Abstract
Introduction Skin prick testing (SPT) can reliably diagnose food and environmental allergies. Previous studies have shown mixed results on the diurnal pattern for SPT, which has not been evaluated in food allergens. Methods Retrospective chart review of pediatric patients at one institution from 6/2008- 6/2017 who received SPT to food and/or environmental allergens. Our hypothesis was that SPT wheal and erythema size would be higher in PM (12:00-19:30) vs. AM (7:00-11:59). Results We reviewed 15,960 charts; 13,077 had adequate histamine response without antihistamine use within 5 days of SPT (58% male, PM µ±SD=6.3±4.4 years vs. AM 5.7±4.2). Wheal size for histamine SPT was not significantly increased in PM vs. AM (µ±SD=5.7± 1.9 mm, n=6562 vs. 5.7±1.9, n=6388; p=0.76), nor for the most common food allergens. Significantly increased erythema for histamine SPT was noted in PM vs. AM (µ±SD=14.6±6.3, n= 6501 vs. 14.2±6.1, n=6352; p14.7(14.3-14.5). There was no significant difference in wheal size in this sub-analysis. Conclusions SPT in the PM is associated with increase erythema size for histamine and several other allergens, but without a significant difference in wheal size. Diurnal cortisol variations likely influence erythema size, but do not influence clinical outcomes of SPT. Thus, SPT can be reliably performed at any time of day. Skin prick testing (SPT) can reliably diagnose food and environmental allergies. Previous studies have shown mixed results on the diurnal pattern for SPT, which has not been evaluated in food allergens. Retrospective chart review of pediatric patients at one institution from 6/2008- 6/2017 who received SPT to food and/or environmental allergens. Our hypothesis was that SPT wheal and erythema size would be higher in PM (12:00-19:30) vs. AM (7:00-11:59). We reviewed 15,960 charts; 13,077 had adequate histamine response without antihistamine use within 5 days of SPT (58% male, PM µ±SD=6.3±4.4 years vs. AM 5.7±4.2). Wheal size for histamine SPT was not significantly increased in PM vs. AM (µ±SD=5.7± 1.9 mm, n=6562 vs. 5.7±1.9, n=6388; p=0.76), nor for the most common food allergens. Significantly increased erythema for histamine SPT was noted in PM vs. AM (µ±SD=14.6±6.3, n= 6501 vs. 14.2±6.1, n=6352; p14.7(14.3-14.5). There was no significant difference in wheal size in this sub-analysis. SPT in the PM is associated with increase erythema size for histamine and several other allergens, but without a significant difference in wheal size. Diurnal cortisol variations likely influence erythema size, but do not influence clinical outcomes of SPT. Thus, SPT can be reliably performed at any time of day.
Published Version
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