Skin Testing

Aka: Skin Testing, Hypersensitivity Skin Testing, Intradermal Test, Skin Prick Test

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II. Indications

  1. Allergic response to inhalants, food, Insect Bites or medications
    1. High probability of Food Allergy based on detailed history

III. Mechanism

  1. IgE mediated, immediate-type Hypersensitivity
  2. Reaction results in a wheal at the exposure site, whose size correlates with the likelihood of allergy

IV. Contraindications (Use serum Ige testing instead)

  1. Severe Eczematous Dermatitis
  2. Dermatographism
  3. History of Anaphylaxis to Antigen to be tested
  4. Very young
  5. Unable to discontinue Antihistamines
  6. Uncontrolled Asthma (Peak Expiratory Flow < 75%)

V. Preparation

  1. Have Epinephrine and Albuterol available in case of Anaphylaxis
  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. Avoid High potency Topical Corticosteroids
    1. Avoid at the test site for 3 weeks prior to testing
  4. Medications that do NOT affect testing
    1. Leukotriene Receptor Antagonists
    2. Inhaled Corticosteroids
    3. Short-term Systemic Corticosteroids

VI. Technique

  1. Test 6-10 Antigens to determine presence of IgE disease
  2. Antigen exposure techniques
    1. Prick method
    2. Scratch method
    3. Intradermal (injected)
      1. Most accurate
      2. Used in cases requiring higher Test Sensitivity (e.g. Insect sting allergy, Penicillin Allergy)
  3. Use Controls
    1. Positive Control: Histamine
    2. Negative Control: Glycerol-Saline
  4. Read test 15 minutes after application of allergen
    1. Positive if wheal diameter 3 mm > negative control
  5. Use Regional Allergy Screening guidelines
  6. Relies on cross reactivity among Antigen groups
    1. Tree
    2. Grass
    3. Weed
    4. Mold
    5. House Dust mite
    6. Cat

VII. 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)

VIII. Efficacy

  1. High Test Sensitivity and Test Specificity
  2. Expect smaller positive reactions in age <2 years or age >70 years
  3. There is a lack of standardization of extracts
    1. Results may vary between testing facilities

IX. References

  1. (1999) NPI Allergy Testing Conference, Las Vegas
  2. Chang (2018) Am Fam Physician 98(1): 34-9 [PubMed]
  3. James (2002) Am Fam Physician 66(4):621-6 [PubMed]

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Related Studies

Ontology: Intradermal Tests (C0021881)

Definition (MSH) Skin tests in which the sensitizer is injected.
Definition (ALT) Injecting an intradermal, delayed-type reaction allergy test into a client/patient to detect his or her allergic response(s) to various allergens. Service is billed per test.
Concepts Diagnostic Procedure (T060)
MSH D007428
SnomedCT 2885009
English Intradermal Test, Intradermal Tests, Test, Intradermal, Tests, Intradermal, intradermal skin testing, intradermal test, intradermal testing, Intradermal test, Intracutaneous test, Intradermal allergen test, Intradermal skin test (procedure), Intradermal skin test, Intradermal skin test, NOS, Intracutaneous allergy test delayed-type reaction with allergen extract(s) each test, IC alrg tst deltyp rxn W alr
Dutch intracutane test, intradermale test, Test, intradermale, Tests, intradermale
French Intradermoréaction, Tests intradermiques, TID (Test IntraDermique), Intradermoréactions, IDR (IntraDermoRéaction), Intradermo-réactions, Test intradermique
German Intrakutantest, Intradermaler Hauttest, Intradermale Tests, Intrakutantests
Italian Prova cutanea, Test intradermico, Prove intradermiche
Portuguese Prova intra-cutânea, Teste intradérmico, Testes Intradérmicos
Spanish Prueba intracutánea, Prueba intradérmica, Tests Intradérmicos, prueba cutánea intradérmica (procedimiento), prueba cutánea intradérmica, Pruebas Intradérmicas
Swedish Intradermala tester
Czech intradermální testy, Intrakutánní test, Intradermální test
Finnish Ihopistokokeet
Russian PRAUSNITTSA-KIUSTNERA REAKTSIIA, PASSIVNOGO PERENOSA REAKTSIIA, VNUTRIKOZHNYE TESTY IN"EKTSIONNYE, ВНУТРИКОЖНЫЕ ТЕСТЫ ИНЪЕКЦИОННЫЕ, ПАССИВНОГО ПЕРЕНОСА РЕАКЦИЯ, ПРАУСНИТЦА-КЮСТНЕРА РЕАКЦИЯ
Japanese プラウスニッツ-キュストネル反応, Prausnitz-Kustnerテスト, 受身伝達試験, プラウスニッツ-キュストネルテスト, 皮内試験, 皮内反応, プラウスニッツ-キュストネル試験, 被動性転嫁, P-K反応, 皮内テスト, ﾋﾅｲﾃｽﾄ
Polish Próby śródskórne
Hungarian Intracután vizsgálat, Intradermális vizsgálat
Norwegian Tester, intradermale, Intradermale tester
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hypersensitivity skin testing (C0037296)

Definition (NCI_NCI-GLOSS) 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)
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.
Concepts Diagnostic Procedure (T060)
MSH D012882
SnomedCT 141999001, 165005004, 164995003, 142177006, 142167009, 268402005, 268377001, 252515007, 53309004, 164838003
CPT 1011969
LNC LP32995-0
English Skin Tests, Test, Skin, Tests, Skin, immunologic skin test, Hypersensitivity skin test NOS, skin test (lab test), skin test, Skin tests, hypersensitivity skin tests, skin testing, hypersensitivity skin test, hypersensitivity tests, skin tests, Hypersensitivity skin test NOS (procedure), Skin test - hypersens., Allergy skin test, Skin test, Special dermatological testing, Hypersensitivity skin testing (procedure), Skin test (procedure), Special dermatological testing (procedure), Skin test, NOS, 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
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
Norwegian Hudtester, Prikktester
Spanish Hypersensitivity skin test NOS, prueba cutánea de hipersensibilidad, SAI, prueba cutánea de hipersensibilidad, SAI (procedimiento), Tests Cutáneos, cutirreacción, 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, Pruebas Cutáneas
Portuguese Teste cutâneo, Testes Cutâneos
Dutch huidtest, Huidtest, Huidtests, Test, huis-
German Hauttest, Hauttests
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Skin prick test (C0430561)

Definition (NCI) A test for sensitivity to allergens. A solution containing a suspected allergy-causing substance is placed on the skin and then the skin is pricked or scratched to allow the allergen to enter the skin. If the skin develops a red, raised wheal it usually means that the person is allergic to that allergen.
Concepts Diagnostic Procedure (T060)
SnomedCT 37968009
Dutch priktest
French Test de la piqûre
German Prick-Test
Italian Test di cutireazione
Portuguese Prova de picada
Spanish Prueba de punción, prueba del pinchazo (procedimiento), prueba del pinchazo
Japanese 皮刺試験, ﾋｼｼｹﾝ
Czech Prick test
English Allergy Skin Prick Test, Skin Prick Test, SPT, Skin prick test, prick testing, prick skin test, epicutaneous test, prick skin testing, skin prick test, prick test, prick skin tests, Epicutaneous test, Prick test, Prick test (procedure), Prick test, NOS
Hungarian Prick vizsgálat
Derived from the NIH UMLS (Unified Medical Language System)

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