Allergy Reports of Dubious Value in Pediatric Asthma
In my opinion, the authors of this article have it all backwards. They compare the parents’ and childrens’ report of allergies to skin prick testing and found poor correlation. This is not surprising since skin prick testing looks for immediate onset allergy, and I believe that this is not the major contributor to chronic diseases. The delayed type hypersensitivity appears to be much more practical of a measure of sensitivities to foods and environmental influences. I have run IgG4 tests on patients that have almost no reaction in the immediate onset category and yet show a delayed hypersensitivity to almost all items tested.
J Asthma 2000;37:685-690 Reports of allergies by young asthma patients and their parents are “no better than chance” in predicting reaction to skin tests for common allergens, according to findings published in a recent issue of the Journal of Asthma. Despite a well-documented association between allergy and asthma, “little is known concerning how well allergy history actually agrees with skin testing,” Dr. Edward R. Carter and colleagues, from Madigan Army Medical Center, Tacoma, Washington, explain. To investigate, the researchers studied 95 children, aged 4 to 18 years, with physician-documented asthma. Parents and children answered a series of questions on allergy history. The children then underwent skin testing for allergy to cat, dust mite and grass. Comparison of allergy history and skin test reactivity showed that reports had a 65% diagnostic accuracy in identifying allergy to cat. Corresponding figures for dust mite and grass were 50% and 56%. Outcome was not affected by the severity of asthma. Given the poor predictive performance of such reports, Dr. Carter told Reuters Health that “a patient’s allergy history does not predict skin test reactivity, and, thus, one should not base allergy control measures for patients with asthma on skin test results or allergy history alone.” Furthermore, he added that the findings emphasize “the need of performing formal allergy testing…and combining this with allergy history and asthma severity to come up with an individualized plan for allergy control measures in each patient with asthma.”