Principles of Allergy Skin Testing

• Knowledge of specific sensitivities would improve care.

1. Guidance of environmental controls and avoidance measures

– Removing animals from home or reducing pet dander

– High-efficiency particulate air filters

– Dust mite controls: covers for bedding, removal of carpets/upholstery, washing bedding in high temperatures, acaricides

2. Guidance of medical therapy

– Use of appropriate allergy medications

– Subcutaneous immunotherapy

– Sublingual immunotherapy


• History of dermatographism

• Inability to discontinue antihistamine for testing

• Current use of beta blocker

• Previous episode of anaphylaxis


• Performed on volar surface of forearms, upper back, upper/outer aspects of arms, or anterior thighs

• Prick or prick-puncture testing developed to allow reproducible introduction of antigen into epidermis

• Less invasive, less discomfort when compared with intradermal testing

• Less likely to lead to systemic reaction than intradermal testing

Individual Prick Testing

• Useful when isolated testing of one antigen desired

• Place one drop of antigen concentrate per antigen (1:20 weight/volume) to be tested on skin, or dip test device into well of antigen.

• Pass single needle or lancet through antigen to create prick in skin, introducing antigen into epidermis without causing bleeding.

• In sensitized patient, IgE-induced wheal and flare will result.

Multiple-Allergen Prick Testing

• Several systems designed to test multiple antigens with one application

• Practitioner should consult individual test device packet insert for specific details regarding testing with that device.

• Device allows for equal distribution of pressure among needles

• Less variability among antigens, less technique-dependent influence on results

• Dip technique performed with antigen (1:20 weight/volume) in concentrate with 50% glycerin

• Positive control is histamine; negative control is 50% glycerin only.

• Antigens should be left on skin for at least 5 minutes, then blotted to avoid smearing.

Interpretation of Epicutaneous Testing

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Jul 20, 2019 | Posted by in OTOLARYNGOLOGY | Comments Off on Principles of Allergy Skin Testing
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