What is skin allergy test

Source: , Asthma and Allergy Foundation of America (AAFA)

Allergy skin testing is done to discover out exactly what things a person may be allergic to.

With my mom’s assist, I kept a record of my allergy symptoms for 2 weeks. I wrote below when I had my symptoms, how endless they lasted, where I was, what I was doing and medicines I took for them. My doctor reviewed the record but still couldn’t figure out what I was allergic to. So he referred me to an allergist for skin testing, which showed I was allergic to mold.

The next step was to get rid of the mold in our home.

Jamie, age 17

How should I prepare for the test?

  1. Tell your allergist about every medicines you’re taking, including over-the-counter medicines.
  2. Don’t take antihistamines for 3 to 7 days before the test. Enquire your allergist when to stop taking them. (It’s okay to use nose [nasal] steroid sprays and asthma medicines. They will not interfere with skin tests. Talk to your allergist’s staff before the testing to discover out which medications you can continue using.)

What do the skin test results mean?

If you’re sensitive to an allergen:

  1. With the prick or scratch test and intradermal test, a little red bump appears on the skin where that allergen was placed, and this area may itch.

    The larger the bump, the more sensitive you may be to it.

These results are called positive skin tests and mean that you may be allergic to the allergen tested.

Even if a skin test shows that you’re allergic to something, you may not react to it when you’re exposed to it later. Your allergist will review your medical history and skin test results to assist discover out what you’re allergic to.

Is the test safe?

Very little amounts of allergens are tested on your skin, so skin testing is safe.

During the test, the allergist will watch for a possible severe allergic reaction, but it rarely happens.

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To schedule or update an appointment and general questions, please call

What is an allergy?

An allergy occurs when you react to things love pollen or cats that don’t affect most people. If you come into contact with something you are allergic to (called an allergen), you may own symptoms such as itching or sneezing. This is called an allergic reaction.

What happens if the skin test shows I own allergies?

Your allergist will create a plan for controlling your allergies. This means preventing and treating symptoms.

Take these steps:

  1. Avoid or limit contact with your allergens. For example, if you’re allergic to dust mites, reduce the clutter in your home, which collects dust.
  2. Take medicine to relieve your symptoms. Your allergist may prescribe medicines such as antihistamines, decongestants, nose (nasal) sprays, or eye drops.
  3. Get allergy shots if the allergist says you should. Some people need them when they can’t avoid an allergen. The shots contain a tiny but increasing quantity of the allergen you’re sensitive to. Whether given in shot form or under the tongue, immunotherapy involves giving gradually increasing doses of the substance to which you are allergic (also known as your allergen).

    The little increases over time in the quantity of your allergen – things love dust, pollen, mold and pet dander – cause the immune system to become less sensitive to it. That reduces your allergy symptoms when you come across the allergen in the future. Immunotherapy also reduces the inflammation that comes with hay fever and asthma.

What can I expect during a skin test?

A number of diverse allergens will be tested. It takes about 5 to 10 minutes to put the allergens on your skin. They are generally put on the forearm in adults and on the back in children.

Then you will wait about 15 minutes to see if a little red lump appears where any of the allergens were placed.

The prick or scratch test and intradermal test may hurt slightly. If you are sensitive to any of the allergens, your skin may itch where the allergen was placed.

How are skin tests done?

Skin tests are done in an allergist’s office.

There are two types of skin tests:

  1. Prick or scratch test: In this test, a tiny drop of a possible allergen—something you are allergic to— is pricked or scratched into the skin. (This is also called a percutaneous test.) It is the most common type of skin test.
  2. Intradermal test: This test shows whether someone is allergic to things such as insect stings and penicillin.

    A little quantity of the possible allergen is injected under the skin through a thin needle.

Who does skin testing to diagnose allergies?

Allergists are experts who test for, diagnose and treat allergies.

Does health insurance cover skin testing for allergies?

Most health insurance plans cover allergy testing and treatment. Enquire your insurance carrier:

  1. Do I need a referral from my doctor to see an allergist?
  2. Does my insurance cover patient education or special services for my allergies?
  3. What allergy testing and medicines does my plan cover?

This sheet was reviewed and updated 4/16/

At Carolina Asthma & Allergy Middle, we’re committed to providing the highest quality asthma and allergy care in North and South Carolina.

To better serve both states, our Rock Hill location is located near the South Carolina border, making it easily accessible to South Carolina residents in Rock Hill, Fort Mill, and Lake Wylie as well as North Carolina areas such as Pineville.

We own five medical experts on hand at our Rock Hill office, including Natasha Laungani, FNP-C; S. Nicole Chadha, MD; Roopen R. Patel, MD; Susan I. Hungness, MD; and Glenn W. Errington, MD. Dr. Laungani, who is exclusive to our Rock Hill location, studied at the University of Kentucky and the University of Cincinnati. Dr. Errington specializes in children over two years ancient and adults. He received certifications through the American Board of Internal Medicine and the American Board of Allergy and Immunology.

You’ll discover our shot room at our Rock Hill office as well, which is open until p.m.

on weekdays. This is for our allergy patients dealing with skin allergies, food allergies, insect allergies, and more. Our patients who need allergy treatment or asthma treatment can set up an appointment for any day of the week until 5 p.m. with one of our specialists. The phone number for our Carolina Asthma & Allergy Middle, including our Rock Hill office, is

Or Contact Us

Please note: Due to healthcare privacy laws, we cannot answer any questions pertaining to personal health information by e-mail.

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Allergy Diagnostic Testing

Updated: July
Originally posted: November

Dr.

John Oppenheimer
Director of Clinical Research,
Pulmonary and Allergy Associates
Denville, NJ, USA

Prof. Stephen Durham
Department Allergy and Respiratory Medicine,
Imperial College, London, UK

Dr. Harold Nelson
National Jewish Medical and Research Center
Denver, CO, USA

Dr. Ole D. Wolthers
Clinical Institute, Health, Aarhus University
Asthma and Allergy Clinic, Children’s Clinic Randers
Randers, Denmark

Credit for the first skin testing goes to Charles H.

Blackley, who in abraded a quarter-inch area of his skin with a lancet, applied grass pollen on a piece of wet lint, and covered the scarified area with an occlusive bandage. This resulted in intense itching and a extremely large cutaneous response.

Percutaneous skin test ranks first in confirming the presence of IgE-mediated sensitization in the allergist's office. This should come as no surprise, as it has numerous advantages. Skin testing is minimally invasive, and when it is performed correctly it has excellent reproducibility, is easily quantified, and allows the evaluation of multiple allergens at one session.

The results correlates within vivochallenges.in vitrotesting is an alternative, generally a back up tool for diagnosing allergic illness. Skin testing alone or in combination within vitrotesting is relied upon for the evaluation of allergic rhinitis, asthma, eczema, food allergy, insect sting allergy, drug allergy (especially beta-lactam and local anesthetic allergy), occupational disease and anaphylaxis. However, the reliability of these tests depends on a number of factors. In the case of skin testing, it is significant that the technician performing the skin tests and the clinician ordering or interpreting these tests are aware of the advantages and pitfalls of the type of skin testing, the device used, the location of the tests on the body, the extracts used and the potential for suppression of the skin response by medications used to treat allergies or depression.

These issues own been reviewed elsewhere in greater detail.1Forin vitrotesting, it is imperative that quality standards be met. These include calibration of the assay, training and experience of the technician and the use of quality allergens in the solid phase.2As in any diagnostic test, it is of paramount importance that the clinician consider the positive and negative predictive worth of the tests performed. These tests should always be considered as adjuncts to the medical history and physical exam in formulating the diagnosis in each individual case, bearing in mind that both test types can yield untrue positive or, less commonly, untrue negative results.

Skin Testing Devices

Whereas intradermal skin tests are always performed using a hypodermic syringe and needle, percutaneous tests may be performed with a variety of devices.

Comparisons of percutaneous devices own been reviewed elsewhere in greater detail.5 Some devices own a single stylus with one or several points, whereas others own multiple heads and permit up to 10 tests to be accomplished with one application. The degree of skin trauma created by these devices for percutaneous testing varies and so may result in differences in the size of positive reactions, and the likelihood of producing a reaction at the site of the negative control. Thus, they require diverse criteria for what constitutes a positive reaction (see Table 1).

Table 1. Wheal size indicating a positive response to skin tests using various devices.a

a Positive response is defined as a wheal greater than 99% of wheals generated by the istration of saline to the subject's back by the same operator.

Adapted from ref.
b HS = Hollister Steir, Greer = Greer laboratories, Lincoln = Lincoln Diagnostics, ALK = ALK America, ALO = Labs of Ohio

Proficiency Testing

Like every other laboratory tests, it is imperative that quality assurance standards be met to ensure that the testing technique produces precise results. To confirm such standards, it is recommended that every technicians performing skin testing undergo evaluation of their technique.11 Certainly, it would be comforting to know that skin test technicians achieve some degree of consistency in skin test performance.

Although there are no formal standards available for skin test proficiency testing, several publications propose some possible criteria. European publications propose a coefficient of variation of less than 20% following repeated skin test control applications, and the Childhood Asthma Management Program study requires that a coefficient of variation of less than 30% be attained with repeated testing with histamine and consistently negative reactions to saline to confirm proficiency in skin testing.

The National Committee for Clinical Laboratory Standards recommends quality control procedures for daily performance ofin vitroallergy testing, with a recommended coefficient of variation of less than or equal to 15%.2Even with such calibration and the increased use of automation,in vitroassays still own flaws.

Williams and colleagues examined the performance of 6 large commercial laboratories on tests of blinded samples of the same sera, both diluted and non-diluted.12They found that only two of the laboratories demonstrated acceptable precision and accuracy.

Recording and Scoring of Skin Test Results

Skin test results are often reported by clinicians in semi-quantitative terms. They may record results only as positive or negative, or express them on a 0 to 4+ scale without any indication of the size of the reactions that these numbers represent.

However, allergy patients may own to change their allergist for numerous reasons, and it is significant that records of prior allergy testing be interpretable by the receiving physician. At the extremely least, a record of skin testing should contain sufficient information to permit another physician to interpret the results and avoid the need to repeat skin testing. Standardized forms own been developed and are available through the American Academy of Allergy Asthma and Immunology website (for an exampleAAAAI's Skin Test and Immunotherapy Forms).

Although the area of the wheal and erythema are the most precise measurements, the longest diameter or two diameters at correct angles to each other correlate with area (r > ).8The importance of performing such measurements is exemplified by the study of McCann and Ownby in which allergists were asked to interpret photographs of skin test reactions.

The scoring and interpretation of the skin test results varied greatly.9The authors of this study reinforce the thought that the most dependable method of reporting a skin test reaction is to measure and record the reaction size. At the extremely minimum, skin test results should be graded 0 to 4+, and the criteria for each grade of reaction clearly stated along with the skin test results.

Various investigators propose diverse criteria for interpreting a skin test response as positive.

To assess the reliability of diverse means of interpreting the results of skin prick testing, Vanto and colleagues studied a group of children sensitive to dogs.10A determination of sensitivity to dog was based on a composite score derived from the history, RAST, and bronchial or conjunctival allergen challenges. Although in this study the overall efficacy was greatest with the histamine reference method (in which the allergy skin test response is compared to a histamine control, with a positive response considered to be a response at least as grand as that of the histamine control), maximal sensitivity was achieved when using a cutoff of a wheal 3 mm.

What is skin allergy test

If a clinician wishes to maximize sensitivity, the latter criterion would be most useful; however, adjustment must be made for the device used. Therefore, the criteria for a positive test should be: 1) the larger of a 3 mm mean wheal diameter or 2) equal to or greater than the 99th percentile reaction with that device at negative control sites (see Table 1).

Comparing in vivo to in vitro Testing:

The preponderance of comparative studies protest skin tests to be more sensitive thanin vitrotests. However, the majority of these studies were performed with earlier generationin vitrotests.

The newerin vitrotests produce higher test sensitivity and specificity13by using a matrix capsule containing antigen bound to a hydrophilic carrier to produce enhanced specific IgE binding with lower nonspecific IgE binding.2Levels of specific IgE measured by diverse commercial assays are not equivalent, as each assay differs in the composition of allergen reagents, methods of measurement and standardization procedures.

The advantages ofin vitrotesting are largely related to use in patients with extensive dermatoses (e.g., atopic dermatitis), resulting in an inability to act out tests on unaffected skin, or in patients who are unable to discontinue medicines that block the histamine response, i.e., antihistamines or tricyclic antidepressants.

The disadvantages ofin vitrotesting include a potential decrease in sensitivity, added cost, and lack of immediate and visible response. Performing bothin vitroandin vivotests may yield improved sensitivity.15

Methods of Skin Testing

Skin testing may be performed using either the prick/puncture (percutaneous) or intradermal (intracutaneous) technique. Intradermal testing is far more sensitive than prick/puncture testing, which means that it requires about fold less concentrated extracts than those used for prick/puncture testing to achieve a similar response. Although direct comparisons indicate that intradermal testing is more reproducible than percutaneous testing, there are numerous factors that favor the routine use of percutaneous allergy tests.

These include economy of time, patient comfort and patient safety. Percutaneous testing allows the use of extract in 50% glycerin, which provides greater extract stability. Intradermal testing cannot use this diluent, as it may incite a false-positive irritant response. However, the most significant consideration is that results of percutaneous testing correlate better with clinical allergy. The higher sensitivity of intradermal skin tests does not generally offer added benefit, since the results of skin prick tests performed with potent extracts are of sufficient sensitivity for use in clinical practice.

Two studies reinforce this concept.3,4Each study compared intradermal with skin prick tests by correlating their results with patients' responses to natural exposure to allergen as well as by allergen challenge testing.

In the first study, three groups of patients with seasonal rhinitis were compared. These subjects were classified into 3 groups based on their degree of sensitization to Timothy grass pollen. They were either skin prick test positive, only intradermal test positive, or were negative by both skin prick and intradermal testing. Both nasal allergen provocation testing and symptom scores during the pollen season correlated best with a positive skin prick test (>60% of subjects with positive skin prick tests had symptoms on allergen exposure).

The frequency of positive nasal provocation (11%) and symptom scores (21%) in subjects with positive intradermal testing alone were not diverse from subjects who were skin prick test and intradermal test negative. The authors conclude that under the conditions of this study, the presence of a positive intradermal skin test response to Timothy grass in the presence of a negative skin prick test did not indicate the presence of clinically significant sensitivity to this grass.

In the second study, patients were challenged with cat exposure for one hour.4Both positive skin prick tests andin vitrotests to cat were highly predictive of the development of symptoms upon allergen exposure in the cat challenge room.4Subjects with a negative skin prick test were just as likely to own a positive challenge result if they had a negative intradermal skin test (31%) as subjects with a positive intradermal skin test (24%).

The authors conclude that, at least with regard to cat allergy, major therapeutic decisions, such as environmental control or immunotherapy, should never be based on a positive intradermal skin test alone.

Both of these studies were performed in adults and both relied upon skin testing with relatively potent allergens (Timothy grass and cat). The clinical applicability of these results to less potent allergens, such as dog, or to younger patients (especially infants) is a matter of clinical judgment, because no specific evidence is available for these groups.

"Gold Standard" Confirmation of Allergy

Although there are challenge protocols available in the research setting to confirm allergic rhinitis and asthma, the standard tool available to the clinician is a careful history and physical exam.

Skin testing correlates with results of nasal challenge and with bronchial challenges when allowance is made for nonspecific airway responsiveness.

When evaluating potential food allergy, the clinical history is the initial screening, with skin testing orin vitrotests used to corroborate the history. Oral food challenges represent the "gold standard" for the confirmation of food allergy. These can be performed as open challenges or in a single- or double-blind fashion. Food challenges are not without risk and thus require that appropriate supportive care be available.

Several studies protest that the magnitude of thein vitrotest or the skin test reaction size may be useful in determining the utility of performing a food challenge.16,17One additional advantage of skin testing for food allergies is the ability to act out skin testing with the unused food, "prick-prick" test. Several reports protest that unused foods provide greater sensitivity for certain foods.18, 19This is particularly significant in assessing allergy to fruit; however, useful results own also been demonstrated for other foods, including seafood, peanut, tree nuts, vegetables, milk and eggs.

Molecular-based allergy diagnostic

It is hoped that the predictive worth of allergy diagnostic testing can be improved with the use of molecular-based allergy diagnostics.

This methodology is used to map the allergen sensitization of a patient at the epitope level, using purified natural or recombinant allergenic molecules (components) 20,21Molecular-based allergy diagnostics is available either using singleplex platforms which utilize panels of single allergens together with the corresponding allergen extract or can also be performed using multiplex technology to measure serum IgE antibodies against multiple allergens in a single assay The technique allows for the testing of a large number of allergens using a little quantity of serum (as little as 20 µL; conventional specific IgE tests use 50 µL per allergen).

Currently one multiplex platform is available on the market (the Immuno-Solid phase Allergen Chip (ISAC) platform) 23,24 Though a higher degree of variability in low IgE levels own been found, ISAC results own been similar to those obtained from singleplex platforms 25,26 At low serum IgE levels singleplex platforms may be more sensitive than ISAC and thus this should be considered when interpreting testing using the ISAC. Although more than epitopes own been identified, the clinical relevance of numerous of these is not known.

Evidence, however, has been provided for use of several epitopes in clinical practice, such as peanut.

In numerous cases of peanut sensitization detected solely by prick skin testing or by whole allergen specific IgE it is hard to decide whether true allergy exists versus sensitization with no clinical symptoms as a manifestation of cross reactivity to pollen. In such cases there is excellent evidence for analyzing IgE to the epitopes Ara h 2 (genuine IgE mediated allergy) and Ara h 8 (Bet v 1 (birch pollen) homologue; a marker of cross-reactivity) 27,28 IgE sensitization to Ara h 2 often correlates with positive IgE against Ara h 1 and Ara h 3.

If there were IgE antibodies in serum to Ara h 2 and/or Ara h 1/Ara h 3, more than 95% of patients own reported symptoms when ingesting peanuts 29 If there was IgE only to Ara h 2 and not to Ara h 1, 3 or 8, 87% reported symptoms. Whether there may be a threshold level of serum IgE to Ara h 2 above which peanut allergy may be diagnosed with a sufficient sensitivity and specificity which may forsake the need for oral provocation remains to be prospectively evaluated 30If there was only IgE to Ara h 8 and not to Ara h 1, 2 or 3 only around 18% of patients own reported symptoms, and these were generally extremely mild 29 More serious symptoms cannot be ruled out, however, in Ara h 8 sensitized patients.

In the event of itching and swelling in the mouth and throat both Ara h 2 and Ara h 8 should be sure, and, at the same time, assessment of sensitization to birch pollen should be made by analyzing IgE to Bet v 1.

Bet v 1, PR protein is the major allergen in birch pollen and approximately 95% of birch pollen sensitized patients own specific IgE antibodies to Bet v 1 31 Specific IgE to Bet v 1 may also be found in patients with primary sensitization to other tree pollens (e.g.

elm: Aln g 1; hazel pollen: Cor a 1) as well as to foods (hazelnut, apple, soy, peanut (Ara h 8), kiwi, celery). IgE antibodies to Bet v 2 (profilin) and/or Bet v 4 (calcium-binding protein) are markers of cross-reactivity 31 and as opposed to Bet v 1 if increased are indicators that the patient is primarily sensitized to another pollen. IgE to Bet v 2 is a marker of cross-reactivity with numerous pollens and vegetable foods 32 while IgE to Bet v 4 is a marker of cross-reactivity only with other pollen allergens 33

IgE antibodies to Phl p 1 and Phl p 5 are specific markers for sensitization to Phleum pratense (Timothy grass).

Phl p 7 (calcium-binding protein) and Phl p 12 (profilin) are markers of cross-reactivity with fruits and vegetables. Increased IgE to these components and not to Phl p 1 and/or Phl p 5 indicates primary sensitization to a diverse species of grass pollen than Phleum pratense 34 It has been suggested that if relevant symptoms are present in addition to elevated IgE Phl p 1 and p 5 levels immunotherapy with phleum pratense extract would likely be clinically effective because phleum pratense extracts contain mainly Phl p5 and p6 24,35

Molecular-based allergy diagnostics are also likely to be of utility when considering immunotherapy for dust mite allergy.

Der p 1 and Der p 2 are the most significant component markers for sensitization to home dust mites 36as more than % of patients allergic to home dust mites own IgE antibodies to these epitopes.

What is skin allergy test

Approximately 10% of patients allergic to home dust mites, however, own increased IgE levels to Der p 10 37 These patients will not benefit from specific immunotherapy since home mite extracts contain mainly Der p 1 and Der p 2 and variable or low amounts of Der p Whether molecular-based allergy diagnostics may increase the effect ratio of immunotherapy of Phleum pratense and houst dust mite allergic patients has not, however, been tested in prospectively planned trials.

Positive IgE to both bee and wasp venom is often due to cross-reactivity between cross-reactive carbohydrate-determining reagents (CCD) 38 shared in these two species.

In the frequently occurring clinical situation of an uncertain history and positive IgE to both allergens, determination of specific molecular epitopes may be of aid. An increase in both Api m 1 and Ves v 5 would indicate a true double sensitization and immunotherapy with both bee and wasp extracts would be indicated 38,39

Understanding the paucity of data, a recent consensus document concluded that molecular-based allergy diagnosis may be considered for investigation of 20

  1. Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations.

    J Allergy Clin Immunol Pract ; Jan;1(1) doi: / Epub Dec

  2. MS Dykewicz, JK Lemmon, DL Keaney. Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices. Ann Allergy Asthma Immunol ;
  3. Ferrer M, Sanz ML, Sastre et al. Molecular diagnosis in allergologgy: application of the microarray technique. J Investig Allergol Clin Immunol ;19(suppl 1)
  4. Oppenheimer J, Nelson HS. Skin Testing. Ann Every Asthma Immunol. ;S
  5. Droste JH, Kerkhof M, de Monchy JGR et al. Association of skin test reactivity, specific IgE, entire IgE, and eosinophils with nasal symptoms in a community-based population study J Every Clin Immunol ;
  6. Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children.

    Clin and Exp Every ;

  7. Hiller R, Laffer S, Harwanegg C, Huber M, et al. Microarrayed molecules: diagnostic gatekeepers for allergy treatment. FASEB J ;
  8. Yoon I-K, Martin BL, Carr WW. A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc ;
  9. Adkinson NF Jr. The radioallergosorbent test in limitations and refinements Jl Every Clin Immunol ;
  10. Canonica GW, Ansetegui IJ, Pawankar R, et al. A WAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics.

    WAOJ ;&

  11. Meliol G, Bonifazi F, Bonni S, et al. The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms. Clin Biochem ;
  12. Turkeltaub P. Performance standards for allergen skin testing: An approach to proficiency testing in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p
  13. Constantin C, Quirce S, Poorafshar M et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy ;
  14. Yunginger, J.

    MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI ;

  15. Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy ;
  16. Hejl C, Wurtzen PA, Kleine-Tebbe J, Johansen N, Broge L, Ipsen H. Phleum pratense alone is sufficient for allergen-specific immunotherapy against allergy to pooideae grass pollens. Clin Exp Allergy ;
  17. Martinez A, Asturias JA, Monteseirin J et al. The allergenic relevance of profilin (Ole e 2) from Olea europaea pollen. Allergy ;57(suppl 71)
  18. Ortolani C, Ispano M., Pastorello EA.,.

    Ansaloni R, Magri GC Comparison of results of skin prick tests (with unused foods and commercial food extracts) and RAST in patients with oral allergy syndrome Jl Every Clin Immunol ;

  19. McCann WA, Ownby, DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Every Asthma Immunol ;
  20. selected cases of suspected peanut allergy, birch pollen allergy and associated cross-reactivity (Ara h2, h8 (h1, h3) (Bet v1, v2, v4).
  21. Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy.

    J Allergy Clin Immunol ,

  22. Nicolaou N, Murray C, Belgrave D et al. Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut alergy. J Allergy Clin Immunol
  23. patients with insect allergy (Api m1; Ves v5).
  24. Dreborg S. ed. Skin tests used in type I allergy testing Position paper. Allergy ;s
  25. Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients. Allergy. Feb;68(2) doi: /all Epub Dec
  26. Nelson HS, Oppenheimer JJ, Buchmeier A, et al. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass.

    J Allergy Clin Immunol ,

  27. Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy ;
  28. Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomysin, in unexposed Orthodox Jews.

    What is skin allergy test

    Clin Exp Allergy ;

  29. Oppenheimer J. Devices for epicutaneous skin testing. in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p
  30. Ownby DR.

    What is skin allergy test

    Computerized measurement of allergen-induced skin reactions. J Allergy Clin Immunol , ;

  31. Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics ; doi: // Epub Aug 5.
  32. Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every
  33. Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC. Clin Chem Lab Med ;
  34. Sastre J. Molecular diagnosis in allergy.

    Clin Exper Allergy ;40(10)

  35. Pittner G, Vrtala S, Thomas WR et al. Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy ;
  36. Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol ;
  37. Sampson H Update on food allergy Jl Every Clin Immunol ;
  38. Swoboda I, Twaroch T, Valenta R, Grote M.

    Tree pollen allergens. Clin Allergy Immunol ;

  39. Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity? Jl Every Clin Immunol ;
  40. patients and triggering allergens for specific immunotherapy, specifically
    — grass, (Phl p1, p5, p12)
    — home dust mites, (Der p1, p2, p10)
    — hymenoptera venom (Api m1; Ves v5).
  41. Valenta R, Hayek B, Seiberler S et al. Calcium-binding allergens: from plants to man.

    Int Arch Allergy Immunol ;

  42. De Graaf DC, Aerts M, Danneels E, Devreese B. Bee, wasp and ant venomics pave the way for a component-resolved diagnosis of sting allergy. J Proteomics ;

Rather than classic testing, alternative molecular-based allergy diagnostics should be seen as an adjunct to the traditional whole allergen specific IgE tests. It is significant to remember that numerous patients can still be sufficiently assessed using conventional prick skin testing or specific IgE to whole allergens in the blood in addition to a thorough history and clinical examination 20 The clinical significance of sensitization detected via molecular-based allergy diagnostics should only be used in relation to the clinical history and physical signs.

ISAC testing is likely to be most useful in poly-sensitized patients for evaluation of sensitization to cross-reacting food and airborne allergens. Prospectively planned studies should be undertaken to determine to what extent such extensive panel screening may be helpful in clinical practice. Robust evidence has not yet been provided to prove that molecular-based allergy diagnostics can be utilized in lieu of oral challenge testing in food allergy.

ConclusionDiagnostic testing remains an essential tool for the evaluation of the allergic patient.

Several variables should be controlled to produce more dependable skin test results and improve the predictive values of allergy skin testing. It is also imperative that allergists ensure that the results of skin testing are dependable by conducting proficiency testing. In addition, the results must be properly documented to make them easily understandable by others. Similar standards must be applied toin vitrotesting; as in the case of skin testing, it is imperative that the ordering physician be familiar with the operating characteristics that thein vitrolab employs.

Lastly, it is likely that in the future, molecular based allergy diagnostics will frolic a bigger role in the evaluation of allergic patients.

References

  • Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract ; Jan;1(1) doi: / Epub Dec
  • Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every
  • Sastre J. Molecular diagnosis in allergy.

    Clin Exper Allergy ;40(10)

  • Droste JH, Kerkhof M, de Monchy JGR et al. Association of skin test reactivity, specific IgE, entire IgE, and eosinophils with nasal symptoms in a community-based population study J Every Clin Immunol ;
  • Sampson H Update on food allergy Jl Every Clin Immunol ;
  • Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity? Jl Every Clin Immunol ;
  • Ferrer M, Sanz ML, Sastre et al. Molecular diagnosis in allergologgy: application of the microarray technique. J Investig Allergol Clin Immunol ;19(suppl 1)
  • Ownby DR. Computerized measurement of allergen-induced skin reactions.

    J Allergy Clin Immunol , ;

  • Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin and Exp Every ;
  • Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics ; doi: // Epub Aug 5.
  • Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC.

    Clin Chem Lab Med ;

  • Adkinson NF Jr. The radioallergosorbent test in limitations and refinements Jl Every Clin Immunol ;
  • Hejl C, Wurtzen PA, Kleine-Tebbe J, Johansen N, Broge L, Ipsen H. Phleum pratense alone is sufficient for allergen-specific immunotherapy against allergy to pooideae grass pollens. Clin Exp Allergy ;
  • Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA.

    What is skin allergy test

    A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol ,

  • Nicolaou N, Murray C, Belgrave D et al. Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut alergy. J Allergy Clin Immunol
  • Constantin C, Quirce S, Poorafshar M et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy ;
  • Martinez A, Asturias JA, Monteseirin J et al. The allergenic relevance of profilin (Ole e 2) from Olea europaea pollen. Allergy ;57(suppl 71)
  • Ortolani C, Ispano M., Pastorello EA.,. Ansaloni R, Magri GC Comparison of results of skin prick tests (with unused foods and commercial food extracts) and RAST in patients with oral allergy syndrome Jl Every Clin Immunol ;
  • Turkeltaub P.

    Performance standards for allergen skin testing: An approach to proficiency testing in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p

  • Dreborg S. ed. Skin tests used in type I allergy testing Position paper. Allergy ;s
  • MS Dykewicz, JK Lemmon, DL Keaney. Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices. Ann Allergy Asthma Immunol ;
  • Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients.

    Allergy. Feb;68(2) doi: /all Epub Dec

  • Yunginger, J. MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI ;
  • Oppenheimer J. Devices for epicutaneous skin testing. in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders , p
  • Swoboda I, Twaroch T, Valenta R, Grote M. Tree pollen allergens. Clin Allergy Immunol ;
  • Nelson HS, Oppenheimer JJ, Buchmeier A, et al. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol ,
  • Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN.

    Diagnosis of hymenoptera venom allergy. Allergy ;

  • Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomysin, in unexposed Orthodox Jews. Clin Exp Allergy ;
  • McCann WA, Ownby, DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Every Asthma Immunol ;
  • Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol ;
  • Hiller R, Laffer S, Harwanegg C, Huber M, et al.

    Microarrayed molecules: diagnostic gatekeepers for allergy treatment. FASEB J ;

  • Oppenheimer J, Nelson HS. Skin Testing. Ann Every Asthma Immunol. ;S
  • Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy ;
  • Meliol G, Bonifazi F, Bonni S, et al. The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms. Clin Biochem ;
  • Pittner G, Vrtala S, Thomas WR et al.

    Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy ;

  • Yoon I-K, Martin BL, Carr WW. A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc ;
  • Canonica GW, Ansetegui IJ, Pawankar R, et al. A WAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics. WAOJ ;&
  • Valenta R, Hayek B, Seiberler S et al. Calcium-binding allergens: from plants to man. Int Arch Allergy Immunol ;
  • De Graaf DC, Aerts M, Danneels E, Devreese B.

    Bee, wasp and ant venomics pave the way for a component-resolved diagnosis of sting allergy. J Proteomics ;


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