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Leonard Bielory, MD; Ralph Wright, BSN; Arthur W. Nienhuis, MD; Neal S. Young, MD; Michael A. Kaliner, MD

JAMA. 1988;260(21):3164-3167.

Abstract
We evaluated the predictive value of immediate epicutaneous (prick) skin testing in 36 patients receiving a heterologous protein of equine origin, antithymocyte globulin (ATG), for bone marrow failure. Three of the 36 patients had positive epicutaneous test results. Two of these three received ATG treatment; one died of anaphylaxis while the other was desensitized successfully. Intradermal skin tests revealed positive wheal-flare reactions to progressively increasing dilutions of ATG in 96% of patients tested. None of these patients suffered any anaphylactic symptoms during treatment. Nine patients who had received ATG were evaluated subsequently for the possible development of immediate epicutaneous reactions three to 12 months after treatment; one of the nine patients developed a positive epicutaneous skin test reaction. We recommend that all patients who are to be treated or re-treated with heterologous antisera should be tested using the epicutaneous technique and that patients with positive reactions should be desensitized.

(JAMA 1988;260:3164-3167)

Author Affiliations
From the Division of Allergy and Immunology, the Department of Medicine, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark (Dr Bielory); the Allergic Diseases Section, Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases (Dr Kaliner and Mr Wright), and the Cell Biology Section, Clinical Hematology Branch, National Heart, Lung, and Blood Institute (Drs Nienhuis and Young), National Institutes of Health, Bethesda, Md.

Footnotes
Reprint requests to Division of Allergy and Immunology, Department of Medicine, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 185 S Orange Ave, 1-512, Newark, NJ 07103-2757 (Dr Bielory).

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