Allergy testing: in vivo versus in vitro.

Abstract:

:Table 4 briefly summarizes the relative advantages and disadvantages of skin tests versus in vitro tests for detecting allergen-specific IgE. The skin test remains unexcelled as a sensitive and cost efficient test for specific IgE. The high degree of skin test sensitivity is very important when a patient must be evaluated for potentially life-threatening allergies such as to penicillin or stinging insects. The results of both skin tests and in vitro assays depend very much on the quality of the allergen extracts used for the tests. Although the quality of extracts is improving, there is still little standardization. Both skin tests and in vitro assays are difficult to quality control. Practicing allergists rely on experience, and the correlation between patient histories and skin tests results for quality control of the results. Although this system suffices for common allergens, the results for uncommon allergens may be misleading. Quality control is also difficult for in vitro tests. Participation in quality control programs, such as that being offered by the College of American Pathologists, will increase and lead to better quality and standardization of in vitro test results. At the present time, properly performed skin tests are the best available method for detecting the presence of allergen specific IgE. They are rapid, sensitive, and inexpensive on a per test basis. In vitro tests are acceptable substitutes for skin tests in some circumstances. If the patient does not have normal skin, cannot discontinue interfering medications, or is so sensitive by history that anaphylaxis seems possible, in vitro tests are preferred. In vitro tests are better when it is necessary to test a difficult patient such as a combative, mentally retarded adult. In vitro tests also have been invaluable in many allergy research studies. Physicians must remember that positive tests for allergen-specific IgE do not diagnose allergy. They only indicate the presence of IgE molecules with a particular immunologic specificity. A decision whether the specific IgE molecules are responsible for clinically apparent disease must be made by a well-trained physician. The ultimate standard for the diagnosis of allergic disease remains the combination of: (1) positive double-blind challenge, (2) the presence of specific IgE, and (3) demonstration that the symptoms are the result of IgE-mediated inflammation.

journal_name

Pediatr Clin North Am

authors

Ownby DR

doi

10.1016/s0031-3955(16)36544-0

subject

Has Abstract

pub_date

1988-10-01 00:00:00

pages

995-1009

issue

5

eissn

0031-3955

issn

1557-8240

pii

S0031-3955(16)36544-0

journal_volume

35

pub_type

杂志文章,评审
  • Inherited abnormalities of coagulation: hemophilia, von Willebrand disease, and beyond.

    abstract::Bleeding disorders are broadly classified into primary and secondary hemostatic defects. Primary hemostatic disorders (disorders of platelets and von Willebrand factor) mainly result in mucocutaneous bleeding symptoms such as epistaxis, menorrhagia, petechiae, easy bruising, and bleeding after dental and surgical inte...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2013.09.002

    authors: Kumar R,Carcao M

    更新日期:2013-12-01 00:00:00

  • Pediatric and adolescent gynecology for the primary care pediatrician.

    abstract::This review represents the author's personal style of practice in a new and evolving field, where the standard academic framework is still in its infancy. When there is no prior established practice to follow, good clinical care needs to come from listening very carefully to patients and empirically judging appropriat...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70107-3

    authors: Craighill MC

    更新日期:1998-12-01 00:00:00

  • Approach to the Child with Hematuria.

    abstract::The causes of macroscopic and microscopic hematuria overlap; both are often caused by urinary tract infections or urethral/bladder irritation. Coexistent hypertension and proteinuria should prompt investigation for glomerular disease. The most common glomerulonephritis in children is postinfectious glomerulonephritis....

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2018.08.003

    authors: Brown DD,Reidy KJ

    更新日期:2019-02-01 00:00:00

  • Remaining problems in the treatment of patients with Wilms' tumor.

    abstract::Major advances have been made in the treatment of children with Wilms' tumor. Remaining areas of investigation include the role of adriamycin and the treatment of children with stage III and IV disease and the role of whole lung radiation therapy in the treatment of children with pulmonary metastases. Long-term follow...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)38088-9

    authors: Green DM,Finklestein JZ,Breslow NE,Beckwith JB

    更新日期:1991-04-01 00:00:00

  • Update on pain assessment in sick neonates and infants.

    abstract::This article describes developments in pain assessment in critically ill neonates and infants during the last 5 to 6 years. Pain assessment instruments show a redundancy of items and a lack of profound psychometric background. Although most research focuses primarily on acute pain, in clinical practice there is also t...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2012.07.012

    authors: van Dijk M,Tibboel D

    更新日期:2012-10-01 00:00:00

  • Pediatric Hospital Medicine: Where We Are, Where We Are Headed: State of the Specialty, Looking Forward.

    abstract::Although pediatric hospital medicine (PHM) is in its adolescence, it is already having a major impact on patient care, quality, safety, and education. Pediatric hospitalists have been front-and-center in the safety and quality movement, driving change as clinicians, applying evidence-based medicine to standardize prac...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2019.03.013

    authors: Ramotar MW,Sectish TC

    更新日期:2019-08-01 00:00:00

  • Clinical and genetic evidence that juvenile arthritis is not a single disease.

    abstract::Ample evidence shows that what was formerly called "juvenile rheumatoid arthritis" is not a single disease. At least six separate diseases were included as subgroups or subtypes of juvenile rheumatoid arthritis in other classifications. The clinical and laboratory features that differentiate these diseases are discuss...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)40057-x

    authors: Fink CW,Fernandez-Vina M,Stastny P

    更新日期:1995-10-01 00:00:00

  • Pitfalls in developmental diagnosis.

    abstract::The more common and more glaring pitfalls in developmental diagnosis encountered during infancy and early childhood have been outlined. Much of the ability to avoid these traps depends on a comfortable understanding of the four spheres of early child development and a sound familiarity with the principles of developme...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)38228-1

    authors: Blasco PA

    更新日期:1991-12-01 00:00:00

  • Care of the Neonatal Intensive Care Unit Graduate after Discharge.

    abstract::Premature and critically ill term infants are often discharged from the neonatal intensive care unit (NICU) with ongoing medical problems, including respiratory problems; growth, nutrition and feeding problems; and neurologic injury. At discharge, they may also be dependent on technology such as supplemental oxygen, t...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2018.12.014

    authors: Goldstein RF,Malcolm WF

    更新日期:2019-04-01 00:00:00

  • Combination antimicrobial therapy.

    abstract::In spite of a large volume of data regarding the in vitro activity of single and combined antimicrobial activity, the clinical relevance of these studies is unclear. Few comparative trials of combined and single antibiotic therapy of human infection have been performed. Synergistic combination therapy has been shown t...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)34325-5

    authors: Shlaes DM,Bass SN

    更新日期:1983-02-01 00:00:00

  • An approach to the evaluation and treatment of microscopic hematuria.

    abstract::Persistent microscopic hematuria in children is most often benign or untreatable. The evaluation of microscopic hematuria in an otherwise healthy child need not require invasive and costly laboratory studies. The initial evaluation must look for signs of life-threatening causes of hematuria, i.e., hypertension, edema,...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)38119-6

    authors: Lieu TA,Grasmeder HM 3rd,Kaplan BS

    更新日期:1991-06-01 00:00:00

  • Adolescent varicocele.

    abstract::The evaluation and management of adolescents with varicoceles continue to evolve. Current recommendations for repair are based on the findings of impaired testicular growth or spermatogenesis; however, with early evaluation and selective treatment, clinicians should be able to reduce the potential for future fertility...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70391-6

    authors: Kass EJ

    更新日期:2001-12-01 00:00:00

  • Chronic and recurrent headaches in children and adolescents.

    abstract::Headache is a common chronic and recurrent symptom in children and adolescents. The author discusses the prevalence of headache, its differential diagnosis, interpretation of symptoms, methods of assessment, and pharmacologic and nonpharmacologic treatment approaches. ...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)34683-1

    authors: Gascon GG

    更新日期:1984-10-01 00:00:00

  • Update on perinatal HIV transmission.

    abstract::Over the past decade, much progress has been made in understanding the risk factors and timing of perinatal HIV transmission. Even more impressive have been the successful clinical trials with antiretrovirals, such as ZDV, ZDV-3TC, and nevirapine, that demonstrated significant reductions in the risk for infant infecti...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70193-0

    authors: Fowler MG,Simonds RJ,Roongpisuthipong A

    更新日期:2000-02-01 00:00:00

  • Fluid needs in acute renal failure.

    abstract::Derangements of fluid, electrolyte, and acid-base homeostasis are an inevitable part of acute renal failure. Understanding the pathophysiology of these disorders is essential to treating and preventing potentially life-threatening complications. Appropriate nutritional support is also an important part of management i...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)36872-9

    authors: Feld LG,Cachero S,Springate JE

    更新日期:1990-04-01 00:00:00

  • Cysticercosis. A modern day plague.

    abstract::The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment. ...

    journal_title:Pediatric clinics of North America

    pub_type: 临床试验,杂志文章,评审

    doi:10.1016/s0031-3955(16)34864-7

    authors: Brown WJ,Voge M

    更新日期:1985-08-01 00:00:00

  • Patient safety in ambulatory care.

    abstract::Understanding of the types and frequency of errors among children in the outpatient setting is paramount. The most commonly described errors involve medical treatment, communication failures, patient identification, laboratory, and diagnostic errors. Research suggests that adverse events and near misses are frequent o...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2012.08.006

    authors: Neuspiel DR,Stubbs EH

    更新日期:2012-12-01 00:00:00

  • Pediatric stomas, tubes, and appliances.

    abstract::Pediatric patients with ostomies are a challenge to health care providers. An ostomy is not without problems. Knowledge of surgical techniques and a commitment to the care and management of the stoma and appliances are needed to prevent and manage complications. Ongoing patient education is paramount for compliance an...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70097-3

    authors: Borkowski S

    更新日期:1998-12-01 00:00:00

  • Pediatric trauma. Prevention strategies.

    abstract::Injury is the most important threat to the health of children in the United States and the leading cause of death after the first year of life. Injuries must be viewed as diseases that can be prevented by using principles of epidemiology, engineering, biomechanics, and health education. Effective preventative strategi...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章

    doi:10.1016/s0031-3955(16)38666-7

    authors: Stylianos S,Eichelberger MR

    更新日期:1993-12-01 00:00:00

  • Identifying normal and abnormal development of dental occlusion.

    abstract::Abnormalities of occlusal development manifest themselves clinically as a need for orthodontic treatment. There are many circumstances in which there is an interaction between traditional pediatric concerns and occlusal abnormalities. In some cases medical treatment impacts on the development of occlusion. In other ca...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)38192-5

    authors: Smith RJ

    更新日期:1991-10-01 00:00:00

  • Endocrine manifestations of critical illness in the child.

    abstract::The stress response in humans commonly includes elevations in plasma concentrations of glucocorticoids, catecholamines, glucagon, growth hormone, aldosterone, and renin, resulting in alterations in the metabolism of glucose and other energy substrates, and in increased sodium and water retention. In severe illness, tr...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)36185-5

    authors: Weise K,Zaritsky A

    更新日期:1987-02-01 00:00:00

  • Malignant bone tumors of childhood.

    abstract::Improvements in diagnosis and treatment have increased survival for many children with malignant bone tumors. New molecular genetic discoveries are providing insights into the mechanisms of tumorigenesis and may provide novel therapeutic modalities based on interfering with aberrant transcriptional activation by hybri...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70445-4

    authors: Himelstein BP,Dormans JP

    更新日期:1996-08-01 00:00:00

  • The child who has severe neurologic impairment.

    abstract::The formulation of a diagnosis in a child who has neurologic impairment should not (except in extreme circumstances) be made on the basis of a single finding. For example, the presence of delayed milestones, primitive or exaggerated reflexes, abnormal muscle tone, abnormal posture, abnormal neurologic examination, and...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章

    doi:10.1016/s0031-3955(05)70586-1

    authors: Liptak GS

    更新日期:1998-02-01 00:00:00

  • Breast disease in adolescents and young women.

    abstract::Breast lesions, including mastalgia; benign proliferative changes; and benign masses, including fibroadenomas, are common in adolescents and young adult women. Breast cancer is rare in women less than 20 years old and uncommon in women less than 30 years old. Discrete masses in women less than 30 years old that do not...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70140-1

    authors: Neinstein LS

    更新日期:1999-06-01 00:00:00

  • Current update of pediatric hepatitis vaccine use.

    abstract::Vaccines are now available for the prevention of hepatitis A and hepatitis B. In this article, biologics are reviewed with special attention to their use in the pediatric patient. Special attention is paid to issues that developed in 1999. For hepatitis A vaccine, it is the change in US recommendations regarding incre...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(05)70213-3

    authors: Malay S,Tizer K,Lutwick LI

    更新日期:2000-04-01 00:00:00

  • Advances in monitoring and management of shock.

    abstract::Early recognition and treatment of pediatric shock, regardless of cause, decreases mortality and improves outcome. In addition to the conventional parameters (eg, heart rate, systolic blood pressure, urine output, and central venous pressure), biomarkers and noninvasive methods of measuring cardiac output are availabl...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2013.02.013

    authors: Mtaweh H,Trakas EV,Su E,Carcillo JA,Aneja RK

    更新日期:2013-06-01 00:00:00

  • Conjunctivitis in children.

    abstract::Conjunctivitis is a common, usually mild, self-limited problem. Pathogens vary at different ages. Conjunctivitis occurs alone or as a manifestation of a systemic infection or a systemic disease. Diagnosis can usually be established by the combination of clinical and laboratory findings. Topical, systemic or combinatio...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/s0031-3955(16)36367-2

    authors: Fisher MC

    更新日期:1987-12-01 00:00:00

  • Adjunctive Steroid Therapy for Treatment of Pediatric Septic Shock.

    abstract::Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of antimicrobials, and vasoactive-inotropic drug infusions are all key to achieving good sepsis outcomes, therapy using various steroid drug classes remains...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2017.06.010

    authors: Zimmerman JJ

    更新日期:2017-10-01 00:00:00

  • Nutrition therapy for the child and adolescent with Type I diabetes mellitus.

    abstract::The author enumerates the objectives of nutritional instruction and therapy for the child with diabetes mellitus and examines some of the principles upon which this therapy is based. Also discussed are the methods used to formulate meal plans, stressing the fact that instruction and counseling in nutritional principle...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章

    doi:10.1016/s0031-3955(16)34623-5

    authors: Arky RA

    更新日期:1984-06-01 00:00:00

  • Choosing the Right Oral Contraceptive Pill for Teens.

    abstract::Oral contraceptive pills (OCPs) continue to be the most commonly used form of prescription contraceptives used by adolescents in the United States. With proper use, oral contraceptives provide safe and effective birth control. Broad categories of OCPs include progestin-only pills (POPs) and combined oral contraceptive...

    journal_title:Pediatric clinics of North America

    pub_type: 杂志文章,评审

    doi:10.1016/j.pcl.2016.11.005

    authors: Powell A

    更新日期:2017-04-01 00:00:00