Who can order skin allergy testing?

Who Can Order Skin Allergy Testing

Clinicians who can perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing include allergist-immunologists, otolaryngologists, dermatologists, and primary care physicians with appropriate training. 1

Qualified Specialists and Their Roles

• Allergist-Immunologists: These specialists are the most comprehensively trained in performing and interpreting allergy testing, including skin prick tests, intradermal tests, and in vitro specific IgE testing 1
• Otolaryngologists (ENT): Often perform allergy testing, particularly for patients with allergic rhinitis and chronic rhinosinusitis, with a higher likelihood of using intradermal testing compared to other specialties 2
• Dermatologists: May perform allergy testing, especially for patients with atopic dermatitis and other skin conditions with potential allergic components 3
• Primary Care Physicians: Can order allergy testing, though they more commonly use in vitro specific IgE testing rather than skin testing, or refer to specialists 2

Testing Indications and Requirements

• Skin allergy testing should be ordered for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy 1
• Any program of allergy testing should be set up and overseen by an allergist, but day-to-day testing can be performed by healthcare professionals who have received appropriate training as determined by the allergist 1
• Healthcare professionals performing skin testing must have:
  • Basic life support training
  • Immediate access to a resuscitation team
  • Access to on-site critical care facilities
  • Equipment for IV and intra-osseous access
  • Immediate access to epinephrine
  • Immediate access to a defibrillator
  • Equipment for airway management 1

Types of Allergy Testing

• Skin Prick Testing: The initial technique for detecting IgE, more specific but less sensitive than intradermal testing 4, 5
• Intradermal Testing: More sensitive but less specific than skin prick testing, involves injecting a small amount of allergen into the dermis 4, 5
• In Vitro Specific IgE Testing: Blood tests that quantify free specific serum IgE, with approximately 70-75% sensitivity compared to skin prick tests 1

Safety Considerations

• Systemic reactions to skin testing are rare (33 per 100,000 tests) but can occur, particularly in patients with asthma 6
• The risk varies by allergen tested:
  • Latex: 152-228 reactions per 100,000 tests
  • Penicillin and antibiotics: 72 reactions per 100,000 tests
  • Aeroallergens: 15-23 reactions per 100,000 tests 6
• Due to these risks, appropriate emergency equipment and trained personnel must be available when skin testing is performed 1

Common Pitfalls to Avoid

• Ordering testing without clinical suspicion of a symptom-provoking episode can lead to misleading or inaccurate results due to false positives 1
• Using laboratory-offered standard panels of common foods should be discouraged; testing should be limited to what reasonably may have provoked the reaction 1
• Misinterpreting positive test results as definitive diagnosis of clinical allergy rather than evidence of sensitization 1
• Failing to correlate test results with the patient's clinical history and symptoms 1