J Rhinol.  2017 Nov;24(2):89-93. 10.18787/jr.2017.24.2.89.

Difference according to Interpretation Methods in Allergic Skin Test

• Dong SH
• Jung SY
• Min JY
• Kim SJ
• Lee KH
• Cho JS
• Kim SW

• KMID: 2398826
• DOI: http://doi.org/10.18787/jr.2017.24.2.89

Abstract

BACKGROUND AND OBJECTIVES
The skin prick test is a widely used test that uses three methods (allergen/histamine ratio method, erythema size method, and wheal size method) to interpret the results. However, there has been no comparison of these methods. The aim of this study is to compare the three different interpretation methods and define the relationship among them.
SUBJECTS AND METHOD
A total of 139 patients who visited our allergy clinic complaining of nasal symptoms were enrolled. Three interpretation methods were used for defining positivity in the skin prick test, and their results were compared. The validity of each interpretation method was evaluated by total nasal symptom score.
RESULTS
Positivity in the skin prick test was reported in 48.2% of patients according to the allergen/histamine ratio method and in 64.0% of patients according to the wheal size method and erythema size method. The proportion of subjects who showed a negative result with the allergen/histamine ratio method but positive results with the wheal size method or erythema size method was 15.8%. This group had a significantly higher total nasal symptom score, especially rhinorrhea and nasal obstruction, than subjects who showed negative results on all three methods.
CONCLUSION
When diagnosing allergic rhinitis patients using the skin prick test, the wheal size method and erythema size method should be considered rather than the allergen/histamine ratio method.

Keyword

Diagnosis; Skin test; Allergic rhinitis

MeSH Terms

Diagnosis
Erythema
Humans
Hypersensitivity
Methods*
Nasal Obstruction
Rhinitis, Allergic
Skin Tests*
Skin*

Reference

1). Fatteh S, Rekkerth DJ, Hadley JA. Skin prick/puncture testing in North America: a call for standards and consistency. Allergy Asthma Clin Immunol. 2014; 10:44.

2). Shin JH, Kim BG, Cho JH, Kim SW, Lee BJ, Kim YW, et al. Skin Prick Testing of Patients with Allergic Rhinitis and/or Asthma: a Study in Catholic Medical Center, Korea. Journal of Rhinology. 2012; 19:29–34.

3). Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013; 3:3.

4). Oppenheimer J, Nelson HS. Skin testing: a survey of allergists. Ann Allergy Asthma Immunol. 2006; 96:19–23.

5). Dreborg S. Allergen skin prick test should be adjusted by the histamine reactivity. Int Arch Allergy Immunol. 2015; 166:77–80.

6). Antunes J, Borrego L, Romeira A, Pinto P. Skin prick tests and allergy diagnosis. Allergol Immunopathol (Madr). 2009; 37:155–64.

7). Malling HJ. Skin prick testing and the use of histamine references. Allergy. 1984; 39:596–601.

8). Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:466–76.

9). Nelson HS, Knoetzer J, Bucher B. Effect of distance between sites and region of the body on results of skin prick tests. J Allergy Clin Immunol. 1996; 97:596–601.

10). van der Valk JP, Gerth van Wijk R, Hoorn E, Groenendijk L, Groenendijk IM, de Jong NW. Measurement and interpretation of skin prick test results. Clin Transl Allergy. 2015; 6:8.

11). Konstantinou GN, Bousquet PJ, Zuberbier T, Papadopoulos NG. The longest wheal diameter is the optimal measurement for the evaluation of skin prick tests. Int Arch Allergy Immunol. 2010; 151:343–5.

12). Aas K, Belin L. Standardization of diagnostic work in allergy. Int Arch Allergy Appl Immunol. 1973; 45:57–60.

13). Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012; 67:18–24.

14). Gergen PJ, Turkeltaub PC, Kovar MG. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. popu-lation: results from the second National Health and Nutrition Ex-amination Survey. J Allergy Clin Immunol. 1987; 80:669–79.

15). Fokkens WJ, Jogi R, Reinartz S, Sidorenko I, Sitkauskiene B, van Oene C, et al. Once daily fluticasone furoate nasal spray is effective in seasonal allergic rhinitis caused by grass pollen. Allergy. 2007; 62:1078–84.

16). Jang TY, Kim YH. Evidences for Local Allergic Rhinitis. Journal of Rhinology. 2016; 23:1–5.

17). Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Annals of Allergy, Asthma & Immunology. 2008; 100:S1–S148.

18). Ewan P, Coote D. Evaluation of a capsulated hydrophilic carrier polymer (the ImmunoCAP) for measurement of specific IgE antibodies. Allergy. 1990; 45:22–9.

19). Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008; 100:S1–148.

20). McCann WA, Ownby DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Allergy Asthma Immunol. 2002; 89:368–71.

21). Nelson HS, Lahr J, Buchmeier A, McCormick D. Evaluation of de-vices for skin prick testing. J Allergy Clin Immunol. 1998; 101:153–6.