Authors Response:

Abstract

We thank the authors for their comments. Although most allergists reported in a survey 1 Oppenheimer J Nelson HS Skin testing: a survey of allergists. Ann Allergy Asthma Immunol. 2006; 96: 19-23 Abstract Full Text PDF PubMed Scopus (60) Google Scholar that they routinely use intradermal skin testing (IDST) when evaluating inhalant allergy, most evidence 2 Wood R Phipatanakul W Hamilton R Eggleston P A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol. 1999; 103: 773-779 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar , 3 Sharma H Wood R Bravo A Matsui E A comparison of skin prick tests, intradermal skin tests, and specific IgE in the diagnosis of mouse allergy. J Allergy Clin Immunol. 2008; 121: 933-939 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar , 4 Nelson HS Oppenheimer J Buchmeier A Kordash T Freshwater L An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol. 1996; 97: 1193-1201 Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar , 5 Schwindt C Hutcheson P Leu S Kykewicz M The role of intradermal skin tests in the evaluation of clinically relevant respiratory allergy assessed using history and nasal challenges. Ann Allergy Asthma Immunol. 2005; 94: 627-633 Abstract Full Text PDF PubMed Scopus (28) Google Scholar suggests that with a negative skin prick test (SPT) result, a positive IDST result is generally clinically irrelevant. It is hoped that the evidence presented in the review 6 Calabria CW Hagan L The role of intradermal skin testing in inhalant allergy. Ann Allergy Asthma Immunol. 2008; 101: 337-347 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar will enable physicians to objectively evaluate their approach to inhalant IDST. Although one may obtain a positive IDST result, in most cases, this represents sensitization rather than clinical allergy. In particular, with well-designed challenge models having been performed for cat, 2 Wood R Phipatanakul W Hamilton R Eggleston P A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol. 1999; 103: 773-779 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar timothy grass, 3 Sharma H Wood R Bravo A Matsui E A comparison of skin prick tests, intradermal skin tests, and specific IgE in the diagnosis of mouse allergy. J Allergy Clin Immunol. 2008; 121: 933-939 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar and mouse, 4 Nelson HS Oppenheimer J Buchmeier A Kordash T Freshwater L An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol. 1996; 97: 1193-1201 Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar a positive IDST result for these allergens is unlikely to be helpful. In addition, a recent evidence-based review demonstrated that IDSTs generally have likelihood ratios near 1.0, meaning that they do not shift disease probability and are just as likely to be positive in patients without disease. 7 Gendo K Larson E Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004; 140: 278-289 Crossref PubMed Scopus (88) Google Scholar , 8 Brown WG Halonen M Kaltenborn W Barbee R The relationship of respiratory allergy, skin test reactivity, and serum IgE in a community population sample. J Allergy Clin Immunol. 1979; 63: 328-335 Abstract Full Text PDF PubMed Scopus (104) Google Scholar THE USE OF INTRADERMAL SKIN TESTING IN ALLERGY DIAGNOSISAnnals of Allergy, Asthma & ImmunologyVol. 102Issue 4PreviewAs Calabria and Hagan1 observed in their recent review, 85.2% of allergists perform intradermal skin tests (IDSTs),2 a practice discordant with their conclusion, “Most of the literature suggests that with a negative skin prick test (SPT) result, a positive IDST result adds little to the diagnostic evaluation of inhalant allergy.” This inconsistency seems to be at least partly explained by frequently used methods of interpretation of IDST results. Virtually all research studies are based on classification of IDST results as either positive or negative. Full-Text PDF