Abstract
The purpose of this study was to determine whether the sensitivity advantage of intradermal dilutional testing (IDT) is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD) or otitis media with effusion (OME). This retrospective, private-practice cohort study compared the sensitivity of skin prick tests (SPT) vs. IDT in 110 adults and children with suspected allergy and OME. Primary outcome measure was symptom resolution from allergy immunotherapy (AIT). IDT identified 57% more patients as being allergic, and 8.6 times more reactive allergens than would have been diagnosed using only SPT. Patients diagnosed by IDT had the same degree of symptom improvement from immunotherapy, independent of allergen sensitivity (66% by SPT vs. 63% by IDT; p = 0.69, not different). Low-sensitivity allergy tests, which may fail to identify allergy in over two thirds of children aged 3 to 15 as being atopic, or among 60% of patients with ETD, may explain why many physicians do not consider allergy as a treatable etiology for their patient’s OME/ETD. IDT offers superior sensitivity over SPT for detecting allergens clinically relevant to treating OME/ETD. These data strongly support increased utilization of intradermal testing and invite additional clinical outcome studies.
Highlights
Allergy tests detect hypersensitivity to allergens suspected of triggering symptoms, but are all skin tests equivalent in their responses? Skin prick tests (SPT) are often the only tests used to diagnose allergy, because intradermal dilutional tests (IDT) are thought by some to offer no additional relevant information [1]
All patients diagnosed with obstructive Eustachian tube dysfunction (ETD) and who opted for allergy immunotherapy (AIT) were included in this study
A majority of our ETD patients improved with AIT, we found that adults are less likely to improve than children
Summary
Allergy tests detect hypersensitivity to allergens suspected of triggering symptoms, but are all skin tests equivalent in their responses? Skin prick tests (SPT) are often the only tests used to diagnose allergy, because intradermal dilutional tests (IDT) are thought by some to offer no additional relevant information [1]. The subsequent decision to treat with allergy immunotherapy (AIT), and the resulting therapeutic response, depend on the ability of the chosen test to identify truly allergic individuals and their significant allergens [2]. Physicians face a conundrum in diagnosing patients with classic signs and symptoms of allergy when SPT are negative. IDT and SPT is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD), presenting as barochallenge, tympanic retraction, or OME. We compared the AIT responses of low-sensitivity patients who were identified only by IDT, that is, those who have had negative results with SPT and those showing positive results with IDT; i.e., low-sensitivity (SPT−/IDT+) vs. high-sensitivity patients (SPT+).
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