title: Intradermal testing after negative skin prick testing for patients with high suspicion of allergy.
abstract: BACKGROUND
  Skin testing is a widely accepted method for identifying inhalant allergies. Intradermal (ID) testing is often performed after negative skin prick testing (SPT) when a practitioner has a high level of clinical suspicion for a particular allergen.
  
  
  METHODS
  A retrospective chart review study was performed over a 5-year period in patients with negative SPT for airborne allergens who also underwent ID testing based on a high level of suspicion for clinical allergy.
  
  
  RESULTS
  Eighty-seven patients had negative SPT and went on to receive an average of 7 ID tests per patient. A total of 592 ID tests were performed after negative SPT. Of these, 20.8% (123/592) had a positive ID result with negative SPT. The allergens with the greatest percentage of positive ID results with negative SPTs were dog, cat, D. farinae, and D. pteronyssinus (33.3%, 34.3%, 39.4%, and 39.6%, respectively). The allergens least likely to test positive on ID testing after negative SPT were red maple, Cladosporium, and Alternaria (0%, 6.3%, and 6.5%, respectively).
  
  
  CONCLUSIONS
  Approximately 20% of all negative results on SPT will have a positive ID test, more likely for indoor allergens. If a high suspicion for allergy exists in a patient with a negative SPT result, it may be useful to proceed with ID testing. However, the clinical significance of a positive ID test after negative SPT still needs to be elucidated.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Yuna C
authors.initials: YC
authors.lastname: Larrabee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: William
authors.initials: W
authors.lastname: Reisacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology*; D007428:Intradermal Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens
keywords: allergens; allergic rhinitis; allergy immunotherapy; allergy injections; immunotherapy; rhinitis; skin prick test