Intradermal Dilutional Testing Research Articles

Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction

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.

Skin testing for inhalant allergy.

Allergy is diagnosed by a combination of history, physical examination, and confirmatory testing. Modalities for testing include skin testing, in vitro assessment, and challenge testing of the conjunctiva or nasal mucosa. Challenge testing is primarily reserved for research. A review of the literature on skin testing methods for inhalant allergic rhinitis was performed. Different forms of commonly used skin testing are available, including: individual prick; multiple prick; single, intradermal, and intradermal dilutional testing; and blended techniques. Each has inherent benefits and limitations. Skin testing remains a valid and in some cases superior means of identifying inhalant allergy. Skin-prick testing and intradermal testing are the primary categories, although different formats exist for each. Caution must be taken to avoid creating a serious systemic reaction by injecting an injudicious amount of antigen into the skin, or in skin testing a patient whose medication profile puts them at increased risk.

Diagnostic Evaluation of Inhalant Allergies: A Cost-effectiveness Analysis

The purpose of this study was to compare the cost-effectiveness of modified quantitative testing (MQT), intradermal dilutional testing (IDT), and in vitro allergy testing as diagnostic methods used in the management of patients with suspected IgE-mediated inhalant allergies. A systematic review was conducted to determine key statistics for analysis, such as prevalence of disease, and sensitivity and specificity of each diagnostic modality. Costs were calculated based on charges from distribution companies to providers. A deterministic cost-effectiveness analysis then was conducted using a decision tree model to evaluate the various diagnostic strategies. After identifying results at baseline, we performed a sensitivity and threshold analysis to assess the strength of recommendations. At an allergic rhinitis prevalence of 20%, MQT dominated IDT and in vitro testing, with 85 people correctly diagnosed at a baseline total cost of $6630 for the 100 patients tested. Although in vitro testing had the highest effectiveness, it had an incremental cost-effectiveness ratio of $3185. The results were sensitive to changes in the prevalence, costs, and sensitivities and specificities of the different modalities. The prevalence of allergic rhinitis is high and rising according to many studies, leading to a growing population of patients requiring allergy testing. Not only does today's medical community want effective health interventions, but also there is pressure to make health care cost efficient. This study looks at the cost-effectiveness of various diagnostic allergy tests. In our model, we found MQT to be the most cost-effective method of diagnosing allergic disease.

Comparison of intradermal dilutional testing, skin prick testing, and modified quantitative testing for common allergens

To compare and correlate wheal size using the Multi-Test II applicator with the endpoint obtained by intradermal dilutional testing (IDT) for 5 common allergens. To examine the safety of modified quantitative testing (MQT) for determining immunotherapy starting doses. Prospective comparative clinical study. A total of 134 subjects were simultaneously skin tested for immediate hypersensitivity using the Multi-Test II device and IDT. There was a 77% concordance between results from IDT and results from MQT. When there was a difference, MQT predicted a safer endpoint for starting immunotherapy in all but 2 cases. Wheal size by SPT is predictive of endpoint by IDT. MQT is nearly as effective as formal IDT in determining endpoint. Modified quantitative testing appears to be a safe alternative to IDT for determining starting doses for immunotherapy.

Use of Intradermal Dilutional Testing and Skin Prick Testing: Clinical Relevance and Cost Efficiency

The objective was to determine the agreement of the positive results from a multiple skin prick test (SPT) device with the ability to determine a definable endpoint through intradermal dilutional testing (IDT) to compare semiquantitatively the degree of positivity of SPT results with quantitative results from IDT and to analyze the cost of immunotherapy based on SPT compared with IDT guided by SPT. Retrospective review of clinical data (random accrual). One hundred thirty-four patients underwent allergy screening using a multiple SPT device. Antigens testing positive by skin prick device were tested using IDT on a separate day. Antigens testing negative by SPT were not evaluated by IDT. Regional allergy testing practice patterns were determined, and a cost analysis using Medicare rates was performed There was good agreement between an antigen testing positive by SPT and the determination of a definable endpoint (93.33%, n = 1,334 antigens). The degree of positivity from the SPT correlated poorly with the final endpoint concentration (r = 0.40, P < .0001). Blended testing techniques were similar in cost when compared with several commonly used allergy testing protocols. Antigens which show reactivity to a multiple SPT device usually have a treatable endpoint that is independent of the degree of positivity of the SPT result. IDT is an important step in the determination of the strongest starting dose of immunotherapy that may be safely administered. Initiating immunotherapy in this manner may potentially create significant health care savings by shortening the time required for a patient to reach their individual maximally tolerated dose. The use of a relatively large screening panel is cost effective and does not increase the average number of antigens treated by immunotherapy. Blended allergy testing techniques that include IDT in their protocol are comparable in cost with commonly used allergy testing protocols.

Comparison of Intradermal Dilutional Testing with the Multi‐Test II Applicator in Testing for Mold Allergy

To compare and correlate wheal size using the Multi-Test II applicator with the endpoint obtained by intradermal dilutional testing (IDT) for common mold allergens. To validate the safety and efficacy of modified quantitative testing (MQT) for determining immunotherapy starting doses. Prospective study of 86 subjects with Multi-Test II and IDT for 6 common mold antigens. There was 84% concordance between IDT results and the results expected from the MQT method. When IDT and MQT results differed, the MQT algorithm predicted a safer endpoint for starting immunotherapy in all but 2 cases. The correlation between Multi-Test II and IDT is not strong enough to infer IDT endpoint from Multi-Test II results for molds. MQT is nearly as effective as formal IDT in determining endpoint. MQT appears to be a safe method for determining starting doses for immunotherapy with fungal allergens.

Allergy Practice in the Academic Otolaryngology Setting: Results of a Comprehensive Survey

To survey academic otolaryngology centers and obtain information regarding their practice of otolaryngic allergy. A 12-item multiple-choice survey was sent to all academic otolaryngology department chairmen and program directors, as well as all academic liaisons known to the American Academy of Otolaryngic Allergy. Representatives of 71 of 102 (69.6%) accredited otolaryngology programs responded; 52 of 84 respondents reported an active otolaryngic allergy practice at their institution. The testing method most widely employed by those surveyed is intradermal dilutional testing (IDT). The majority of respondents (74.5%) felt that the addition of allergy increased referrals to their department, and a similar majority (72%) were operating at a profit. The most common reasons cited for adding allergy services were to meet educational and residency requirements. The majority of academic otolaryngology programs in the United States currently offer otolaryngic allergy services. The primary reason cited for adding these services is for educational purposes, but there appear to be potential financial benefits as well. C-4.

Comparison of Multi-Test II® skin prick testing to intradermal dilutional testing

Objectives/hypothesis Intradermal dilutional testing (IDT) has been considered more sensitive than prick testing for detecting low-level allergies. Multi-Test II® is one of the most sensitive and reproducible prick testing methods available. This study compares Multi-Test II® prick testing with IDT. Design Retrospective chart review and data analysis on patients who had allergy testing with both Multi-Test II® and IDT. Setting Outpatient allergy clinic in the otolaryngology department of an academic tertiary care medical center. Population Forty adult patients had complete allergy testing with both Multi-Test II® and IDT for a standard panel of twelve antigens between January 2002 and April 2002. Intervention Analysis and comparison of test results on Multi-Test II® and IDT for each antigen separately and across all antigen tests together. Results Forty patients had complete testing for all antigens during the time period for the study. Six of these patients did not react to the positive control on Multi-Test II® and were eliminated from the main analysis. Of the 34 patients included in the main analysis, all were positive for at least one antigen on IDT; one half (17/34) were negative for all antigens on Multi-Test II®. A significantly greater number of patients were positive on IDT than Multi-Test II® for all antigens except dog ( P < 0.05). There was a statistically significant correlation between IDT endpoint and Multi-Test II® score for several antigens ( P < 0.05). Of 408 total antigen tests performed, 339 (83.1%) were negative on Multi-Test II®. Of these 339 negative Multi-Test II® tests, 148 (43.7%) were negative on IDT and 191 (56.3%) were positive on IDT; 174/339 (51.3%) had an IDT endpoint of 2 or 3 and 17/339 (5.0%) had an IDT endpoint ≥ 4 . A significantly greater number of antigen tests were positive on IDT than on Multi-Test II® ( P < 0.001). The overall Spearman correlation coefficient between IDT endpoint and Multi-Test II® score was 0.370 ( P < 0.001). Conclusion Patients were more likely to have a positive test on IDT than on Multi-Test II®. IDT therefore may be a more sensitive testing technique for inhalant allergies than Multi-Test II® prick testing. In addition, Multi-Test II® score may not be a good predictor of IDT endpoint. Although a statistically significant correlation is demonstrated between Multi-Test II® score and IDT endpoint, the correlation coefficient is low enough that clinical application may not always be safe or appropriate. The clinical significance of positive IDT results in the presence of negative Multi-Test II® results is not known.

Prevalence of hypersensitivity to specific fungal allergens as determined by intradermal dilutional testing

Objective: To determine fungal allergen reactivity prevalence by intradermal dilutional testing in patients with and without chronic rhinitis or rhinosinusitis symptoms. Study Design: Prospective comparison of fungal allergen reactivity prevalence in symptomatic and asymptomatic patients. Setting: University medical center. Methods: Group I (chronic rhinitis and/or rhinosinusitis symptoms) and Group II (asymptomatic) patients underwent intradermal dilutional testing with usual and fungal allergens. Results: Fungal reactivity occurred in 65% (13/20) of Group I, and 13% (4/30) of Group II ( P < 0.0002 by χ 2 testing). Group I was more reactive to non-fungal allergens (85% vs. 33%, p < 0.0004), and to all allergens considered together (95% vs. 40%, p < 0.0001). Conclusions: Patients with chronic rhinitis and rhinosinusitis symptoms were more reactive to fungal and nonfungal allergens. Fungal allergens were as likely as nonfungal to elicit reactivity. Significance: These findings suggest a role for fungal hypersensitivity in chronic rhinitis and chronic rhinosinusitis. (Otolaryngol Head Neck Surg 2001;125:491-4.)

Prevalence of hypersensitivity to specific fungal allergens as determined by intradermal dilutional testing*1

Prevalence of hypersensitivity to specific fungal allergens as determined by intradermal dilutional testing*1