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Allergy ScreeningAka: Allergy Test, Skin Testing

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  1. Preparation
    1. Have Epinephrine and Albuterol available
    2. Discontinue Antihistamines before testing
      1. Second generation Antihistamines: 2 weeks before test
      2. First generation Antihistamines: 3 days prior to test
      3. Other Antihistamine-type agents to stop before test
        1. Phenothiazine
        2. Tricyclic Antidepressants
        3. Anticholinergic Medications
        4. H2 Receptor blocking medications (e.g. Ranitidine)
    3. Inhaled Corticosteroids do not affect test
    4. Short-term Systemic Corticosteroids do not affect test
  2. Indications
    1. Refractory Allergic Rhinitis
    2. Refractory Asthma
    3. Food Allergy or drug allergy suspected
    4. Insect sting allergy suspected
  3. Contraindications to skin testing
    1. Severe Eczematous Dermatitis
    2. Dermatographism
    3. History of Anaphylaxis
    4. Very young
    5. Unable to discontinue Antihistamines
    6. Uncontrolled Asthma (Peak expiratory flow < 75%)
  4. Devices
    1. Morrow-Brown Needle
    2. Multi-Test (Lincoln Diagnostics)
    3. Quintest (Bayer)
    4. Modified RadioAllergoSorbent Test (RAST)
    5. Quidel finger stick device
  5. Technique
    1. Test 6-10 antigens to determine presence of IgE disease
    2. Use Controls
      1. Positive Control: Histamine
      2. Negative Control: Glycerol-Saline
    3. Read test 15 minutes after application of allergan
      1. Positive if wheal diameter 3 mm > negative control
    4. Use Regional Allergy Screening guidelines
    5. Relies on cross reactivity among antigen groups
      1. Tree
      2. Grass
      3. Weed
      4. Mold
      5. House Dust mite
      6. Cat
  6. Interpretation
    1. All Tests negative: No further testing needed
    2. One or more inhalants positive: Complete regional panel
    3. Dust mite only positive: No further testing needed
      1. Avoid Dust mites
      2. Consider Immunotherapy
    4. Cat only positive: No further testing needed
      1. Avoid exposure and reduce dander
      2. Consider Immunotherapy
    5. If Positive Control is Negative
      1. Try RAST testing
      2. Patient may be on Antihistamine or steroid
        1. IF short acting Antihistamine
          1. Stop Antihistamine and retest after 2 days
        2. IF long acting Antihistamine
          1. Stop Antihistamine and retest after 3-4 weeks
    6. If reaction occurs to Negative Control
      1. Dermatographism
    7. Intradermal Allergy Test Indications
      1. Suspected Insect Sting Allergy (e.g. bee, hornet)
      2. Suspected Drug Allergy (e.g. Penicillin, anesthetic)
  7. References
    1. (1999) NPI Allergy Testing Conference, Las Vegas
    2. James (2002) Am Fam Physician 66(4):621

Hypersensitivity skin testing (C0037296)

Definition (MSH)Epicutaneous or intradermal application of a sensitizer for demonstration of either delayed or immediate hypersensitivity. Used in diagnosis of hypersensitivity or as a test for cellular immunity.
Definition (CSP)epicutaneous or intradermal application of a sensitizer for demonstration of either delayed or immediate hypersensitivity; used in diagnosis of hypersensitivity or as a test for cellular immunity.
Definition (NCI)A test for an immune response to a compound by placing it on or under the skin.
Definition (NCI)A preparation of an antigenic component of an infectious agent that is administered to a patient in order to determine whether previous exposure to the agent has occurred, and/or to assess the integrity of the patient's cellular immune system. Depending on the clinical situation, the appearance of a delayed (cellular) hypersensitivity response, which manifests as an area of induration and erythema at the injection site, i.e. a positive test result, may indicate previous exposure to a particular infectious agent. (NCI04)
ConceptsDiagnostic Procedure (T060)
MSHD012882
EnglishAllergy skin test, Hypersensitivity skin testing, hypersensitivity test, immunologic skin test, skin test, Skin test - hypersens., SKIN TESTING, Skin Tests, Special dermatological testing
Spanishcutirreaccion, prueba cutanea, prueba de hipersensibilidad cutanea, prueba dermatologica especial, prueba en la piel, reaccion cutanea
Parent ConceptsImmunologic Tests (C0021061), Immunology procedure (C0519671), Diagnostic Techniques and Procedures (C0525034), diagnostic procedure (C0430022), Hypersensitivity skin testing (C0037296), Diagnostic procedure on skin (C0191276), In vivo test of hypersensitivity (C0549104), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, LCH, LNC, MSH, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Allergy profile (C0430344)

ConceptsLaboratory Procedure (T059)
EnglishAllergy profile, Allergy screening, Atopy screening, Hypersensitivity profile, Hypersensitivity screening
Spanishdeteccion selectiva de alergia, deteccion selectiva de atopia, deteccion selectiva de hipersensibilidad, estudio de perfil alergico, perfil de hipersensibilidad, pesquisa de alergia, pesquisa de atopia, pesquisa de hipersensibilidad, tamizaje de alergia, tamizaje de atopia, tamizaje de hipersensibilidad
Parent ConceptsImmunology profile (C0430339), In vivo test of hypersensitivity (C0549104)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


In vivo test of hypersensitivity (C0549104)

ConceptsDiagnostic Procedure (T060)
EnglishAllergy test, Allergy testing, In vivo test of hypersensitivity
Spanishprueba in vivo de alergia, prueba in vivo de hipersensibilidad
Parent ConceptsClinical immunological test (C0430556)
SourcesMTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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