Skin Testing for IgE Mediated Disease can be Done Safely in The Family Practice Office

Abstract

Background: Aeroallergen skin testing for assessing allergic disease has been in use for well over 100 years. Initially, trepidation to the use of skin puncture testing (SPT) occurred because of reported morbidity and mortality. SPT has most frequently been utilized in the specialist office due to fear of adverse reactions. Methods: Analysis of 156,335 SPT tests (morbidity and mortality) allowed equivalency testing versus superiority testing to show 95% confidence level. The ninety-five percent confidence interval around the 11.5/100,000 SPT is (11.3-11.7/100,000). Results: The literature documents 1 death from SPT from 1990 to 2001 and 1 death from 1945 to 1987. These 2 reported deaths have been contrasted with 0 deaths in 125,295 SPT patients reviewed in a primary care setting utilizing United Allergy Service protocols (UAS). Systemic reactions (SR) occurred in only 18 patients. The SR rate amongst subspecialists has been reported as a 0.015-0.023% SR per 100,000 SPT. Statistically, this result is not significantly different from the UAS SR rate of 0.0115% without associated anaphylaxis or deaths. Conclusion: Based on the findings evident in this study, SPT is safely performed in the primary care (PC) office and allows for a larger percentage of the symptomatic population to be assessed. The observed SR rate of 11.5/100,000 SPT was statistically similar to the lowest published rate of 15/100,000 SPT (p=0.45) and statistically lower than the highest published rate of 23/100,000 SPT (p=0.02). These data suggest that SPT is as safe in the (PC) office as it is in the specialist office.