The skin prick test – European standards

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Abstract

Skin prick testing is an essential test procedure to confirm sensitization in IgE-mediated allergic disease in subjects with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and food and drug allergy. This manuscript reviews the available evidence including Medline and Embase searches, abstracts of international allergy meetings and position papers from the world allergy literature. The recommended method of prick testing includes the appropriate use of specific allergen extracts, positive and negative controls, interpretation of the tests after 15 – 20 minutes of application, with a positive result defined as a wheal ≥3 mm diameter. A standard prick test panel for Europe for inhalants is proposed and includes hazel ( Corylus avellana), alder ( Alnus incana), birch ( Betula alba), plane ( Platanus vulgaris), cypress ( Cupressus sempervirens), grass mix ( Poa pratensis, Dactilis glomerata, Lolium perenne, Phleum pratense, Festuca pratensis, Helictotrichon pretense), Olive ( Olea europaea), mugwort ( Artemisia vulgaris), ragweed ( Ambrosia artemisiifolia), Alternaria alternata ( tenuis), Cladosporium herbarum, Aspergillus fumigatus, Parietaria, cat, dog, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and cockroach ( Blatella germanica). Standardization of the skin test procedures and standard panels for different geographic locations are encouraged worldwide to permit better comparisons for diagnostic, clinical and research purposes.

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GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe.

L Heinzerling, G J Burbach, G Edenharter … (2009)

Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. The Global Asthma and Allergy European Network (GA(2)LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.

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Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysis

Rosanne A H M van den Oord, Aziz Sheikh (2009)

Objective To investigate whether filaggrin gene defects, present in up to one in 10 western Europeans and North Americans, increase the risk of developing allergic sensitisation and allergic disorders. Design Systematic review and meta-analysis. Data sources Medline, Embase, ISI Science Citation Index, BIOSIS, ISI Web of Knowledge, UK National Research Register, clinical trials.gov, the Index to Theses and Digital dissertations, and grey literature using OpenSIGLE. Study selection Genetic epidemiological studies (family, case-control) of the association between filaggrin gene defects and allergic sensitisation or allergic disorders. Data extraction Atopic eczema or dermatitis, food allergy, asthma, allergic rhinitis, and anaphylaxis, along with relevant immunological variables relating to the risk of allergic sensitisation as assessed by either positive skin prick testing or increased levels of allergen specific IgE. Data synthesis 24 studies were included. The odds of developing allergic sensitisation was 1.91 (95% confidence interval 1.44 to 2.54) in the family studies and 1.57 (1.20 to 2.07) in the case-control studies. The odds of developing atopic eczema was 1.99 (1.72 to 2.31) in the family studies and 4.78 (3.31 to 6.92) in the case-control studies. Three studies investigated the association between filaggrin gene mutations and allergic rhinitis in people without atopic eczema: overall odds ratio 1.78 (1.16 to 2.73). The four studies that investigated the association between filaggrin gene mutations and allergic rhinitis in people with atopic eczema reported a significant association: pooled odds ratio from case-control studies 2.84 (2.08 to 3.88). An overall odds ratio for the association between filaggrin gene mutations and asthma in people with atopic eczema was 2.79 (1.77 to 4.41) in case-control studies and 2.30 (1.66 to 3.18) in family studies. None of the studies that investigated filaggrin gene mutations and asthma in people without atopic eczema reported a significant association; overall odds ratio was 1.30 (0.7 to 2.30) in the case-control studies. The funnel plots suggested that publication bias was unlikely to be an explanation for these findings. No studies investigated the association between filaggrin gene mutations and food allergy or anaphylaxis. Conclusions Filaggrin gene defects increase the risk of developing allergic sensitisation, atopic eczema, and allergic rhinitis. Evidence of the relation between filaggrin gene mutations and atopic eczema was strong, with people manifesting increased severity and persistence of disease. Filaggrin gene mutations also increased the risk of asthma in people with atopic eczema. Restoring skin barrier function in filaggrin deficient people in early life may help prevent the development of sensitisation and halt the development and progression of allergic disease.

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GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe.

G J Burbach, L Heinzerling, G Edenharter … (2009)

Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan-European population of patients presenting with suspected allergic disease. Clinical relevance of skin prick tests was recorded with regard to patient history and optional additional tests. A putative correlation between sensitization and allergic disease was assessed using logistic regression analysis. While an overall rate of >or=60% clinically relevant sensitizations was observed in all countries, a differential distribution of clinically relevant sensitizations was demonstrated depending on type of allergen and country where the prick test was performed. Furthermore, a significant correlation between the presence of allergic disease and the number of sensitizations was demonstrated. This study strongly emphasizes the importance of evaluating the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.

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Journal

Journal ID (nlm-ta): Clin Transl Allergy

Journal ID (iso-abbrev): Clin Transl Allergy

Title: Clinical and Translational Allergy

Publisher: BioMed Central

ISSN (Electronic): 2045-7022

Publication date Collection: 2013

Publication date (Electronic): 1 February 2013

Volume: 3

Page: 3

Affiliations

[1 ]Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany

[2 ]Board Member of the EAACI Allergy Diagnosis Interest Group, IDI-IRCCS, Center for Molecular Allergology, Rome, Italy

[3 ]Department of Dermatology and Allergy, Charité Universitätsmedizin-Berlin, Berlin, Germany

[4 ]Consiglio Nazionale delle Ricerche, Rome, Italy

[5 ]Department of Dermatology and Allergy Biederstein and Division of Environmental Dermatology and Center of Allergy and Environment (ZAUM), Technical University, Munich, Germany

[6 ]Department of Respiratory Medicine, Royal Brompton Hospital, London, UK

[7 ]Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, Netherlands

[8 ]Consiglio Nazionale delle Ricerche, Palermo, Italy

[9 ]Skin and Allergy Hospital, University Central Hospital, Helsinki, Finland

[10 ]ImunoAlergologia, Coimbra University, Coimbra, Portugal

[11 ]Department of Dermatology, Medical University of Vienna, Vienna, Austria & Floridsdorf Allergy Centre (FAZ), Vienna, Austria

[12 ]Department of Dermatology, University of California, San Francisco, California, USA

[13 ]Division of Allergy & Immunology, University of South Florida College of Medicine, Tampa, Florida, USA

Article

Publisher ID: 2045-7022-3-3

DOI: 10.1186/2045-7022-3-3

PMC ID: 3565910

PubMed ID: 23369181

SO-VID: 4655bda3-a014-4a98-82fe-d2704518f1e8

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 20 September 2012

Date accepted : 18 January 2013

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The skin prick test – European standards

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Most cited references 111

GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe.

Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysis

GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe.

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