Allergy Diagnostic Testing: An Updated Practice Parameter

Bernstein, I. Leonard; Li, James T.; Bernstein, David I.; Hamilton, Robert G.; Spector, Sheldon L.; Tan, Ricardo; Sicherer, Scott H.; Golden, David B.K.; Khan, David A.; Nicklas, Richard A.; Portnoy, Jay M.; Blessing-Moore, Joann; Cox, Linda; Lang, David M.; Oppenheimer, John; Randolph, Christopher; Schuller, Diane E.; Tilles, Stephen A.; Wallace, Dana; Levetin, Estelle; Weber, Richard J.

doi:10.1016/s1081-1206(10)60305-5

Cited by 484 publications

(624 citation statements)

References 946 publications

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“…4,10 On skin level, the IgE-mediated immune response is dependent on both chemical and neurogenic mediators. 11,12 After intracutaneous injection, allergens cross-link preformed IgE bound to the high-affi nity receptor FcERI mast cells and a complex signal transduction cascade is activated.…”

Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

“…For this reason, SPT sensitivity tends to be higher among aeroallergens, in particular pollens, house dust mite, fungi and certain epidermals. 10 In clinical practice, skin testing has been extensively used for assessing sensitisation to inhalant allergens. SPT is useful to confi rm or exclude a suspected diagnosis of allergic rhinitis, allergic conjunctivitis or asthma triggered by allergens 10,20,21 and to demonstrate sensitisation to inhalant occupational allergens.…”

Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

“…10 In clinical practice, skin testing has been extensively used for assessing sensitisation to inhalant allergens. SPT is useful to confi rm or exclude a suspected diagnosis of allergic rhinitis, allergic conjunctivitis or asthma triggered by allergens 10,20,21 and to demonstrate sensitisation to inhalant occupational allergens. 22,23 Previous observations suggest that skin test positivity at an early age is associated with subsequent development of rhinitis and wheeze.…”

Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

“…4,48,49 A saline solution, phenol at 0.5 % or glycerine at 50 % are recommended. 10 For positive control, histamine dihydrochloride 10 mg/ml (54.3 mmol/1), equivalent to 6.14 mg/ml of histamine base, or codeine phosphate at 9 % can be recommended. 49 Some authors advocate the use of histamine at 1 mg/ml 50 ; however, in a study by Morais de Almeida et al, the concentration of 1 mg/ml consistently presented negative results in more than 10 % of the patients.…”

Section: Techniquementioning

confidence: 99%

“…A suggested protocol for quality assurance testing and profi ciency testing for SPT can be found in literature. 10 In Europe, a coeffi cient variation of less than 20 % after histamine control test has been suggested 57 , whereas a recent Childhood Asthma Management Study considered a variation inferior to 30 %. 58 …”

Section: Techniquementioning

confidence: 99%

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Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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Skin testing remains an essential diagnostic tool in modern allergy practice. A signifi cant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors. Skin has an important physiological role in the internal balance homeostasis and constitutes a crucial barrier against external aggressions, with well-known immunological properties. 1 It has been used by allergists for decades as an easily assessed laboratory of the immunological status of the individual.The fi rst skin testing technique was developed by Charles H. Blackley in 1865, a Manchester homeopathic physician with allergic rhinitis. He abraded a quarter-inch area of his skin with a lancet and then applied grass pollen grains. 2 The so-called scratch test was later adopted by Schloss for the diagnosis of food allergy in children. 3 Epicutaneous tests can be divided into scratch tests and prick/puncture tests. The fi rst method, proposed by Blackley 2 , implied a linear scratch without drawing blood and could either be performed fi rst, with the extract then dropped on the abraded skin, or be made through a drop of extract. 4 Although it was used extensively in the past, this technique became progressively obsolete due to patient discomfort, poor reproducibility, possible residual lesions and newer and innocuous procedures. 4 Therefore, scratch test is mentioned here for historical purposes only. It was Sir Thomas Lewis who, in 1924, fi rst applied skin prick tests (SPT). 5 Nevertheless, their generalised use in clinical practice only became a reality about 30 years ago, as a result of technique modifi cations proposed by Pepys. 6 For the purpose of this review and for easier comprehension, skin testing will be referred interchangeably as SPT, whatever device is used for its application.In 1966, Ishizaka's work on immunoglobulin E (IgE) and immediate hypersensitivity reactions 7 established the scientifi c corpus to what was done till then on a strictly empiric basis.As written by Dr Walzer in 1974, "the fact that skin testing has not turned out to be a simple and completely reliable technique does not detract from the fact that, when it is intelligently and skilfully performed, it remains the most effective diagnostic procedure in reaginic allergic disorders". 8 The reliability of skin testing and proper documentation of test results are essential in allergy practice. A recent survey to all physician members and fellows of the American College of Allergy, Asthma and Immunology practicing in the

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Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

Section: Skin Prick Tests General Considerations and Indicationsmentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

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Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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Clinical Management ofStaphylococcus aureusBacteremia

Holland

Arnold

Fowler

2014

JAMA

380

261

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Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed.

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Evidence-Based Evaluation for Allergies to Avoid Inappropriate Testing, Diagnosis, and Treatment

Huston

Cox

2014

JAMA Intern Med

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Allergy Diagnostic Testing: An Updated Practice Parameter

Cited by 484 publications

References 946 publications

Skin prick tests and allergy diagnosis

Skin prick tests and allergy diagnosis

Clinical Management ofStaphylococcus aureusBacteremia

Evidence-Based Evaluation for Allergies to Avoid Inappropriate Testing, Diagnosis, and Treatment

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