Reactions to prick and intradermal skin tests.
BACKGROUND
Allergy skin testing is a common procedure for the diagnosis of atopic diseases with a small risk of systemic reactions.


OBJECTIVE
To determine the 12-month incidence of systemic reactions (SRs) to skin prick testing (SPT) and intradermal skin testing (ST) and the symptoms and response to immediate treatment with epinephrine intramuscularly.


METHODS
A prospective study was conducted to evaluate SRs from ST in 1,456 patients. A standard form was used to record symptoms, signs, and treatment. The SRs are defined as any sign or symptom other than a local reaction thought to be secondary to ST. No vasovagal reactions were included. Nurses, as instructed by attending physicians, administered epinephrine (0.2 mL of a 1:1,000 dilution) intramuscularly in the deltoid as soon as any remote signs or symptoms occurred.


RESULTS
Fifty-two patients (3.6%) had SRs (6 SPT and 46 intradermal): 43 (83%) were female, and 17 (33%) had asthma. Systemic symptoms included (SPT/intradermal) pruritic eyes, nose, or pharynx (0%/46%); worsening cough (50%/26%); sensation of difficulty swallowing (0%/20%); worsening nasal congestion (17%/15%); rhinorrhea (17%/13%); chest tightness or shortness of breath (33%/11%); generalized pruritus (17%/11%); sneezing (33%/9%); wheeze (0%/4%); and urticaria (17%/2%). No severe asthma, shock, hypotension, unconsciousness, or biphasic reactions occurred. All 52 patients received epinephrine intramuscularly, 48 (92%) oral prednisone, 9 (17%) oral prednisone to take 6 to 8 hours after a reaction, 50 (96%) oral antihistamine, and 6 (12%) nebulized beta-agonist.


CONCLUSIONS
Of patients who underwent ST, SRs occurred in 3.6% (0.4% for SPT and 3.2% for intradermal ST), all of whom readily responded to epinephrine intramuscularly in the deltoid. This immediate administration of epinephrine seems to prevent more serious and biphasic reactions.
Bagg
Andrew
A
Division of Allergy and Immunology, Department of Medicine, University of South Florida College of Medicine, Tampa, Florida, USA.
Chacko
Thomas
T
Lockey
Richard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects* / Q000276:immunology; D000707:Anaphylaxis / Q000517:prevention & control; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D012882:Skin Tests; D055815:Young Adult
D000485:Allergens; D004837:Epinephrine