Intradermal testing after negative skin prick testing for patients with high suspicion of allergy

Abstract

Approximately 20% of all negative results on SPT will have a positive ID test, more likely for indoor allergens. If a high suspicion for allergy exists in a patient with a negative SPT result, it may be useful to proceed with ID testing. However, the clinical significance of a positive ID test after negative SPT still needs to be elucidated.

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

“…Other studies demonstrated that, the higher the concentrations used for IDST, the more likely it is to diagnose sensitizations. 2,9,10,12,15 In our retrospective study, we combined the results of patients treated at different hospitals, which used different protocols for IDST. Even though this may be considered a bias or a lack of standardization, different allergen concentrations used for IDST are widely used in the clinical practice: e.g.…”

“…, ImmunoCap [Phadia, Uppsala, Sweden] and Immulite [Siemens Health Care Diagnostics, Tarrytown, NY]) have been shown to be as sensitive as SPT. 1–7 Hence, the American Academy of Pediatrics 8 and Asthma Management guidelines set forth by the National Asthma Education and Prevention Program 5 in 2007 recommend either SPT or ssIgE testing to establish a diagnosis of environmental allergies.…”

“…This is not unreasonable because it has been shown that IDST may pick up 10–30% additional sensitizations, and, if higher concentrations are used, even >50% of additional sensitizations are found compared with SPT alone. 2,9–11 However, it is not well established how much information is gained through IDST compared with ssIgE testing when the SPT result is negative. As of yet, studies to determine the yield of ssIgE and IDST in diagnosing multiple allergen sensitizations in daily allergy practice have not been performed.…”

High volume of polysorbate‐containing (Tween® 80) solutions induces false‐positive results in intradermal test

“…Skin prick test is the first‐line diagnostic tool to confirm allergic sensitization. As prick test results may be negative or elicit skin test reactions to allergens that do not fit the period of the observed subjective complaints, intradermal test might serve as a further diagnostic tool . Intradermal test is also valuable especially in revealing hypersensitivity to penicillin, insect venoms, insulin, heparins, muscle relaxants, chemotherapeutic agents and biologics .…”

“…As prick test results may be negative or elicit skin test reactions to allergens that do not fit the period of the observed subjective complaints, intradermal test might serve as a further diagnostic tool. [9][10][11][12] Intradermal test is also valuable especially in revealing hypersensitivity to penicillin, insect venoms, insulin, heparins, muscle relaxants, chemotherapeutic agents and biologics. [13][14][15] Depending on the allergen used, intradermal test is performed using a suitable dose, i.e., 30 lg of major allergen for inhalant allergies and injected at a volume of 0.02-0.05 mL.…”