II. Indications

  1. Refractory Allergic Rhinitis
  2. Refractory Asthma
  3. Food Allergy or drug allergy suspected
  4. Insect sting allergy suspected
  5. Angioedema
  6. Contact Dermatitis

III. Types: In Vivo Tests

  1. Hypersensitivity Skin Testing (Skin Prick Test or Intradermal Test)
    1. IgE immediate Type 1 Hypersensitivity Reaction
  2. Patch Testing
    1. Contact Dermatitis (Delayed Type 4 Hypersensitivity, T Cell-mediated response)
  3. Oral Food Challenge
    1. IgE immediate Type 1 Hypersensitivity Reaction
    2. Indicated in Food Allergy

IV. Types: In Vitro Tests

  1. Allergen Specific IgE Antibody Measurement (via ImmunoCAP or RadioAllergoSorbent Test)
    1. IgE immediate type Hypersensitivity
    2. Indicated in patients at risk for severe Anaphylaxis with allergan exposure
    3. Not impacted by Dermatographism or dermatitis (and not altered by Antihistamine use)

V. Devices

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

VI. Approach

  1. Inhalant Allergy
    1. See Regional Allergy Screening
    2. Skin Testing is preferred (most cost-effective)
    3. IgE specific Antibody testing panels are available for each U.S. region
  2. Food Allergy
    1. Food Allergy testing has a high False Positive Rate and should only be performed based on a specific history
    2. Start with a history of common Food Allergy causes
      1. Hen's eggs, cow's milk or peanuts (85% of food allergies in children and teens)
      2. Fish or shellfish
      3. Soy
      4. Tree nuts (e.g. cashews, walnuts)
      5. Wheat allergy (gluten sensitivity, Celiac Sprue)
    3. Patient should eliminate food they suspect as allergan
      1. If symptoms improve after food elimination, then consider Allergy Testing for that food item
    4. Skin Testing or IgE specific Antibody testing
      1. High Negative Predictive Value
      2. Positive test results are of limited value (high False Positive Rate)
        1. Many patients may tolerate food items despite a positive test
        2. Avoid broad-based Food Allergy panel screening
    5. Food challenge
      1. Confirms negative Allergy Testing
  3. Insect Allergy
    1. Testing indicated in suspected Stinging InsectAnaphylaxis or diffuse skin reactions
    2. Test via Skin Testing or IgE specific Antibody testing
    3. Test for most common Insect allergans (e.g. fire ants, honey bees, yellow hornets, yellow jackets, wasps)
    4. Immunotherapy for those at high risk for severe future reactions
    5. Obtain serum tryptase level
      1. Evaluate for Mast Cell activation syndrome if serum tryptase >11.5 ng/ml
  4. Antibiotic allergy (esp. Penicillin Allergy)
    1. Only 1-10% of self-reported Penicillin Allergy have an abnormal skin test
    2. Penicillin Skin Testing has a Negative Predictive Value >95%
      1. Often confirmed with a monitored oral challenge in allergy clinic
      2. Penicillins may safely be prescribed after negative skin test

VII. References

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Related Studies

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 (SCTSPA) Procedimiento sobre el sistema inmunitario que observa la evidencia de hipersensibilidad
Definition (SNOMEDCT_US) 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