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Skin testing: a survey of allergists
John Oppenheimer1, Harold S Nelson
1Department of Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA. nallop@optonline.net
Summary
Allergists show significant variation in skin testing practices, including the number of tests, extract concentrations, and result interpretation. This highlights a need for standardized allergy skin testing protocols and reporting for improved patient care.
Area of Science:
- Allergy and Immunology
- Diagnostic Procedures
- Clinical Practice Variation
Background:
- Skin testing is a cornerstone for diagnosing allergic responses in allergy clinics.
- Anecdotal evidence suggests considerable variation in allergists' skin testing methods, but this has not been systematically documented.
Purpose of the Study:
- To quantify the diversity in skin testing practices among allergists in the United States.
- To identify specific areas of variability in allergy skin testing procedures.
Main Methods:
- A nationwide online survey was distributed to members of the American College of Allergy, Asthma and Immunology.
- The survey collected data on extract concentrations, skin test devices, number/type of tests, interpretation, documentation, and quality assurance.
Main Results:
- Significant variability was found in the number of tests performed, extract concentrations (e.g., 1:100 to 1:1,000 for intradermal tests), devices used, and interpretation methods (e.g., 0-4+ scale vs. orthogonal diameters).
- Most clinicians used the most concentrated extract for skin prick testing, but reporting methods varied widely, with many not measuring orthogonal diameters or standardizing to histamine controls.
- While 61.2% reported quality assurance, less than 10% used objective protocols.
Conclusions:
- The study reveals substantial heterogeneity in allergy skin testing practices among US allergists.
- There are clear opportunities to enhance the standardization and reporting of skin tests to improve diagnostic accuracy and patient outcomes.