II. Indications
- Allergic response to inhalants, food, Insect Bites or medications
III. Mechanism
- IgE mediated, immediate-type Hypersensitivity
IV. Contraindications
- Severe Eczematous Dermatitis
- Dermatographism
- History of Anaphylaxis
- Very young
- Unable to discontinue Antihistamines
- Uncontrolled Asthma (Peak Expiratory Flow < 75%)
V. Preparation
- Have Epinephrine and Albuterol available
- Discontinue Antihistamines before testing
- Second Generation Antihistamines: 2 weeks before test
- First Generation Antihistamines: 3 days prior to test
- Other Antihistamine-type agents to stop before test
- Phenothiazine
- Tricyclic Antidepressants
- Anticholinergic Medications
- H2 Receptor blocking medications (e.g. Ranitidine)
- Inhaled Corticosteroids do not affect test
- Short-term Systemic Corticosteroids do not affect test
VI. Technique
- Test 6-10 Antigens to determine presence of IgE disease
-
Antigen exposure techniques
- Prick method
- Scratch method
- Intradermal (injected)
- Most accurate
- Used in cases requiring higher Test Sensitivity (e.g. Insect sting allergy, Penicillin Allergy)
- Use Controls
- Positive Control: Histamine
- Negative Control: Glycerol-Saline
- Read test 15 minutes after application of allergen
- Positive if wheal diameter 3 mm > negative control
- Use Regional Allergy Screening guidelines
- Relies on cross reactivity among Antigen groups
- Tree
- Grass
- Weed
- Mold
- House Dust mite
- Cat
VII. Interpretation
- All Tests negative: No further testing needed
- One or more inhalants positive: Complete regional panel
-
Dust mite only positive: No further testing needed
- Avoid Dust mites
- Consider Immunotherapy
- Cat only positive: No further testing needed
- Avoid exposure and reduce dander
- Consider Immunotherapy
- If Positive Control is Negative
- Try RAST testing
- Patient may be on Antihistamine or steroid
- IF short acting Antihistamine
- Stop Antihistamine and retest after 2 days
- IF long acting Antihistamine
- Stop Antihistamine and retest after 3-4 weeks
- IF short acting Antihistamine
- If reaction occurs to Negative Control
- Intradermal Allergy Test Indications
- Suspected Insect Sting Allergy (e.g. bee, hornet)
- Suspected Drug Allergy (e.g. Penicillin, Anesthetic)
VIII. References
- (1999) NPI Allergy Testing Conference, Las Vegas
- Chang (2018) Am Fam Physician 98(1): 34-9 [PubMed]
- James (2002) Am Fam Physician 66(4):621-6 [PubMed]
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Related Studies
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 |
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 |
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 |