Comparative effectiveness of allergy testing method in driving immunotherapy outcomes

Kaffenberger, Thomas M.; Dedhia, Raj C.; Schwarzbach, Hannah L.; Mady, Leila J.; Lee, Stella E.

doi:10.1002/alr.22061

Cited by 7 publications

(10 citation statements)

References 16 publications

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“…Fourth, Kaffenberger acknowledged that it took SPT-based AIT patients an average of 265 days longer to reach maintenance [ 41 ], or 38 additional weekly visits. Thus, the long-term total of testing plus treatment cost difference favors IDT.…”

Section: Discussionmentioning

confidence: 99%

“…A Likert scale was chosen because of simplicity, validity, and especially ease of clinical use [ 26 , 42 ], although QOL scores tend to have more statistical power [ 43 , 44 , 45 ]. Unlike our study, Kaffenberger measured AIT treatment outcomes following IDT using a multi-question quality of life (QOL) instrument, but only 14 of their 37 patients who reached maintenance completed the full questionnaire, resulting in a small study with insufficient power for definite conclusions [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

et al. 2021

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The purpose of this study was to determine whether the sensitivity advantage of intradermal dilutional testing (IDT) is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD) or otitis media with effusion (OME). This retrospective, private-practice cohort study compared the sensitivity of skin prick tests (SPT) vs. IDT in 110 adults and children with suspected allergy and OME. Primary outcome measure was symptom resolution from allergy immunotherapy (AIT). IDT identified 57% more patients as being allergic, and 8.6 times more reactive allergens than would have been diagnosed using only SPT. Patients diagnosed by IDT had the same degree of symptom improvement from immunotherapy, independent of allergen sensitivity (66% by SPT vs. 63% by IDT; p = 0.69, not different). Low-sensitivity allergy tests, which may fail to identify allergy in over two thirds of children aged 3 to 15 as being atopic, or among 60% of patients with ETD, may explain why many physicians do not consider allergy as a treatable etiology for their patient’s OME/ETD. IDT offers superior sensitivity over SPT for detecting allergens clinically relevant to treating OME/ETD. These data strongly support increased utilization of intradermal testing and invite additional clinical outcome studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

et al. 2021

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“…Because of their higher diagnostic sensitivity for symptomatic allergy, skin tests are generally preferred over in vitro methods such as antigen specific IgE or total IgE [37], especially in food allergy testing [38,39]. Skin prick test results correlate well with symptoms and the specificity is satisfactory, although "patients with a low-sensitivity IDT often have the only positive results" [14].…”

Section: Allergy Skin Tests-sensitivity Vs Specificitymentioning

confidence: 99%

“…Any such benefit must be judged by patients' superior response to AIT based on their particular test results [10][11][12]. Prior efforts to compare SPT and IDT have had insufficient populations to validly compare AIT outcomes [13,14].…”

Section: Introductionmentioning

confidence: 99%

Clinical Relevance and Advantages of Intradermal Test Results in 371 Patients with Allergic Rhinitis, Asthma and/or Otitis Media with Effusion

Hurst

McDaniel

2021

Cells

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Background: We evaluated the value of positive intradermal dilution testing (IDT) after negative skin prick tests (SPT) by retrospectively determining allergy immunotherapy (AIT) outcomes. Methods: This private practice, cohort study compared the relative value of SPT vs. IDT in 371 adults and children with suspected manifestations of allergy: chronic allergic rhinitis (AR), asthma and/or chronic otitis media with effusion (OME). The primary outcome measure was symptom resolution following immunotherapy, as determined by symptom severity questionnaires completed by patients before and after AIT. Results: Positive IDT identified 193 (52%) patients who would not otherwise have been diagnosed. IDT detected 3.7-fold more allergens per patient than SPT (8.56 vs. 2.3; p < 0.01). Patients positive only on IDT responded to AIT equally well as those identifiable by SPT, independent of allergen sensitivity (67% by SPT vs. 62% by IDT; p = 0.69, not significantly different). Conclusion: Intradermal titration can identify patients who will benefit from allergy immunotherapy more accurately than SPT. Outcomes analysis in 371 patients shows that IDT doubled their chance of successful treatment with no greater risk of therapeutic failure. Positive IDT, following negative SPT, is clinically relevant and offers superior sensitivity over SPT for detecting allergens clinically relevant to diagnosis of AIT-responsive atopic disease.

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“…Investigations into allergy also feature prominently as the lead article by Kaffenberger et al . explores the relationship between immunotherapy outcomes and the method of allergy testing.…”

mentioning

confidence: 99%

A “golden age” in skull base and rhinology research

Bleier¹

2018

Int Forum Allergy Rhinol

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Comparative effectiveness of allergy testing method in driving immunotherapy outcomes

Abstract: IDT reached maintenance immunotherapy quicker than IVT but there was no difference compared to SPT. TTM did not correlate with improvements in patient symptoms between testing methods. This study represents a novel comparison of outcomes based on initial allergy testing method.

Cited by 7 publications

References 16 publications

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

Clinical Relevance and Advantages of Intradermal Test Results in 371 Patients with Allergic Rhinitis, Asthma and/or Otitis Media with Effusion

A “golden age” in skull base and rhinology research

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