Value of a negative aeroallergen skin-prick test result in the diagnosis of asthma in young adults: correlative study with methacholine challenge testing.
BACKGROUND
None of the existing tests for the diagnosis of asthma are considered to be definitive. Certain circumstances require prompt diagnosis, and a test able to predict the absence of asthma would be very useful.


OBJECTIVE
To evaluate the contribution of a skin-prick test (SPT) to the diagnostic workup of subjects with suspected asthma.


METHODS
The study included three groups of subjects aged 18 to 24 years: group A, asthmatic patients (n = 175); group B, control subjects (n = 100); and group C, subjects with suspected asthma (n = 150) with normal spirometry findings and a negative exercise challenge test result. All underwent an SPT to a battery of common aeroallergens, and group C underwent a methacholine challenge test (MCT) in addition. The sensitivity, specificity, positive predictive value, and negative predictive values (NPV) of the SPT were calculated using provocative concentrations of methacholine causing a 20% fall in FEV(1) (PC(20)) of < 4 mg/mL and < 8 mg/mL as diagnostic cutoff values for asthma in the MCT. Bayes' formula was used to determine posttest probabilities of having asthma, both for positive and negative SPT results.


RESULTS
A positive SPT result to at least one allergen was found in 95.5%, 54%, and 69% of patients in the three groups, respectively. The sensitivity, specificity, and NPV of the SPT were 90.7%, 52.0%, and 84.8%, respectively, with a cutoff value of PC(20) < 8 mg/mL. The lower cutoff, PC(20) < 4 mg/mL, increased the sensitivity and NPV to 98.2% and 97.8%, respectively. A negative SPT result decreased the probability of having asthma by 10-fold to 20-fold in subjects whose pretest probability was low to moderate.


CONCLUSIONS
Incorporating an SPT into the workup of subjects with suspected asthma can reduce the cost of this process significantly. The SPT may be used as a simple, fast, safe, inexpensive, and reliable method to predict the absence of asthma in young adults.
Graif
Yael
Y
Allergy and Pulmonary Clinic, Israel Defense Forces, Tel Aviv, Israel. graif@post.tau.ac.il
Yigla
Mordechai
M
Tov
Naveh
N
Kramer
Mordechai R
MR
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000485:Allergens; D001249:Asthma / Q000175:diagnosis*; D001250:Asthma, Exercise-Induced / Q000175:diagnosis; D001985:Bronchial Provocation Tests; D005260:Female; D006801:Humans; D007428:Intradermal Tests; D008297:Male; D016210:Methacholine Chloride; D011237:Predictive Value of Tests; D012130:Respiratory Hypersensitivity / Q000175:diagnosis*
D000485:Allergens; D016210:Methacholine Chloride