title: Bevel-down superior to bevel-up in intradermal skin testing.
abstract: BACKGROUND
  Intradermal skin testing is one of the most widely used procedures in the diagnosis of hypersensitivity diseases in vivo. It is critical to perform the test accurately and expediently. Yet, there are few articles describing its detailed technique or proficiency available.
  
  
  OBJECTIVE
  To identify the better method for intradermal testing between the bevel-up and bevel-down techniques.
  
  
  METHODS
  Three inexperienced testers performed intradermal injections using both methods. Four sets of paired trails each consisting of ten injections were applied randomly, alternating between the same volunteer subject's contralateral arms. Duration to complete ten injections was measured. Numbers of injection sites that bled, that squirted into the air, and failed to form a bleb were counted. The overall comfort level was determined.
  
  
  RESULTS
  The time to complete the injections by bevel-up and by bevel-down methods were 165.5 +/- 31.3 and 152.5 +/- 27.4 seconds, respectively (P < .015). The number of injection sites that bled was higher in the bevel-up method, particularily on trial one (P < .001). Completion rate of successful bleb formation in bevel-down was 27.3 as compared with 23.3 in bevel-up method (P = .013). The comfort level was higher with the bevel-down than the bevel-up method (P = .0001).
  
  
  CONCLUSIONS
  The bevel-down method of intradermal testing is superior to the bevel-up method.
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, USA.
authors.forename: A
authors.initials: A
authors.lastname: Howard
authors.forename: P
authors.initials: P
authors.lastname: Mercer
authors.forename: H C
authors.initials: HC
authors.lastname: Nataraj
authors.forename: B C
authors.initials: BC
authors.lastname: Kang
mesh_terms: D004864:Equipment and Supplies / Q000592:standards; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis; D015203:Reproducibility of Results; D012882:Skin Tests / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors