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Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

ABSTRACT: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings.To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points.The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated.Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ? 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen.These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.

SUBMITTER: Haahtela T

PROVIDER: S-EPMC4215109 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

Haahtela T T Burbach G J GJ Bachert C C Bindslev-Jensen C C Bonini S S Bousquet J J Bousquet-Rouanet L L Bousquet P J PJ Bresciani M M Bruno A A Canonica G W GW Darsow U U Demoly P P Durham S R SR Fokkens W J WJ Giavi S S Gjomarkaj M M Gramiccioni C C Kowalski M L ML Losonczy G G Orosz M M Papadopoulos N G NG Stingl G G Todo-Bom A A von Mutius E E Köhli A A Wöhrl S S Järvenpää S S Kautiainen H H Petman L L Selroos O O Zuberbier T T Heinzerling L M LM

Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 20140301 3

<h4>Background</h4>Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings.<h4>Objective</h4>To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points.<h4>Methods</h4>The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-repo ...[more]

PMID: 24283409

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Project description:BackgroundThe burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa.MethodsFrom August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined.ResultsOf the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics.ConclusionThere is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study.Trial registrationThe ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017.

Dataset Information

Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

Publications

Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

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