Am Fam Physician. 2006 May 1;73(9):1517.
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
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.
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