Concordance of Skin Prick Test, Intradermal Testing, Serum IgE Levels and Symptoms in Patients with Allergic Rhinitis

Tilman Huppertz,Martha Dahlem,Boris R Haxel,Veronika Weyer-Elberich

doi:10.3390/allergies1030017

Abstract

Background: Diagnosis of allergic rhinitis is achieved by a combination of patient history and different screening tools, followed by specific provocation testing. Screening tools usually involve a skin prick test (SPT), specific serum IgE or a combination of both. Objective: The purpose of this study was to evaluate the correlation of SPT, intradermal testing and specific serum IgE testing in certain allergens and to evaluate sensitization rates, symptom patterns and time of symptoms in a cohort of patients with suspected allergic rhinitis. Methods: Data on 4653 patients with suspected allergic rhinitis were included and divided into five groups: spring bloomers (birch, hazel, etc.), summer bloomers (grasses and rye), autumn bloomers (ribwort and mugwort), mites and mold. Correlation of SPT, intradermal testing and specific IgE test results using Cohen’s kappa and logistic regression were carried out to evaluate the probability of symptoms. Results: Comparison of SPT and specific serum IgE led to kappa coefficients between 0.33 and 0.47, corresponding to a minor to moderate concordance. Comparing the symptoms reported by patients with sensitization diagnosed by SPT, a correlation was only found for spring and summer bloomers with an odds ratio of 1.5 and 2.1, respectively. The most prevalent symptom in the study cohort was rhinitis, followed by others such as asthma, sense of smell and atopic dermatitis. Conclusions: SPT seems to be more sensitive than specific IgE for detection of sensitization. Patients’ symptoms as well as the timing of symptoms, especially for perennial allergies, are not always very pronounced.

Highlights

Common and chronic forms of nasal inflammation include rhinosinusitis, nasal polyposis, nonallergic rhinitis with eosinophilia syndrome (NARES) and allergic rhinitis (AR).Allergic rhinitis is the most frequent manifestation of atopic diseases, with almost 80 million people affected in the United States
Diagnosis of allergic rhinitis is achieved by a combination of differentiated patient history and screening tests, followed by specific in vitro testing and nasal provocation to confirm the diagnosis
The advantage of this study is the large number of patients tested for allergic rhinitis, which provides consistent testing results of skin tests and specific serum IgE, together with data on symptom duration and questionnaire responses

Summary

Introduction

Common and chronic forms of nasal inflammation include rhinosinusitis, nasal polyposis, nonallergic rhinitis with eosinophilia syndrome (NARES) and allergic rhinitis (AR).Allergic rhinitis is the most frequent manifestation of atopic diseases, with almost 80 million people affected in the United States. Diagnosis of allergic rhinitis is achieved by a combination of differentiated patient history and screening tests, followed by specific in vitro testing and nasal provocation to confirm the diagnosis. In a screening test (usually skin prick test (SPT) or intradermal testing), the sensitization of a patient to a specific allergen can be evaluated This can be further specified or confirmed by in vitro diagnosis of specific serum IgE. Diagnosis of allergic rhinitis is achieved by a combination of patient history and different screening tools, followed by specific provocation testing. Objective: The purpose of this study was to evaluate the correlation of SPT, intradermal testing and specific serum IgE testing in certain allergens and to evaluate sensitization rates, symptom patterns and time of symptoms in a cohort of patients with suspected allergic rhinitis. Comparing the symptoms reported by patients with sensitization diagnosed by SPT, a correlation was only found for spring and summer bloomers with an odds ratio of 1.5 and

Methods

Discussion

Conclusion