Skin Tests for Immediate Hypersensitivity

  • Charlotte Gotthard MortzEmail author
  • Carsten Bindslev-Jensen
Living reference work entry


Skin testing for immediate hypersensitivity serves as a very useful tool in the diagnostic workup of a suspected allergic patient, but it is mandatory to bear in mind that the tests measure sensitization and not clinical disease. Most widely used are skin prick tests (SPT), whereas intracutaneous (intradermal) testing (ICT) should be restricted to cases where skin prick testing is negative and only performed with sterile material. Any soluble allergen can be used for SPT, as long as it is noninfectious or nontoxic, but care should be taken to avoid false-positive or false-negative reactions. Other skin tests like skin application food test, open application test, or scratch-patch test should not be used routinely outside specialized settings.


Skin prick test Intracutaneous test Immediate hypersensitivity Type I allergy Sensitization 


  1. 1.
    Poulsen LK (2001) In vivo and in vitro techniques to determine the biological activity of food allergens. J Chromatogr B 756:41–55CrossRefGoogle Scholar
  2. 2.
    Brockow K, Romano A, Aberer W et al (2009) Skin testing in patients with hypersensitivity reactions to iodinated contrast media – a European multicenter study. Allergy 64:234–241CrossRefGoogle Scholar
  3. 3.
    Calabria CW, Hagen L (2008) The role of intradermal skin testing in inhalant allergy. Ann Allergy Asthma Immunol 101(4):337–347CrossRefGoogle Scholar
  4. 4.
    Hansen TK, Host A, Bindslev-Jensen C (2004) An evaluation of the diagnostic value of different skin tests with egg in clinical egg-allergic children having atopic dermatitis. Pediatr Allergy Immunol 15:428–434CrossRefGoogle Scholar
  5. 5.
    Henzgen M, Ballmer-Weber BK, Erdmann S et al (2008) Skin testing with food allergens. Guideline of the German Society of Allergology and Clinical Immunology (DGAKI), the physicians’ Association of German Allergologists (ADA) and the society of pediatric Allergology (GPA) together with the Swiss Society of Allergology. J Dtsch Dermatol Ges 6(11):983–988CrossRefGoogle Scholar
  6. 6.
    Oppenheimer J, Nelson HS (2006) Skin testing. Ann Allergy Asthma Immunol 96(2 suppl):6–12CrossRefGoogle Scholar
  7. 7.
    Oranje AP, Van Gysel D, Mulder D et al (1994) Food-induced contact urticaria syndrome (CUS) in atopic dermatitis: reproducibility of repeated and duplicate testing with skin provocation test, the skin application food test (SAFT). Contact Dermatitis 31(5):314–318CrossRefGoogle Scholar
  8. 8.
    Osterballe M, Scheller R, Skov PS et al (2003) Diagnostic value of scratch-chamber test, skin prick test, histamine release and specific IgE in birch-allergic patients with oral allergy syndrome to apple. Allergy 58(9):950–953CrossRefGoogle Scholar
  9. 9.
    Romano A, Demoly P (2007) Recent advances in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol 7:299–303CrossRefGoogle Scholar
  10. 10.
    De Waard-van Der Spek FB, Elst EF, Mulder PG et al (1998) Diagnostic tests in children with atopic dermatitis and food allergy. Allergy 53(11):1087–1091Google Scholar
  11. 11.
    Brockow K, Garvey LH, Aberer W et al (2013) Skin test concentrations for systemic administered drugs- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 68(6):702–712CrossRefGoogle Scholar
  12. 12.
    Garvey LH, Ebo DG, Mertes P et al (2019) An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions. Allergy 74(10):1872–1884Google Scholar
  13. 13.
    Petersen LJ, Mosbech H, Skov PS (1996) Allergen-induced histamine release in intact human skin in vivo assessed by skin microdialysis technique: characterization of factors influencing histamine releasability. J Allergy Clin Immunol 97(2):672–679CrossRefGoogle Scholar
  14. 14.
    Valenta R, Karaulov A, Niederberger V et al (2018) Allergen extracts for in vivo diagnosis and treatment of allergy: is there a future? J Allergy Clin Immunol Pract 6:1845–1855CrossRefGoogle Scholar
  15. 15.
    Pomés A, Butts CL, Chapman MD (2006) Quantification of Ara h 1 in peanuts: why roasting makes a difference. Clin Exp Allergy 36(6):824–830CrossRefGoogle Scholar
  16. 16.
    Ayuso R, Reese G, Leong-Kee S et al (2002) Molecular basis of arthropod cross-reactivity: IgE-binding cross-reactive epitopes of shrimp, house dust and cockroach tropomyosins. Int Arch Allergy Immunol 129(1):38–48CrossRefGoogle Scholar
  17. 17.
    Blanca M, Romano A, Torres MJ et al (2009) Update on the evaluation of hypersensitivity reactions to betalactams. Allergy 64(2):183–193CrossRefGoogle Scholar
  18. 18.
    Petersen LJ, Skov PS (1995) Methacholine induces wheal-and-flare reactions in human skin but does not release histamine in vivo as assessed by the skin microdialysis technique. Allergy 50(12):976–980CrossRefGoogle Scholar
  19. 19.
    Williams PB, Nolte H, Dolen WK et al (1992) The histamine content of allergen extracts. J Allergy Clin Immunol 89(3):738–745CrossRefGoogle Scholar
  20. 20.
    Garvey LH, Kroigaard M, Poulsen LK et al (2007) IgE-mediated allergy to chlorhexidine. J Allergy Clin Immunol 120(2):490–515CrossRefGoogle Scholar
  21. 21.
    Tarvainen K, Jolanki R, Estlander T et al (1995) Immunologic contact urticaria du to airborne methylhexahydrophthalic and methyltetrahydrophthalic anhydrides. Contact Dermatitis 32(4):204–209CrossRefGoogle Scholar
  22. 22.
    Romano A, Viola M, Bousquet PJ et al (2007) A comparison of the performance of two penicillin reagent kits in the diagnosis of β-lactam hypersensitivity. Allergy 62:53–58CrossRefGoogle Scholar
  23. 23.
    Dreborg S (1989) The skin prick test in the diagnosis of atopic allergy. J Am Acad Dermatol 21(4 pt 2):820–821CrossRefGoogle Scholar
  24. 24.
    Kjaer HF, Eller E, Host A et al (2008) The prevalence of allergic diseases in an unselected group of 6-year old children. The DARC birth cohort study. Pediatr Allergy Immunol 19(8):737–745CrossRefGoogle Scholar
  25. 25.
    Van Kampen V, de Blay F, Kobierski P et al (2013) EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy 34:580–584CrossRefGoogle Scholar
  26. 26.
    Heinzerling L, Frew AJ, Bindslev-Jensen C et al (2005) Standard prick testing and sensitization to inhalant allergens across Europe – a survey from the GALEN network. Allergy 60(10):1287–1300CrossRefGoogle Scholar
  27. 27.
    Poulsen LK, Liisberg C, Bindslev-Jensen C et al (1993) Precise area determination of skin-prick tests: validation of a scanning device and software for a personal computer. Clin Exp Allergy 23(1):61–68CrossRefGoogle Scholar
  28. 28.
    Liccardi G, D’Amato G, Canonica GW et al (2006) Systemic reactions from skin testing: literature review. J Investig Allergol Clin Immunol 16(2):75–78PubMedGoogle Scholar
  29. 29.
    Sellaturay P, Nasser S, Ewan P (2015) The incidence and features of systemic reactions to skin prick tests. Ann Allergy Asthma Immunol 115:229–233CrossRefGoogle Scholar
  30. 30.
    Grattan CE, Wallington TB, Warin RP et al (1986) A serological mediator in chronic idiopathic urticaria – a clinical, immunological and histological evaluation. Br J Dermatol 114(5):583–590CrossRefGoogle Scholar
  31. 31.
    Bousquet PJ, Demoly P, Romano A et al (2009) Pharmacovigilance of drug allergy and hypersensitivity using the ENDA-DAHD database and the GALEN platform. The Galenda project. Allergy 64(2):194–203CrossRefGoogle Scholar
  32. 32.
    Oranje AP (1991) Skin provocation test (SAFT) based on contact urticaria: a marker of dermal food allergy. Curr Probl Dermatol 20:228–231CrossRefGoogle Scholar
  33. 33.
    Lahti A (1980) Non-immunologic contact urticaria. Acta Derm Venereol Suppl (Stockh) 91:1–49Google Scholar
  34. 34.
    Lahti A (1986) Contact urticaria to plants. Clin Dermatol 4(2):127–136CrossRefGoogle Scholar
  35. 35.
    Thormann H, Paulsen E (2008) Contact urticaria to common ivy (Hedera helix cv. ‘Hester’) with concomitant immediate sensitivity to the labiate family (Lamiaceae) in a Danish gardener. Contact Dermatitis 59:179–180CrossRefGoogle Scholar
  36. 36.
    Usmani N, Wilkinson SM (2007) Allergic skin disease: investigation of both immediate- and delayed-type hypersensitivity is essential. Clin Exp Allergy 37:1541–1546PubMedGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Charlotte Gotthard Mortz
    • 1
    Email author
  • Carsten Bindslev-Jensen
    • 1
  1. 1.Department of Dermatology and Allergy CentreOdense University HospitalOdenseDenmark

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