Overview of skin testing for allergic disease
- Hendrik Nolte, MD, PhD
Hendrik Nolte, MD, PhD
- Allergy and Asthma Unit
- Bispebjerg University Hospital, Copenhagen, Denmark
- Krzysztof Kowal, MD
Krzysztof Kowal, MD
- Department of Allergy and Internal Diseases
- University Medical School, Bialystok, Poland
- Lawrence DuBuske, MD
Lawrence DuBuske, MD
- Clinical Professor of Medicine
- George Washington University School of Medicine, Washington, DC
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy
- Section Editor — Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
Immunoglobulin E (IgE)-mediated allergies account for the majority of clinically significant environmental, food, and medication allergies. Skin testing is an important element in the diagnosis of IgE-mediated allergy.
This topic review will discuss general principles of skin testing used in the diagnosis of IgE-mediated allergy, including indications, contraindications, factors influencing results, techniques, and accuracy. The two major methods of skin testing used, the prick/puncture technique and the intradermal technique, are described. The use of skin testing to diagnose specific disorders is presented in the appropriate topic reviews. (See "Diagnostic evaluation of food allergy" and "Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis", section on 'Skin testing'.)
Other forms of skin testing, such as patch testing for contact dermatitis or atopy patch testing for eosinophilic gastrointestinal disorders, are reviewed separately. (See "Patch testing" and "Allergy testing in eosinophilic esophagitis".)
ROLE IN DIAGNOSIS
There are three components to the diagnosis of an immunoglobulin E (IgE)-mediated allergic disorder. These are:
●Identification of the possible culprit allergen(s), usually through a careful clinical history.
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- ROLE IN DIAGNOSIS
- OVERVIEW OF SKIN TESTING
- Advantages over in vitro tests
- Biologic mechanism
- Sensitization versus clinical allergy
- General versus focused testing
- High risk for anaphylaxis
- Recent anaphylaxis
- Skin conditions
- FACTORS AFFECTING RESULTS
- Medications that should be discontinued
- - Beta blockers and ACE inhibitors
- Physiologic variables
- Technical variables
- - Quality of the extract
- - Skin test device
- ALLERGEN PREPARATION
- SKIN TESTING METHODS
- Prick/puncture method
- - Technique
- Definition of a positive test
- Prick-by-prick testing with fresh food
- - Accuracy and interpretation
- Positive results
- Negative results
- Intradermal method
- - Technique
- Definition of a positive test
- End-point dilution technique
- - Accuracy
- Intradermal testing and high-risk allergens
- Overall incidence of systemic reactions
- Anaphylaxis with prick/puncture testing
- INFORMATION FOR PATIENTS