I. 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

II. Indications

  1. Refractory Allergic Rhinitis
  2. Refractory Asthma
  3. Food Allergy or drug allergy suspected
  4. Insect sting allergy suspected

III. 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%)

IV. Devices

  1. Morrow-Brown Needle
  2. Multi-Test (Lincoln Diagnostics)
  3. Quintest (Bayer)
  4. Modified RadioAllergoSorbent Test (RAST)
  5. Quidel finger stick device

V. 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

VI. 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)

VII. References

  1. (1999) NPI Allergy Testing Conference, Las Vegas
  2. James (2002) Am Fam Physician 66(4):621-6

Images: Related links to external sites (from Google)

Ontology: 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)
Concepts Diagnostic Procedure (T060)
MSH D012882
SnomedCT 142177006, 141999001, 165005004, 268377001, 252515007, 53309004, 164838003, 142167009, 164995003, 268402005
English Skin Tests, Test, Skin, Tests, Skin, immunologic skin test, Skin test, NOS, SKIN TESTS, SKIN TESTING, Hypersensitivity skin test NOS, skin test (lab test), 2-44 SKIN TESTS, skin test, Hypersensitivity skin test NOS (procedure), Skin tests, hypersensitivity skin tests, skin testing, hypersensitivity skin test, hypersensitivity tests, skin tests, Allergy skin test, Skin test, Special dermatological testing, Hypersensitivity skin testing (procedure), Skin test (procedure), Special dermatological testing (procedure), Skin test - hypersens., Hypersensitivity skin testing, Skin Test, hypersensitivity test
Italian Test cutaneo, Prove cutanee
Japanese 皮膚テスト, ヒフテスト
Swedish Hudtester
Czech kožní testy, epikutánní testy, kůže - testy, Kožní test
Spanish Hypersensitivity skin testing, Allergy skin test, Special dermatological testing, Skin test - hypersens., Hypersensitivity skin test NOS, cutirreacción, prueba cutánea de hipersensibilidad, SAI (procedimiento), prueba cutánea de hipersensibilidad, SAI, prueba cutánea, prueba de hipersensibilidad cutánea (procedimiento), prueba de hipersensibilidad cutánea, prueba dermatológica especial (procedimiento), prueba dermatológica especial, prueba en la piel (procedimiento), prueba en la piel, reacción cutánea, Prueba cutánea, Tests Cutaneos, Tests Cutáneos, Pruebas Cutaneas, Pruebas Cutáneas
Finnish Ihokokeet
French Tests cutanés d'allergie, Tests cutanés, Tests cutanés allergiques, TCA (Tests Cutanés Allergiques), Test cutané
Russian KOZHNYE TESTY KOMBINIROVANNYE, КОЖНЫЕ ТЕСТЫ КОМБИНИРОВАННЫЕ
Croatian KOŽNI TESTOVI
Polish Próby skórne
Hungarian Bőr vizsgálat
Portuguese Teste cutâneo, Testes Cutâneos
Dutch huidtest, Huidtest, Huidtests, Test, huis-
German Hauttest, Hauttests

Ontology: Allergy profile (C0430344)

Concepts Laboratory Procedure (T059)
SnomedCT 252380005
English Allergy screen, Atopy screen, Hypersensitivity screen, Allergy profile, Hypersensitivity profile, Hypersensitivity screening, Allergy profile (procedure), Allergy screening, Atopy screening
Spanish detección selectiva de alergia, detección selectiva de atopia, detección selectiva de hipersensibilidad, estudio de perfil alérgico (procedimiento), estudio de perfil alérgico, perfil de hipersensibilidad, pesquisa de alergia, pesquisa de atopia, pesquisa de hipersensibilidad, tamizaje de alergia, tamizaje de atopia, tamizaje de hipersensibilidad

Ontology: In vivo test of hypersensitivity (C0549104)

Definition (SNOMEDCT) An immune system procedure that observes for evidence of hypersensitivity
Concepts Diagnostic Procedure (T060)
SnomedCT 252512005
English In vivo test of hypersensitiv, In vivo test of hypersensitivity, allergies tests, allergy testing, allergies test, test allergy, allergy test, allergy tests, in vivo allergy testing, Allergy testing, Allergy test, In vivo test of hypersensitivity (procedure)
Spanish prueba in vivo de alergia, prueba in vivo de hipersensibilidad (procedimiento), prueba in vivo de hipersensibilidad