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By Mark H. Moss MD, Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)
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Additional resources for Allergic Diseases: Diagnosis and Treatment
Patients must not be taking antihistamines or drugs with antihistamine actions, such as tricyclic antidepressants, because these agents can block skin test responses. Patients with severe skin disease or with marked dermatographism cannot be reliably tested. Both the very young and the very old have less reactive skin, and criteria for grading skin test reactions need to be adjusted in these individuals. Following viral exanthems or sunburns the skin may not be normally reactive for several weeks, and skin testing should be postponed.
From: Current Clinical Practice: Allergic Diseases: Diagnosis and Treatment, 2nd Edition Edited by: P. Lieberman and J. , Totowa, NJ 29 Ownby 30 Table 1 Criteria for Diagnosis of Allergic Disease Absolute Criteria (The Gold Standard) 1. Reproducible symptoms occurring during double-blind, placebo-controlled, allergen exposure when the route, dose, and duration of allergen exposure are consistent with estimated or measured natural or occupational exposure. 2. The observed symptoms must be the direct result of the release of chemical mediators when the release of the mediators is triggered by the binding of lgE antibodies to the allergen.
As with prick or puncture tests, intradermal tests should be placed at least 6 em apart to prevent interactions leading to false-positive results. The most common errors with intradermal tests are injecting too deeply, injecting too large a volume, and inducing excess bleeding. If extract is injected too deeply, little or no reaction will be visible on the surface of the skin. Injecting too large a volume may lead to false-positive reactions because of irritation, and a large volume increases the risk of a systemic reaction.
Allergic Diseases: Diagnosis and Treatment by Mark H. Moss MD, Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)