Skin Tests: A Historic Trail

Abstract

Based on review of the flow of archival to current day medical literature and communications, the historical highlights of skin testing are traced, summarizing the uncovering of knowledge on the special property of cutaneous tissue to mirror and mediate expressions of local and systemic immune phenomena. Derivation of leads for design of investigations and applications of that endowed skin capacity are exemplified in 19th century accounts of early, inadvertently affected, tissue reactions to microbial reinfection and attempted immunizations against hay fever with causative pollens introduced through mucous membrane and skin routes. Translation of experimental findings to the development of clinically useful diagnostic materials and methods by the second decade of the 20th century are described-particularly preparation of specific antigenic and allergenic extracts and intro. duction of inventive ophthalmic, scarification, intracutaneous, percutaneous, puncture, passive transfer (P-K), and patch techniques-for study of hypersensitivity, atopic and infectious processes, their immune system inter-relationships, pathogenetic mechanisms and interpretations of symptom manifestations. Through reflection on and recount of seminal and pivotal findings along the pathway that established skin testing as a key resource for physicians dealing with allergic, asthmatic, immunologic, infectious and dermatologic diseases, the reader is appraised of the important role the modality also played as a research tool. References are made to the rewarding use of skin test protocols in generating information that contributed to the definition of mechanisms and agents of immediate hypersensitivity and atopic diseases, immune complex and cell mediated delayed reactions and disorders, immunotherapeutic hyposensitization and blocking antibody, bacterial allergy, histamine release, and epidemiologic features of allergen affected populations.