Letters to the Editor
Diagnosing Allergic Rhinitis: Skin Test vs. IgE Testing
to the editor: I would like to commend the authors of “Vasomotor Rhinitis,”1 in the September 15, 2005, issue of American Family Physician, for raising the issue of testing and its importance in accurately diagnosing allergic versus nonallergic rhinitis.
I believe the article1 implies that skin testing is superior to immunoglobulin E (IgE) testing. Both of these tests have a place in diagnosing patients2; however, because allergic symptoms are highly associated with the production of IgE, a quantitative and objective diagnostic measure such as a specific IgE blood level is important to help accurately identify what is causing a patient's symptoms.3 Furthermore, the latest generation of specific IgE blood tests have been shown to be comparable to skin-prick testing in terms of sensitivity, specificity, and positive and negative predictive value.4 The newest generation assays are significantly more accurate than older radioallergosorbent testing methods.3
In a primary care setting, serum IgE testing using the newest and most accurate methodology is an excellent tool to assist family physicians in accurately diagnosing the cause of symptoms related to rhinitis.5,6
REFERENCES
1. Wheeler PW, Wheeler SF. Vasomotor rhinitis. Am Fam Physician. 2005;72:1057–62.
2. National Asthma Education and Prevention Program. NAEPP expert panel report: guidelines for the diagnosis and management of asthma: update on selected topics 2002. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 2002. NIH publication no. 97–4051.Accessed December 1, 2005, at: http://www.nhlbi.nih.gov/guidelines/asthma/asthupdt.htm.
3. Williams PB, Barnes JH, Szeinbach SL, Sullivan TJ. Analytic precision and accuracy of commercial immunoassays for specific IgE: establishing a standard. J Allergy Clin Immunol. 2000;105:1221–30.
4. Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol. 1999;103:7739.
5. Crobach MJ, Hermans J, Kaptein AA, Ridderikhoff J, Petri H, Mulder JD. The diagnosis of allergic rhinitis: how to combine the medical history with the results of radioallergosorbent tests and skin prick tests. Scand J Prim Health Care. 1998;16:30–6.
6. Current issues relating to in vitro testing for allergen-specific IgE: a workshop report Ann Allergy Asthma Immunol. 1999;82:407–12.
editor's note: This letter was sent to the authors of “Vasomotor Rhinitis,” who declined to reply.
Send letters to Kenny Lin, MD, Assistant Editor, American Family Physician, e-mail: afplet@aafp.org , or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, telephone number, and fax number. Letters should be fewer than 500 words and limited to six references (including citation of original article) and one table or figure.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact
afpserv@aafp.org for copyright questions and/or permission requests.
AFP Home | Past Issues | CME Quiz | Contact AFP | Search AFP
