Skin Testing Versus Serum-Specific IgE Testing: Which Is Better for Diagnosing Aeroallergen Sensitization and Predicting Clinical Allergy?

Curr Allergy Asthma Rep (2014) 14:430

DOI 10.1007/s11882-014-0430-z

Skin Testing Versus Serum-Specific IgE Testing: Which Is Better for Diagnosing Aeroallergen Sensitization and Predicting Clinical Allergy?

Gabriele de Vos

Published online: 16 March 2014# Springer Science+Business Media New York 2014

Abstract An accurate diagnosis of aeroallergen sensitization is pivotal to clinical practice and research. Given the recent technological advances in analyzing serum allergen-specific IgE, the question of which testing method, skin or serum testing, is superior in diagnosing allergic sensitization must be readdressed, as well as their value in predicting clinical disease. This review article provides a detailed summary of recent studies addressing these questions. Conclusively, most studies show substantial discordance between serum-specific IgE and skin testing results, suggesting that the two testing methods compliment each other and cannot be used interchangeably. On average, using only one testing method may misdiagnose every fourth allergically sensitized patient as non-sensitized. In addition, depending on the allergen tested, skin prick testing and serum-specific IgE testing appear to be the methods of choice in predicting outcomes of experimental allergen challenge, while intradermal testing is less contributory.

Keywords Serum allergy testing . Skin allergy testing . Serum-specific IgE . Total serum IgE . Skin prick testing . Intradermal testing . Aeroallergens . Comparison of methods . Nasal challenge . Bronchial provocation test . Allergic sensitization . Clinical allergy

Introduction

Aeroallergen sensitization is strongly associated with rhinitis, asthma, conjunctivitis, eczema and, less frequently, contact urticaria. A correct and comprehensive identification of allergic sensitization is important for allergen avoidance and prescription of allergen immunotherapy in sensitized patients in whom the history (or allergen challenge) indicates that a specific allergen exposure may trigger the symptoms. Moreover, accurately diagnosing aeroallergen sensitization is pivotal in epidemiologic research when associations between sensitization and allergic diseases or asthma are to be established. In clinical practice as well as in most large epidemiologic studies, allergen sensitization is being diagnosed by one of the commercially available testing methodsskin testing or serum allergen-specific IgE testingbut rarely simultaneously using both methods [13]. This can potentially lead to discrepant conclusions. For example, cockroach sensitization diagnosed by skin prick testing (SPT) has been associated with increased asthma morbidity [4, 5]. Yet, in a recent study cockroach sensitization diagnosed via serum-specific IgE testing (ssIgE)...