Skin Testing

Aka: Skin Testing, Hypersensitivity Skin Testing

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II. Indications

  1. Allergic response to inhalants, food, Insect Bites or medications

III. Mechanism

  1. IgE mediated, immediate-type hypersensitivity

IV. Contraindications

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

V. Preparation

  1. Have Epinephrine and Albuterol available
  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. Inhaled Corticosteroids do not affect test
  4. Short-term Systemic Corticosteroids do not affect test

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. 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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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)

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