An advisory from two leading allergists urges clinicians to avoid making diagnoses based solely on allergy test results.
In an article published in the January issue of Pediatrics, researchers Robert Wood of the Johns Hopkins Children’s Centre and Scott Sicherer of Mt. Sinai Hospital in New York, warn that blood tests, an increasingly popular diagnostic tool in recent years, and skin-prick testing, an older weapon in the allergist’s arsenal, should never be used as standalone diagnostic strategies.
These tests, the analysts said, should be used only to confirm suspicion and never to look for allergies in a patient showing no symptoms.
Test results, they added, should be interpreted in the context of a patient’s symptoms and medical history. If a food allergy is suspected, Dr. Sicherer and Dr. Wood advised, the patient should undergo a food challenge – the gold standard for diagnosis – which involves consuming small doses of the suspected allergen under medical supervision.
Unlike food challenges, which directly measure an actual allergic reaction, skin tests and blood tests are proxies that detect the presence of IgE antibodies, immune-system chemicals released in response to allergens. Skin testing involves pricking the skin with small amounts of an allergen and observing if and how the skin reacts.
A large hive-like wheal at the injection site signals that the patient’s immune system has created antibodies to the allergen. Blood tests, on the other hand, measure the levels of specific IgE antibodies circulating in the blood.
These tests can tell whether someone is sensitive to a particular substance but cannot reliably predict if a patient will have an actual allergic reaction, nor can they foretell how severe the reaction might be, the scientists said.
Many people who have positive skin tests or elevated IgE antibodies do not have allergies, they cautioned.
In addition, the researchers said, physicians should be careful when comparing results from different tests and laboratories because commercial tests vary in sensitivity.
Also, laboratories may interpret tests results differently making an apples-to-apples comparison challenging, Dr. Wood said.
In their report, the scientists said skin and blood tests can and should be used to:
Confirm a suspected allergic trigger after observing clinical reactions suggestive of an allergy. For example, children with moderate to severe asthma should be tested for allergies to common household or environmental triggers including pollen, moulds, pet dander, cockroach, mice or dust mites.
Monitor the course of established food allergies via periodic testing. Levels of antibodies can help determine whether someone is still allergic, and progressively decreasing levels of antibodies can signify allergy resolution or outgrowing the allergy. Confirm an allergy to insect venom following a sting that causes anaphylaxis.
Determine vaccine allergies (skin tests only).
Conversely, skin and blood tests should not be used:
As general screens to look for allergies in symptom-free children.
In children with history of allergic reactions to specific foods. In this case, the test will add no diagnostic value, the experts say.
To test for drug allergies. Generally, blood and skin tests do not detect antibodies to medications.