Aeroallergen Extracts in Skin Prick Test: Can we Minimize the Test Battery in Pediatric and Adult Patients in Jordan

Abstract

Background: The skin prick test (SPT) is considered worldwide as the gold standard clinical test to detect IgE mediated allergic diseases. The cost and psychological fear secondary to the use of needles associated with administering the test limit the utilization of the SPT in low-resourced pediatric healthcare settings, such as in Amman, Jordan. Objective: To identify the optimal number of allergens to utilize in the administration of the SPT battery to capture 95% of sensitized individuals to promote healthcare savings and minimize unnecessary needle trauma. Methods: A retrospective analysis of patients who underwent 20 allergens SPT from May 2009 to October 2014 at the University of Jordan Hospital (UJH) was conducted to assess the minimum number of allergens to include in the SPT to identify 95% of sensitized patients in both pediatric and adult patients. Results: A total of 2253 patients (pediatric: adult ratio 1:3.6) with an adult sensitization rate of 48.3%, pediatric sensitization of 50.9% and a total sensitization rate of 48.9% for at least one of the 20 aeroallergens test extracts utilized in the SPT, were analyzed. Overall, only eight allergens (Olive pollen, Dermatophagoides pteronyssinus, Salsola kali, 4 cereals, Wall pellitory, Dermatophagoides farinae, Cypress and Mugwort) were needed to identify 95% of sensitized patients in the total group This finding was also seen in the sub analysis of the adult (18yo+) population; in the pediatric (8-18) population 9 allergens (by adding the 12 grasses pollen mixture) were needed to attain a 95% sensitivity for the SPT. Conclusion: Only eight allergens for adults and nine for pediatric patients were needed to identify 95% of sensitized adults via the SPT. In order to provide individualized medicine and capture all 100% of patients who suffer from IgE mediated allergic disease, the authors propose a two stage screen. Stage one would include the minimum number of allergens to detect 95% of sensitized individuals; stage two would include all 20 allergens in the current SPT for those who tested negative in stage 1.