Allergy skin tests, Techniques, and interpretation
The clinical evaluation of a patient with a suspected allergic disease begins with adetailed history, physical exam and ancillary tests (such as PFT, Xray etc.) intended todefine and characterize the patients disease state.Allergy testing helps define triggers of allergic disease. These tests are intended to detectType 1 ( IgE mediated hypersensitivity) sensitization. Allergy tests, strictly speaking, arenot tests for the diagnosis of allergic disease; they simply report the presence of detectable amounts of allergen specific IgE that might in part be responsible for triggering disease symptoms. Specific IgE can be found in patients with allergic diseaseas well as in about 15% of asymptomatic normal individuals.Allergy testing employs carefully prepared extracts of pollens, fungi, animal products,food, latex etc. Extracts are complex mixtures of allergenic proteins and other substances.Each extract may contain several allergens. For successful testing of a patient, an extractmust contain all relevant major and minor allergens.
Several skin test methods are available. These include patch testing, or the directintroduction of antigen into the skin epicutaneously or intracutaneously.The epicutaneous methods in general use are prick testing and puncture testing.
Patch test has been used for 100 yrs to diagnose contact allergies.Allergens are applied to the intact skin, under an occlusive dressing. In most cases 1 or 2days of exposure is used.Studies have shown that protein and glycoprotein antigens as large as 30,000 Daltons can penetrate intact skin.Patch test typically detect delayed allergic reactions due to either the late phase of type 1immediate hypersensitivity reactions or to type 4 cell mediated hypersensitivity.Advantages include1.Only method to confirm that a specific contact is causing sensitization2.solid antigens such as fabrics can be tested3.not painfuldisadvantages include1.less reproducible – typical sensitivity ranges from 60 to 70% andspecificity 70 to 80%2.difficult to differentiate irritative reactions from true allergic reactions3.Generally safe but may cause flares of atopic dermatitis and locally severeskin reactions