproducibility of the method by registering the forearm under five different poses obtaining a maximum coefficient of variation of 5.24% in the estimated wheal diameters. The proposed method delivers accurate and reproducible measurements of the SPT. © 2019 Pineda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS), COLCIENCIAS: 538871552485 C2018P018, C2018P005This study was supported by Colciencias (www.colciencias.gov.co, Grant 538871552485) and by Universidad Tecnol?gica de Bolivar (www.utb.edu.co, Grants C2018P005 and C2018P018), Colombia

Measurement and interpretation of skin prick test results

Background: There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods. Methods: Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot. Results: Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC. Conclusions: The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC

Blood monitoring systems and methods thereof

A blood monitoring system is capable of monitoring the blood of a subject in vivo. The blood monitoring system comprises: 1) an array of movable microneedle micromachined within associated wells; 2) array of motion actuators able to move each needle in and out of their associated wells; 3) array of microvalves associated with each microneedle able to control the flow of air around the microneedle; 4) an array of chemical sensors inserted into patient by movable microneedles; 5) an array of inductors able to measure chemical concentration in the vicinity of inserted chemical sensors; 6) conducting vias that provide timed actuating signal signals from a control system to each motion actuator; 7) conducting vias that transmit signal produced by array of chemical sensors to the control system for processing, although the blood monitoring system can comprise other numbers and types of elements in other configurations

Enriched mannose glycosylation contributes to Act d 2 allergenicity.

Allergens are responsible for the Th2 response in patients as part of complex mixtures of proteins, fatty acids and other molecules. Plant allergens have hitherto been included in several protein families that share no common biochemical features. Their physical, biochemical and immunological characteristics have been widely studied, but no definite conclusion has been reached about what makes a protein an allergen. N-glycosylation is characteristic of plant allergen sources but is not present in mammals

Ammattinuha : diagnoosi ja terveyteen liittyvä elämänlaatu

Occupational rhinitis is mainly caused by work environment and not by stimuli encountered outside the workplace. It differs from rhinitis that is worsened by, but not mainly caused by, workplace exposures. Occupational rhinitis can develop in response to allergens, inhaled irritants, or corrosive gases. The thesis evaluated the use of challenge tests in occupational rhinitis diagnostics, studied the long-term health-related quality of life among allergic occupational rhinitis patients, and the allergens of wheat grain among occupational respiratory allergy patients. The diagnosed occupational rhinitis was mainly allergic rhinitis, which was caused by occupational agents, most commonly flours and animal allergens. The non-IgE-mediated rhinitis reactions were less frequent and caused more often asthma than rhinitis. Both nasal challenges and inhalation challenges were found to be safe tests. The inhalation challenge tests had considerably resource-intensive methodology. However, the evaluation of nasal symptoms and signs together with bronchial reactions saved time and expense compared with the organization of multiple individual challenges. The scoring criteria used matched well with the weighted amount of discharge ≥ 0.2 g and in most cases gave comparable results. The challenge tests are valuable tools when there is uncertainty whether the patient's exposure should be reduced or discontinued. It was found that continuing exposure decreases health-related quality of life among patients with allergic occupational rhinitis despite of rhinitis medications, still approximately ten years after the diagnosis. Health-related quality of life among occupational rhinitis patients without any longer occupational exposure was mainly similar than that of the healthy controls. This highlights the importance of the reduction and cessation of occupational exposure. To achieve this, 17% of occupational rhinitis patients had been re-educated. Alpha-amylase inhibitors, lipid transfer protein 2G, thaumatin -like protein, and peroxidase I were found to be relevant allergens in Finnish patients with occupational respiratory wheat allergy. Of these allergens, thaumatin-like protein and lipid transfer protein 2G were found as new allergens associated with baker's rhinitis and asthma. The knowledge of the new clinically relevant proteins can be used in the future in the development of better standardized diagnostic preparations.Ammattinuha: diagnoosi ja terveyteen liittyvä elämänlaatu Ammattinuhalla tarkoitetaan työssä esiintyvän tekijän pääasiallisesti aiheuttamaa nuhaa. Se eroaa työn pahentamasta, (tai samanaikaisesta muusta) nuhasta, jossa työympäristö ei ole pääasiallinen nuhan syy. Väitöskirjatyössä tutkittiin ammattinuhan diagnosoinnissa käytettäviä altistuskokeita, allergiseen ammattinuhaan sairastuneiden pitkäaikaista elämänlaatua sekä ammattinuhan yhden pääaiheuttajan, vehnän, allergeeneja ja niiden esiintymistä ammattinuhaa tai -astmaa sairastavilla vehnäallergikoilla. Ammattinuhat todettiin yleensä allergiseksi nuhaksi, ja tavallisimmin ammattinuhan aiheuttajia olivat jauhot ja eläimet. Ei-allergista nuhaa esiintyi selvästi harvemmin kuin allergiaa. Työperäisillä aineilla tehtävät nenä- ja kammioaltistuskokeet todettiin analyyseissä turvallisiksi testeiksi, koska vakavia, vaikeasti hoidettavia allergiareaktioita ei niissä ollut esiintynyt. Ammattinuha todettiin 47% nenäaltistustestein tutkituista potilaista. Kammioaltistustesteissä 13% potilaalle tuli positiivisen testin kriteerit täyttävä nuhaoireisto, niissä astmareaktiot olivat yleisempiä (25%). Altistustestit ovat arvokkaita, kun on epävarmaa voiko altistuminen jatkua tai tuleeko potilaan vaihtaa työtä. Työterveyslaitoksen käyttämä pisteytyskriteeri antoi pääasiassa yhteneväisen tuloksen eritemittauksen kanssa, joka tukee oletusta eri testimenetelmien pääosin samanlaisista tuloksista työperäisen allergian testauksissa. Vaikka kammioaltistuskoe vaatii paljon resursseja, voidaan kammioaltistuksessa yhdistää keuhkoputkialtistus ja nenäaltistus, mikä säästää aikaa ja kustannuksia verrattuna kahteen eri tutkimukseen. Jos työperäinen altistuminen allergeeneille oli jatkunut keskimäärin 10 vuotta ammattinuhan toteamisen jälkeen, terveyteen liittyvä elämänlaatu oli ammattinuhaan sairastuneilla alentunut, nuhalääkityksestä huolimatta. Altistumattomien potilaiden elämänlaatu oli pääosin samankaltainen kuin terveillä verrokkihenkilöillä. Väitöstutkimus korostaa ammattinuhapotilaiden altistumisen vähentämisen tai lopetuksen tarvetta. Ammattinuhapotilaat ja verrokkihenkilöt eivät eronneet toisistaan työssäkäynnin suhteen, mutta merkittävä osa (17 %) ammattinuhapotilaista oli uudelleenkoulutettuja. Useita vesiliukoisia vehnän allergeeneja puhdistettiin ja tunnistettiin. Niiden merkitystä hengitystieallergeeneina tutkittiin leipurin nuhaa ja / astmaa sairastavilla vehnäallergisilla potilailla ihopistotestein. Tutkimuksessa löydettiin kaksi uutta merkityksellistä vehnän allergeenia leipurin ammattinuhassa ja/ tai astmassa. Tietoa uusista vehnän työperäistä hengitystieallergiaa aiheuttavia merkittävistä valkuaisaineista voidaan jatkossa hyödyntää kehitettäessä leipurin nuhaa ja astmaa testaavia testejä

Handbook of clinical allergology

АЛЛЕРГОЛОГИЯУчебник по курсу "Аллергология" написан для иностранных студентов. Содержит 15 глав учебного материала, а также контрольные вопросы и ответы

Cardiovascular responses during IgE-mediated peanut allergic reactions

INTRODUCTION: The pathophysiology of IgE-mediated food allergy is poorly described and this impairs our ability to develop new treatments or predict reaction phenotype. Data from case series and animal models suggest there may be significant cardiovascular changes during severe reactions. The aims of this thesis were to describe the local and systemic cardiovascular (CVS) changes during IgE-mediated reactions to peanut, and evaluate whether local vascular responses to skin prick test can predict threshold or severity of reaction. METHODS: Fifty-seven peanut-allergic adults underwent continuous, non-invasive cardiac monitoring during double-blind placebo-controlled food challenges. CVS parameters during a 10-minute epoch at time of objective symptoms were compared to a 10-minute epoch at baseline. Comparisons were also made to equivalent data at the placebo reaction, and a further repeat open challenge in the same participants. Skin blood flow and titrated skin prick testing (SPT) were performed at each challenge. RESULTS: A significant increase in peripheral blood flow (median 20%, IQR [-2.2 to 46.7%]), decrease in stroke volume (mean -2.3ml/beat/m2, 95% CI [-0.3 to -4.2]) and increase in heart rate (mean 7.7bpm, 95% CI [5.6 to 9.8]) were observed during reactions irrespective of reaction severity, which were reproduced at open challenge. Changes in heart rate variability were also noted, consistent with increased sympathetic activity, however these were not observed at repeat challenge. Titrated SPT (as a measure of local cutaneous vascular response) was found to predict reaction threshold at challenge. Time to resolution of peanut SPT wheal was associated with several measures of reaction severity at challenge. CONCLUSION: There is a significant reduction in stroke volume during IgE-mediated reactions to peanut. This is likely to be caused by peripheral vasodilatation leading to reduced venous return, and was seen in both mild and severe reactions. This finding highlights the importance of adequate fluid resuscitation in the management of IgE-mediated allergic reactions to food.Open Acces

Special propedeutics of internal diseases

ВНУТРЕННИЕ БОЛЕЗНИКУРСЫ ЛЕКЦИЙПРОПЕДЕВТИКА ВНУТРЕННИХ БОЛЕЗНЕЙГИПЕРСЕНСИБИЛИЗАЦИЯЭНДОКРИННОЙ СИСТЕМЫ БОЛЕЗНИГЕМАТОЛОГИЧЕСКИЕ БОЛЕЗНИПОЧЕК БОЛЕЗНИУРОЛОГИЧЕСКИЕ БОЛЕЗНИПИЩЕВАРИТЕЛЬНОЙ СИСТЕМЫ БОЛЕЗНИДЫХАТЕЛЬНЫХ ПУТЕЙ БОЛЕЗНИКРОВООБРАЩЕНИЯ РАССТРОЙСТВАВ лекциях представлены сведения по основам клинической диагностики внутренних болезней