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Cited by 107Allergic Rhinitis and SensitizationFood Allergy and Anaphylaxis ResearchAsthma and respiratory diseases

An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass

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Nelson, Harold S., Oppenheimer, John, Buchmeiera, Andrea, Kordash, Terance R., Freshwaterc, Les L.·1996·Journal of Allergy and Clinical Immunology
DOI 10.1016/s0091-6749(96)70184-7
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Abstract

Background Immediate skin testing is generally the preferred method for establishing the presence of allergy in clinical practice. There is no agreement, however, as to whether intradermal testing should be routinely performed if skin prick test results are negative.Purpose The study was done to address the value of intradermal skin testing in the diagnosis of clinically significant sensitivity to grass pollen in patients exhibiting negative skin prick test responses to timothy extract.Methods Four groups were studied. Group I had a history of seasonal allergic rhinitis, negative skin prick test responses to timothy and Bermuda grass, but positive intradermal skin test responses to timothy grass. Group II had a history of seasonal allergic rhinitis and positive skin prick test responses to timothy grass. Group III had a history of seasonal allergic rhinitis but had negative responses to both prick and intradermal testing with timothy and Bermuda grass. Group IV had no history of rhinitis, had negative responses to skin testing with a panel of locally important allergens, as well as Bermuda and timothy grass, and had a serum IgE value of less than 20 IU/ml. Clinical sensitivity to grass was assessed by two methods: (1) nasal challenge with threefold increasing amounts of timothy pollen performed out of the pollen season and (2) correlation of subjects' daily symptom and medication scores with daily grass pollen counts during the grass pollen season.Results On the basis of nasal challenge with timothy grass, pollen allergic reactions were present in 11% of group I, 68% of group II, 11% of group III, and 0% of group IV. As determined by correlation of symptoms during the grass pollen season with grass pollen counts, 22% of group I, 64% of group II, 21% of group III, and 0% of group IV were considered allergic. If both criteria were required for a diagnosis of clinical allergy to grass, the percent positive was 0 for group I, 46 for group II, 0 for group III, and 0 for group IV.Conclusion Under the conditions of this study the presence of a positive intradermal skin test response to timothy grass (1000 AU/ml) in the presence of a negative skin prick test response to timothy grass (100,000 AU/ml) did not indicate the presence of clinically significant sensitivity to timothy grass, and by inference, to other cross-reacting grasses.

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  • In 28 individuals with SAR history, 11% in both the group with negative SPT but positive intradermal Timothy and the group with negative SPT and negative intradermal had positive nasal challenge with Timothy grass.

    “In both groups, 11% of individuals had a positive nasal challenge with Timothy grass.”

    From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [856]

    The Nasal challenge section reports positive challenge results in 44% of group I and 42% of group III, not 11% in each. Table II gives 11% for each group only after a further assessment classified which challenge reactions indicated allergy; the citing sentence conflates that classification with a positive nasal challenge. (LLM, conf=0.87)

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  • Both intradermal testing and SPT rely heavily on technician skill for interpretation of the wheal and flare reaction.

    “Both intradermal testing and SPT rely heavily on technician skill for interpretation of the wheal and flare reaction.856,928,937”

    From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [856]

    The Skin testing section specifies wheal and erythema criteria for interpreting both SPT and intradermal results. It does not say that interpretation relies heavily on technician skill. No page number is available for this passage in our copy. (LLM, conf=0.78)

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  • Intradermal or epicutaneous testing demonstrates higher sensitivity but lower specificity than SPT for several allergens.

    “Intradermal or epicutaneous testing demonstrates higher sensitivity but lower specificity than SPT for several allergens.793,856,931,932,944”

    From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [856]

    The Abstract describes greater sensitivity as a potential advantage of intradermal testing, while the Discussion (p. 1200) reports that intradermal-positive results were no more predictive of clinical allergy than intradermal-negative results among people with negative skin-prick tests. This supports concern about clinically irrelevant positive intradermal results, but the study does not establish the claimed comparison for epicutaneous testing or for several allergens; its clinical assessment focused on timothy grass. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • A positive intradermal reaction to grass pollen in the setting of negative prick testing may not be clinically relevant.

    “There is evidence to suggest that a positive intradermal reaction to grass pollen in the setting of negative prick testing may not be clinically relevant.793,856”

    From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [856]

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Authors
Nelson, H. S., Oppenheimer, J., Buchmeiera, A., Kordash, T. R., & Freshwaterc, L. L.
Affiliations
National Jewish Health (US)
ORCID
Venue
Journal of Allergy and Clinical Immunology
Publisher
Elsevier BV
Published
1996-06
Volume
97
Issue
6
Pages
1193-1201
ISSN
0091-6749 (ISSN-L)
DOI
10.1016/s0091-6749(96)70184-7
OpenAlex
W2078144114
Cited by
107
References
13
Citations by year
2025: 3 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 7 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 5 · 2012: 3
FWCI
1.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Allergy and Clinical Immunology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
intradermal test, skin prick test, grass pollen allergy, allergic rhinitis, serum IgE, Cynodon dactylon, pollen allergy diagnosis
MeSH terms
Adult, Poaceae, Rhinitis, Allergic, Seasonal, Humans, Hypersensitivity, Intradermal Tests, Nasal Provocation Tests, Pollen

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