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)

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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.
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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
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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
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Czech intradermální testy, Intrakutánní test, Intradermální test
Finnish Ihopistokokeet
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
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Ontology: Hypersensitivity skin testing (C0037296)

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CPT 1011969
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Japanese 皮膚テスト, ヒフテスト
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Czech kožní testy, epikutánní testy, kůže - testy, Kožní test
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Polish Próby skórne
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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
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