Are allergen batch differences and the use of double skin prick test important?

BMC Pulmonary Medicine

Torben Sigsgaard⁵  Øyvind Omland²  David L Sherson⁷  Tine Halsen Malling¹  Lars R Skadhauge⁴  Vivi Schlünssen³  Gert F Thomsen⁶ 

[1] Department of Occupational Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark;Department of Health Science and Technology, The Faculty of Medicine; Aalborg University Hospital, Aalborg, Denmark;Department of Occupational Medicine, Danish Ramazzini centre, Aarhus University Hospital, Aarhus, Denmark;Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;Department of Public Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark;Department of Occupational Medicine, Hospital of Southwest Denmark, Finsensgade 35, Esbjerg, 6700, Denmark;Department of Pulmonal Medicine, Odense University Hospital, Odense, Denmark

关键词: Rhinitis;    Validity;    Population based study;    Aeroallergens;    Skin prick test;   

Others  :  1170566
DOI  :  10.1186/s12890-015-0021-3

 received in 2014-06-19, accepted in 2015-03-10,  发布年份 2015

【 摘 要 】

Background

Skin prick tests (SPT) are widely used both in clinical diagnostics and in research. The standardization of allergen extracts is well documented to be crucial for the validity of SPT, whereas less emphasis has been placed on reproducibility and the SPT procedure itself. The objectives of this study are to clarify how the double skin prick test procedure influence the sensitivity and specificity of the test and to analyse the differences in weal size in skin prick tests between two batches of allergen extracts from the same vendor.

Methods

The association between rhinitis and SPT was assessed among 1135 persons from a general population sample. SPT was performed twice with 10 common aeroallergens. In a subsample of 90 persons SPT was performed simultaneously with five of the allergens using different batches.

Results

Thirty percent had at least one positive SPT. Among asthmatics this number was 62%. Only minor differences were seen between the sizes of two weals from the same batch. A second SPT with the same batch did not change the association between rhinitis and sensitization. When performing SPT with two different batches disagreement was observed in 2% (Birch) to 11% (Cat) of the subjects.

Conclusions

Performing SPT twice with the same allergen batch does not enhance the validity of the test, and value of double testing can be questioned. Considerable differences in SPT response with different batches from the same manufacturer were observed. Thus inter batch differences in allergen extracts might be a source of variability.

【 授权许可】

   
2015 Thomsen et al.; licensee BioMed Central.

【 图 表 】

Figure 5.

【 参考文献 】

• [1]Backman A, Bjorksten F, Haahtela T. Regulatory control and standardization of allergenic extracts. Standardized extracts in prick testing. Arbeiten aus dem Paul Ehrlich Institut, dem Georg Speyer Haus und dem Ferdinand Blum Institut, Heft 78. Stuttgart New York: Gustav Fischer Verlag 1983 1983; p. 71–6.
• [2]Dieges PH, Blaauw PJ, Grieffioen RW, Leezenberg JA, Martens BPM, de Monchy JGR: Report on skin test standardization. The Committee on Skin Test Standardization of The Netherlands Society of Allergology. Clin Allergy 1988, 18(3):305-10.
• [3]Eichler I, Gotz M, Jarisch R, Eichler HG, Moss R: Reproducibility of skin prick testing with allergen extracts from different manufacturers. Allergy 1988, 43(6):458-63.
• [4]Focke M, Marth K, Flicker S, Valenta R: Heterogeneity of commercial timothy grass pollen extracts. Clin Exp Allergy 2008, 38(8):1400-8.
• [5]Larenas-Linnemann D, Cox LS: European allergen extract units and potency: review of available information. Ann Allergy Asthma Immunol 2008, 100(2):137-45.
• [6]Nielsen NH, Dirksen A, Mosbech H, Launbjerg J, Biering I, Soborg M: Skin prick testing with standardized extracts from 3 different manufacturers. A comparative randomized study. Allergol Immunopathol (Madr) 1992, 20(6):246-8.
• [7]Masse MS, Granger Vallee A, Chiriac A, Dhivert-Donnadieu H, Bousquet-Rouanet L, Bousquet PJ, et al.: Comparison of five techniques of skin prick tests used routinely in Europe. Allergy 2011, 66(11):1415-9.
• [8]Dreborg S, Frew AJ, Bousquet J, Malling HJ, Pastorello E, et al.: EAACI: Position paper: Allergen standardization and skin tests. The European Academy of Allergology and Clinical Immunology. Allergy 1993, 48(14 Suppl):48-82.
• [9]Devenney I, Falth-Magnusson K: Skin prick test in duplicate: is it necessary? Ann Allergy Asthma Immunol 2001, 87(5):386-9.
• [10]van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, et al.: Evaluation of commercial skin prick test solutions for selected occupational allergens. Allergy 2013, 68(5):651-8.
• [11]Bjorksten F, Haahtela T, Backman A, Suoniemi I: Assay of the biologic activity of allergen skin test preparations. J Allergy Clin Immunol 1984, 73(3):324-31.
• [12]Skadhauge LR, Baelum J, Siersted HC, Sherson DL, Dahl S, Thomsen GF, et al.: The occurrence of asthma among young adults. A population-based study in five west Danish counties. Ugeskr Laeger 2005, 167(6):648-51.
• [13]Burney P, Potts J, Makowska J, Kowalski M, Phillips J, Gnatiuc L, et al.: A case–control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project. Allergy 2008, 63(7):865-71.
• [14]Burney PGJ, Luczynska C, Chinn S, Jarvis D: The European Community Respiratory Health Survey. Eur Respir J 1994, 7(5):954-60.
• [15]Danish Meteorological Institute. Pollen - Archived Data [Pollen - arkivdata]. http://www.dmi.dk/vejr/sundhedsvejr/pollen/pollenarkiv/2009/. Accessed 20. April 2011.
• [16]Youden WJ: Index for rating diagnostic tests. Cancer 1950, 3(1):32-5.
• [17]Johannessen A, Verlato G, Benediktsdottir B, Forsberg B, Franklin K, Gislason T, et al.: Longterm follow-up in European respiratory health studies - patterns and implications. BMC Pulm Med 2014, 14:63. BioMed Central Full Text
• [18]Linneberg A, Jorgensen T, Nielsen NH, Madsen F, Frolund L, Dirksen A: The prevalence of skin-test-positive allergic rhinitis in Danish adults: two cross-sectional surveys 8 years apart. The Copenhagen Allergy Study. Allergy 2000, 55(8):767-72.
• [19]Dreborg S: Skin tests for diagnosis of IgE-mediated allergy. Allergy 1989, 44(Suppl. 10):31-7.
• [20]Karakaya G, Ozturk AB, Kalyoncu AF: Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis. Allergol Immunopathol (Madr) 2012, 40(1):37-40.
• [21]Smith HE, Hogger C, Lallemant C, Crook D, Frew AJ: Is structured allergy history sufficient when assessing patients with asthma and rhinitis in general practice? J Allergy Clin Immunol 2009, 123(3):646-50.
• [22]Braun-Fahrlander C, Wuthrich B, Gassner M, Grize L, Sennhauser FH, Varonier HS, et al.: Validation of a rhinitis symptom questionnaire (ISAAC core questions) in a population of Swiss school children visiting the school health services. SCARPOL-team. Swiss Study on Childhood Allergy and Respiratory Symptom with respect to Air Pollution and Climate. International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol 1997, 8(2):75-82.
• [23]Schlunssen V, Schaumburg I, Andersen NT, Sigsgaard T, Pedersen OF: Nasal patency is related to dust exposure in woodworkers. Occup Environ Med 2002, 59(1):23-9.