0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Diagnostic Tests for Patients with Suspected Allergic Disease: Utility and Limitations

Paul P. VanArsdel Jr., MD; and Eric B. Larson, MD, MPH
[+] Article and Author Information

Requests for Reprints: Paul P. VanArsdel, Jr., MD, Department of Medicine, RM-13, University Hospital, Seattle, WA 98195.

Current Author Addresses: Dr. VanArsdel: Department of Medicine, RM-13, University Hospital, Seattle, WA 98195.

Dr. Larson: Department of Medicine, RG-20, University of Washington, Seattle, WA 98195.


Ann Intern Med. 1989;110(4):304-312. doi:10.7326/0003-4819-110-4-304
Text Size: A A A

Study Objective: To evaluate the clinical efficacy of diagnostic tests used for persons with suspected allergic disease.

Design: Information synthesis based on historical review of developments in the understanding of the pathophysiology of allergic diseases and on selected recent literature on efficacy of specific diagnostic tests.

Main Results: Skin testing is most effective when based on clues from the patient's history. The sensitivity and specificity of skin testing methods are compared; skin prick testing alone is often sufficient to identify or exclude immunoglobulin E (IgE)-mediated hypersensitivity, including food allergy. Except for penicillin and certain macromolecules, skin testing is not useful for evaluating drug allergy. Skin test titration may be useful for determining the starting dose for immunotherapy; otherwise it is rarely necessary. The patch skin test helps identify the cause of allergic contact dermatitis. Bronchial provocation testing is useful in special cases. Oral provocation testing may be used to identify allergy or other intolerance to suspected foods, food additives, and certain drugs. Provocation testing is time-consuming and requires special precautions. In-vitro methods for identifying allergen-specific IgE are especially useful when skin testing is unreliable, equivocal, or cannot be done. In-vitro tests should be used as adjuncts to the clinical interview and examination.

Conclusions: Tests that are effective for identifying allergenic substances usually can be determined from a careful patient interview. Clinicians should be aware of nonspecific test results and allergy tests of unproven effectiveness.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)