Diagnosing Environmental Allergies: Comparison of Skin-Prick, Intradermal, and Serum Specific Immunoglobulin E Testing

Abstract

Background:Allergists commonly perform intradermal skin testing (IDST) after negative skin-prick testing (SPT) to comprehensively diagnose environmental allergic sensitization. However, with the availability of modern methods to detect serum-specific immunoglobulin E (ssIgE), it is unclear if ssIgE testing could substitute for IDST.Objective:To determine the efficacy of ssIgE testing and IDST when added to SPT in diagnosing environmental allergic sensitizations.Methods:SPT, IDST, and ssIgE testing to nine common environmental allergens were analyzed in 75 patients with oculonasal symptoms who presented to our allergy clinics in the Bronx, New York, between January 2014 and May 2015.Results:A total of 651 SPT and 499 ssIgE tests were independently performed and revealed 162 (25%) and 127 (25%) sensitizations, respectively. When SPT results were negative, IDST results revealed 108 of 452 additional sensitizations (24%). In contrast, when SPT results were negative, ssIgE test results only revealed 9% additional sensitizations. When both SPT and IDST results were negative, ssIgE testing only detected 3% of additional sensitizations, and ssIgE levels were typically low in these cases (median, 1.25 kU/L; range, 0.357–4.47 kU/L). When both SPT and ssIgE test results were negative, IDST results detected 15% additional sensitizations.Conclusion:IDST detected more additional environmental sensitizations compared with ssIgE testing. IDST, therefore, may be useful when the SPT and/or ssIgE testing results were negative, but the exposure history indicated relevant allergic sensitization. Serology added only a little more information if both SPT and IDST results were negative but may be useful in combination with SPT if IDST cannot be performed.

Pattern of allergen sensitivity among bronchial asthma patients in Sohag governorate, Egypt

“…They explained that their findings were due to the presence of protease allergens in the extracts obtained from reported insects, considered the cause of allergy. [15][16][17] Also, in contrast to our study findings, a study done by Kumar R et al, 2012 24 reported that the most common insect allergen was moth followed by mosquito. 24 Patel et al, 2012, has also reported that moth was the most common insect allergen.…”

“…More than one-quarter of the size of the positive control it was scored as 1+; and less than one-quarter of the size of the positive control scored as 0. Scores of 2+ or more were defined as positive reactions 17 .…”

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

“…Calabria and Hagan stated: "For lower potency or non-standardized allergens, the ID skin test may identify a higher percentage of patients with lower levels of clinical sensitivity, and a positive test result may be more clinically relevant" [56]. Several studies in New York City have reported IDT results subsequent to negative SPT, finding among these "non-allergic" patients 20.8% [61] and 24% [62] additional positive antigens.…”

Allergen –induced IL4 levels in patients of allergic rhinitis

“…Once diagnosis of AR has been established and relevant trigger allergens have been identified, it is possible to recommend the appropriate therapies; allergen avoidance, allergen-specific immunotherapy and anti-IgE therapy 5 . Diagnostic strategies that confirm the diagnosis are somewhat problematic, concise diagnosis is based on a detailed patient's history and a diagnostic panel includes in vivo and in vitro tests 6 .…”