Comparison of Multi-Test II skin prick testing to intradermal dilutional testing

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Medical devices in allergy practice

Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Subsequently, medical devices used in allergology could be regarded as: 1) general, servicing the integral diagnostic and management principles and features of allergology, and 2) organ specific, which are shared by organ specific disciplines like pulmonology, otorhinolaryngology, dermatology, and others. The present position paper of the World Allergy Organization (WAO) is meant to be the first integral document providing structured information on medical devices in allergology used in daily routine but also needed for sophisticated diagnostic purposes and modern disease management. It is supposed to contribute to the transformation of the health care system into integrated care pathways for interrelated comorbidities.

[Application of Multi-Test II prick device in the skin prick test for allergens in children]

OBJECTIVE

To study the applicability of Multi-Test II prick device in the skin prick test (SPT) for allergens in children.

METHODS

A total of 87 children with allergic diseases who attended the hospital between March and September, 2017 were enrolled as subjects. The SPT for six inhaled allergens and serum specific IgE (sIgE) measurement were performed for all children. SPT was performed with a single-headed device on the left forearm and Multi-Test II prick device on the right forearm. ELISA was used to measure the serum level of sIgE. Visual Analog Scale (VAS) was used to assess the degree of pain during SPT. The three methods were compared in terms of the detection rates of six allergens, and the sensitivity and specificity of Multi-Test II prick device were analyzed.

RESULTS

There were no significant differences in the detection rates of six allergens among the Multi-Test II method, the single-headed method, and ELISA (P>0.05). Compared with the single-headed method, the Multi-Test II method had a sensitivity of 72.7% and a specificity of 78.2%. Compared with ELISA, the Multi-Test II method had a sensitivity of 73.4% and a specificity of 77.5%. The Multi-Test II method had a significantly lower degree of pain than the single-headed method (P<0.05).

CONCLUSIONS

The Multi-Test II method has high sensitivity and specificity and is easily accepted by children, but the test results should be combined with children's medical history and serum level of sIgE when necessary.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

BACKGROUND

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

METHODS

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

RESULTS

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

CONCLUSION

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Comparison of Intradermal Dilutional Testing with the Multi-Test II Applicator in Testing for Mold Allergy

OBJECTIVES: To compare and correlate wheal size using the Multi-Test II applicator with the endpoint obtained by intradermal dilutional testing (IDT) for common mold allergens. To validate the safety and efficacy of modified quantitative testing (MQT) for determining immunotherapy starting doses.

STUDY DESIGN AND SETTING: Prospective study of 86 subjects with Multi-Test II and IDT for 6 common mold antigens.

RESULTS: There was 84% concordance between IDT results and the results expected from the MQT method. When IDT and MQT results differed, the MQT algorithm predicted a safer end-point for starting immunotherapy in all but 2 cases.

CONCLUSION: The correlation between Multi-Test II and IDT is not strong enough to infer IDT endpoint from Multi-Test II results for molds. MQT is nearly as effective as formal IDT in determining endpoint.

SIGNIFICANCE: MQT appears to be a safe method for determining starting doses for immunotherapy with fungal allergens.

Skin prick/puncture testing in North America: a call for standards and consistency

BACKGROUND

Skin prick/puncture testing (SPT) is widely accepted as a safe, dependable, convenient, and cost-effective procedure to detect allergen-specific IgE sensitivity. It is, however, prone to influence by a variety of factors that may significantly alter test outcomes, affect the accuracy of diagnosis, and the effectiveness of subsequent immunotherapy regimens. Proficiency in SPT administration is a key variable that can be routinely measured and documented to improve the predictive value of allergy skin testing.

METHODS

Literature surveys were conducted to determine the adherence to repeated calls for development and implementation of proficiency testing standards in the 1990's, the mid-2000's and the 2008 allergy diagnostics practice parameters.

RESULTS

Authors publishing clinical research in peer-reviewed journals and conducting workshops at annual scientific meetings have recommended proficiency testing based primarily on its potential to reduce variability, minimize confounding test results, and promote more effective immunotherapeutic treatments. Very few publications of clinical studies, however, appear to report proficiency testing data for SPT performance. Allergen immunotherapy recommendations are updated periodically by the Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI).

CONCLUSIONS

Despite consensus that all staff who perform SPT should meet basic quality assurance standards that demonstrate their SPT proficiency, the gap between recommendations and daily practice persists. By embracing standards, the accuracy of SPT and allergy diagnosis can be optimized, ultimately benefiting patients with allergic disease.

Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran

BACKGROUND

Allergic rhinitis is the most common allergic disease with negative impacts on patients' quality of life. The prevalence and pattern of sensitisation vary between different countries and populations. Identification of the most prevalent aeroallergens in each area has a very important role in diagnosis and treatment of allergic rhinitis. Iran is a fairly large country with different geo-climatic conditions and there are no data about the most prevalent aeroallergen in Mashhad City, which is the second largest city in Iran, with a semiarid climate. The aim of this study was to evaluate the prevalence of positive skin test to various common aeroallergens among allergic rhinitis patients in the city of Mashhad.

MATERIALS AND METHODS

Skin prick tests were performed with 27 common regional aeroallergens including grass, weed, tree, mite and mould in 311 patients with allergic rhinitis.

RESULTS

The overall rate of sensitisation to any allergen was 81 %. 76 % of patients were poly-sensitised and weed and grass were the most prevalent allergens (77 % and 62 % respectively). Salsola Kali and mould were the most and the least prevalent individual allergens (72.5 % and 6.5 % respectively). Mean total IgE in patients with positive skin prick test was significantly higher than in patients without any positive skin prick test (308 vs 128 IU/mL, P = 0.016). 97 % of atopic patients were sensitised to Salsola kali and or Fraxinus americana.

CONCLUSIONS

Our work showed the importance of weeds, especially the Amaranthaceae and Chenopodiaceae families. Diagnosis of pollen allergy can be simplified by using a combination of a few common aeroallergens.

Comparison of intradermal dilutional testing, skin prick testing, and modified quantitative testing for common allergens

OBJECTIVES

To compare and correlate wheal size using the Multi-Test II applicator with the endpoint obtained by intradermal dilutional testing (IDT) for 5 common allergens. To examine the safety of modified quantitative testing (MQT) for determining immunotherapy starting doses.

STUDY DESIGN

Prospective comparative clinical study.

SUBJECTS AND METHODS

A total of 134 subjects were simultaneously skin tested for immediate hypersensitivity using the Multi-Test II device and IDT.

RESULTS

There was a 77% concordance between results from IDT and results from MQT. When there was a difference, MQT predicted a safer endpoint for starting immunotherapy in all but 2 cases.

CONCLUSION

Wheal size by SPT is predictive of endpoint by IDT. MQT is nearly as effective as formal IDT in determining endpoint.

SIGNIFICANCE

Modified quantitative testing appears to be a safe alternative to IDT for determining starting doses for immunotherapy.

Use of intradermal dilutional testing and skin prick testing: clinical relevance and cost efficiency

OBJECTIVES/HYPOTHESIS

The objective was to determine the agreement of the positive results from a multiple skin prick test (SPT) device with the ability to determine a definable endpoint through intradermal dilutional testing (IDT) to compare semiquantitatively the degree of positivity of SPT results with quantitative results from IDT and to analyze the cost of immunotherapy based on SPT compared with IDT guided by SPT.

STUDY DESIGN

Retrospective review of clinical data (random accrual).

METHODS

One hundred thirty-four patients underwent allergy screening using a multiple SPT device. Antigens testing positive by skin prick device were tested using IDT on a separate day. Antigens testing negative by SPT were not evaluated by IDT. Regional allergy testing practice patterns were determined, and a cost analysis using Medicare rates was performed

RESULTS

There was good agreement between an antigen testing positive by SPT and the determination of a definable endpoint (93.33%, n = 1,334 antigens). The degree of positivity from the SPT correlated poorly with the final endpoint concentration (r = 0.40, P < .0001). Blended testing techniques were similar in cost when compared with several commonly used allergy testing protocols.

CONCLUSIONS

Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.

Intradermal positivity after negative prick testing for inhalants

OBJECTIVE

Examine the incidence of positive intradermal tests after a negative skin prick test for 24 inhalant antigens.

STUDY DESIGN AND SETTING

Retrospective study. Charts from patients who underwent modified quantitative testing (MQT) over a 3-year period were reviewed. Patients were initially tested with Multi-Test II. Subjects with negative wheals to a specific allergen were then tested with a 1:500 weight:volume intradermal injection of that allergen.

RESULTS

One hundred thirty-three patients underwent MQT for 24 antigens. Allergens with the highest incidence of positive intradermal wheals after negative prick testing were Dermatophagoides pteronyssinus and Dermatophagoides farinae at 26.67%. Allergens with elevated incidence of positive intradermals included fusarium, cockroach, cocklebur, rough marsh elder, and ragweed, all with incidences of 16% to 19%.

CONCLUSION

Positive intradermal responses after negative prick testing occur commonly. Future study is needed to determine the generalizability and clinical significance of these findings.

EBM RATING

C-4.