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Problems with skin testing in patients with allergic bronchopulmonary aspergillosis
1Airways Disease Center, University Hospitals of Cleveland, Ohio, USA.
Background:
The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is difficult; a prerequisite for one approach is the detection of IgE sensitivity to A. fumigatus.
Objective:
The purpose of the present study was to examine skin test extracts of A. fumigatus from five different extract manufacturers to evaluate their reliability for detecting IgE reactivity.
Methods:
A total of 26 patients with previously diagnosed ABPA underwent intradermal skin testing with A. fumigatus skin test reagents obtained from five separate extract manufacturers from the USA, at 1,000 pnu/mL.
Results:
A marked disparity in skin test reactivity was seen in patients, such that the diagnosis would have been missed in a substantial number of patients if extracts from manufacturers A, B, or C would have been used in the initial skin test screening.
Conclusion:
It is clear that this finding of disparate skin test reactivity rates with extracts from different manufacturers can account for some degree of false negative skin test reactivity in patients suspected of having either ABPA or other mold sensitivity syndromes. A standardized skin test extract of A. fumigatus is badly needed for diagnostic purposes.