Safety of intradermal skin tests for inhalants and foods: a prospective study

• Published in: International forum of allergy & rhinology Vol. 3; no. 3; pp. 171 - 176
• Main Authors: Gordon, Bruce R., Hurst, David S., Fornadley, John A., Hunsaker, Darrell H.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2013; Wiley Subscription Services, Inc
• Subjects: Allergens - immunology; Allergies; anaphylaxis; Anaphylaxis - etiology; Anaphylaxis - prevention & control; Desensitization, Immunologic - adverse effects; Feasibility Studies; Food - adverse effects; food allergy; Food Hypersensitivity - complications; Food Hypersensitivity - diagnosis; Food Hypersensitivity - immunology; Food Hypersensitivity - therapy; Humans; inhalant allergy; Inhalation; intradermal skin tests; Intradermal Tests - adverse effects; Intradermal Tests - methods; Medical treatment; non-IgE-mediated food allergy; Particulate Matter - adverse effects; Particulate Matter - immunology; Patient Safety; Practice Guidelines as Topic; Prospective Studies; Risk; skin test safety; subcutaneous immunotherapy
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.21091

Background Intradermal skin testing is a useful allergy diagnostic tool. Although considered safe when properly performed, systemic reactions have been reported. This is the first large, prospective study to record and evaluate all systemic reactions from intradermal skin testing (IDT) to inhalant or food antigens. Methods A 24‐month prospective study by 40 physician practices, recording all IDT tests, including reactions, symptoms, severity, time after injection, and reaction treatments. Results Eighty systemic reactions (22 major) occurred among 20,530 patients (878,583 wheals). Nine had epinephrine treatment, 4 were observed in an emergency department, and there were no hospitalizations or fatalities. The overall systemic reaction risk was 0.009%. The risk of having a major reaction was 0.003%, or 1 reaction per 933 patients. Conclusion Intradermal skin tests for inhalants or foods, when performed with appropriate precautions, have a safety profile comparable to skin prick tests.