ACAAI/AAAAI Joint Task Force ReportPearls and pitfalls of allergy diagnostic testing: report from the American College of Allergy, Asthma and Immunology/American Academy of Allergy, Asthma and Immunology Specific IgE Test Task Force
Section snippets
INTRODUCTION
Physicians of all specialties commonly encounter patients with symptoms consistent with allergy. It can be difficult to determine if these symptoms are caused by an allergic mechanism (eg, perennial rhinitis caused by dust mite sensitivity vs nonallergic rhinitis with eosinophilia syndrome) or what allergen is causing the symptoms (ie, some allergens have overlapping seasons; house dust can contain multiple allergens) with the patient's history alone.
Two main categories of tests are available
IN VITRO VS IN VIVO ALLERGY TESTS
There is currently no single gold standard test for diagnosing aeroallergen (airborne) allergy. The double-blind, placebo-controlled food challenge that is considered the gold standard for food allergies is a time-consuming procedure that is limited to trained allergy specialists and carries the risk of producing a severe reaction.
The clinical history drives the diagnosis of human allergic disease. Once the history has provided a strong suggestion of IgE-mediated disease, in vivo (skin) or in
What Is an s-IgE Determination?
An allergy blood test is designed to detect and measure circulating IgE antibodies, which are directed at a specific allergen, such as short ragweed. s-IgE tests were first introduced commercially in 1972. The first test evaluated IgE using radioisotopically labeled anti-IgE and was subsequently called the radioallergosorbent test (RAST). RAST, which is no longer in use, was essentially a qualitative test (ie, demonstrated whether s-IgE was present or not and did not provide quantitative
ALLERGY SKIN TESTING
Skin tests for allergic disorders were first described in 1867 and quickly evolved into the scratch test, which was initially used to confirm the diagnosis of food allergy in children. In clinical practice, the scratch has given rise to the prick or puncture test, and in some cases if the results are interpreted as negative, it is followed by the intradermal test.
In the allergist's office, skin testing remains the primary test to confirm an allergic response for several reasons. Skin testing is
Summary of Allergy Skin Testing
Skin testing remains an invaluable tool in the diagnostic evaluation of the allergic patient. The prick or puncture test is generally the preferred method for several reasons, including patient comfort and time, cost, and safety. As with in vitro allergy tests, a number of variables affect results, such as the skin test device or the location where the tests are performed, and these variables should be noted in the skin test report. The skin test report should also include a positive and
ACKNOWLEDGMENTS
The members of the American College of Allergy, Asthma and Immunology/American Academy of Allergy, Asthma and Immunology Specific IgE Task Force who contributed to the document: Linda Cox, MD (chair), Robert Hamilton, PhD, David Golden, MD, John Oppenheimer, Larry Sher, MD, Scott Sicherer, MD, and Brock Williams, PhD. Other members of the Task Force who assisted in review and revision were Don Aaronson, MD, JD, MPH, David Weldon, MD, Warner Carr, MD, David Bernstein, MD, Jay Portnoy, MD, and
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Disclosures: Authors have nothing to disclose.