Difference according to Interpretation Methods in Allergic Skin Test

Sung Hwa Dong; Su Young Jung; Jin Young Min; Su Jin Kim; Kun Hee Lee; Joong Saeng Cho; Sung Wan Kim

doi:10.18787/jr.2017.24.2.89

Journal List > J Rhinol > v.24(2) > 1044397

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Dong, Jung, Min, Kim, Lee, Cho, and Kim: Difference according to Interpretation Methods in Allergic Skin Test

Original Article

J Rhinol 2017;24(2):89-93.

Published online: 8 January 2017

DOI: https://doi.org/10.18787/jr.2017.24.2.89

Difference according to Interpretation Methods in Allergic Skin Test

Sung Hwa Dong, MD¹, Su Young Jung, MD¹, Jin Young Min, MD, PhD¹, Su Jin Kim, MD², Kun Hee Lee, MD, PhD¹, Joong Saeng Cho, MD, PhD¹, Sung Wan Kim, MD, PhD¹

¹Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Graduate School, Seoul, Korea

²Department of Otorhinolaryngology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea

교신저자：김성완, 02447 서울 동대문구 경희대로 23 경희대학교 의과대학 이비인후-두경부외과학교실 Tel: +82-2-958-8474, Fax: +82-2-958-8470, E-mail: drkimsw@hanmail.net

Revised 1 21 20174 25 2017 Accepted 5 31 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives:

The skin prick test is a widely used test that uses three methods (allergen/histamine ratio method, erythema size method, and wheal size method) to interpret the results. However, there has been no comparison of these methods. The aim of this study is to compare the three different interpretation methods and define the relationship among them. Subjects and Method: A total of 139 patients who visited our allergy clinic complaining of nasal symptoms were enrolled. Three interpretation methods were used for defining positivity in the skin prick test, and their results were compared. The valid-ity of each interpretation method was evaluated by total nasal symptom score.

Results:

Positivity in the skin prick test was reported in 48.2% of patients according to the allergen/histamine ratio method and in 64.0% of patients according to the wheal size method and erythema size method. The proportion of subjects who showed a negative result with the allergen/histamine ratio method but positive results with the wheal size method or erythema size method was 15.8%. This group had a significantly higher total nasal symptom score, especially rhinorrhea and nasal obstruction, than subjects who showed negative results on all three methods.

Conclusion:

When diagnosing allergic rhinitis patients using the skin prick test, the wheal size method and erythema size method should be considered rather than the allergen/histamine ratio method.

Keywords: Diagnosisㆍ, Skin testㆍ, Allergic rhinitis

REFERENCES

1). Fatteh S, Rekkerth DJ, Hadley JA. Skin prick/puncture testing in North America: a call for standards and consistency. Allergy Asthma Clin Immunol. 2014; 10:44.

2). Shin JH, Kim BG, Cho JH, Kim SW, Lee BJ, Kim YW, et al. Skin Prick Testing of Patients with Allergic Rhinitis and/or Asthma: a Study in Catholic Medical Center, Korea. Journal of Rhinology. 2012; 19:29–34.

3). Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test - European standards. Clin Transl Allergy. 2013; 3:3.

4). Oppenheimer J, Nelson HS. Skin testing: a survey of allergists. Ann Allergy Asthma Immunol. 2006; 96:19–23.

5). Dreborg S. Allergen skin prick test should be adjusted by the histamine reactivity. Int Arch Allergy Immunol. 2015; 166:77–80.

6). Antunes J, Borrego L, Romeira A, Pinto P. Skin prick tests and allergy diagnosis. Allergol Immunopathol (Madr). 2009; 37:155–64.

7). Malling HJ. Skin prick testing and the use of histamine references. Allergy. 1984; 39:596–601.

8). Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:466–76.

9). Nelson HS, Knoetzer J, Bucher B. Effect of distance between sites and region of the body on results of skin prick tests. J Allergy Clin Immunol. 1996; 97:596–601.

10). van der Valk JP, Gerth van Wijk R, Hoorn E, Groenendijk L, Groenendijk IM, de Jong NW. Measurement and interpretation of skin prick test results. Clin Transl Allergy. 2015; 6:8.

11). Konstantinou GN, Bousquet PJ, Zuberbier T, Papadopoulos NG. The longest wheal diameter is the optimal measurement for the evaluation of skin prick tests. Int Arch Allergy Immunol. 2010; 151:343–5.

12). Aas K, Belin L. Standardization of diagnostic work in allergy. Int Arch Allergy Appl Immunol. 1973; 45:57–60.

13). Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012; 67:18–24.

14). Gergen PJ, Turkeltaub PC, Kovar MG. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. popu-lation: results from the second National Health and Nutrition Ex-amination Survey. J Allergy Clin Immunol. 1987; 80:669–79.

15). Fokkens WJ, Jogi R, Reinartz S, Sidorenko I, Sitkauskiene B, van Oene C, et al. Once daily fluticasone furoate nasal spray is effective in seasonal allergic rhinitis caused by grass pollen. Allergy. 2007; 62:1078–84.

16). Jang TY, Kim YH. Evidences for Local Allergic Rhinitis. Journal of Rhinology. 2016; 23:1–5.

17). Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Annals of Allergy, Asthma & Immunology. 2008; 100:S1–S148.

18). Ewan P, Coote D. Evaluation of a capsulated hydrophilic carrier polymer (the ImmunoCAP) for measurement of specific IgE antibodies. Allergy. 1990; 45:22–9.

19). Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008; 100:S1–148.

20). McCann WA, Ownby DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Allergy Asthma Immunol. 2002; 89:368–71.

21). Nelson HS, Lahr J, Buchmeier A, McCormick D. Evaluation of de-vices for skin prick testing. J Allergy Clin Immunol. 1998; 101:153–6.

Table 1.

Negative and positive result of 3 different methods

	Allergen/Histamine ratio method n (%)	Wheal size method∗ n (%)	Erythema size method∗ n (%)
Negative result	72 (51.8%)	50 (36.0%)	50 (36.0%)
Positive result	67 (48.2%)	89 (64.0%)	89 (64.0%)

^∗ : Eryrthema size method and wheal size method had the same results

Table 2.

Total nasal symptom score of allergen/histamine ratio method

	Rhinorrhea	Nasal obsturction	Itching	Sneezing	Total
Negative result	1.75±1.10	2.14±1.06	1.32±1.07	1.41±1.10	6.62±3.46
Positive result	2.10±1.07	2.35±0.89	1.96±0.97	1.97±0.96	8.38±3.06
p	0.055	0.205	＜0.001∗	0.002∗	0.002∗

^∗ : p＜0.05

Table 3.

Total nasal symptom score of Wheal size method and erythema size method^†

	Rhinorrhea	Nasal obsturction	Itching	Sneezing	Total
Negative result	1.52±2.15	1.92±1.14	1.22±1.11	1.32±1.19	5.98±3.62
Positive result	2.14±1.02	2.43±0.84	1.87±0.97	1.88±0.95	8.33±2.92
p	0.002∗	0.003∗	0.001∗	0.004∗	0.000∗

^∗ : p＜0.05

^† : Eryrthema size method and wheal size method had the same results

Table 4.

Distribution of three different method ( Allergen/Histamine ratio method, wheal size method, and erythema size method)

Allergen/Histamine ratio method	Erythema size method & Wheal size method^†	n (%)	Group
-	-	50 (35.9%)	Group N^‡
-	+	22 (15.8%)	Group D^‡
+	-	0∗
+	+	67 (48.2%)	Group P^‡

^∗ : There were no patients who had positive results on allergen/histamine ratio method and negative results on erythema size method and wheal size method,

^† : Eryrthema size method and wheal size method had the same results

^‡ : Group N (Negative): negative result in three different methods, Group P ( Positive): positive result in three different methods, Group D ( Discrepancy): negative result in Allergen/Histamine ratio method, but positive results in wheal size method and erythema size method

Table 5.

Total nasal symptom scores of Group N, P, and D

	Group N^‡	Group P^‡	Group D^‡	p value^†
Rhinorrhea	1.52±1.11	2.11±1.06	2.23±0.92	0.011∗
Nasal obstruction	1.92±1.14	2.36±0.90	2.64±0.58	0.007∗
Itching	1.22±1.11	1.97±0.97	1.54±0.91	0.232
Sneezing	1.32±1.18	1.98±0.96	1.59±0.85	0.338
Total	5.98±3.62	8.43±3.05	8.00±2.51	0.021∗

^∗ : p＜0.05,

^† : Difference between Group N and Group D

^‡ : Group N ( Negative): negative result in three different methods, Group P ( Positive): positive result in three different methods, Group D ( Discrepancy): negative result in Allergen/Histamine ratio method, but positive results in wheal size method and erythema size method

TOOLS

Similar articles