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

Leonard Fromer, M.D., F.A.A.F.P.

UCLA School of Medicine
2825 Santa Monica Blvd.
Santa Monica, CA 90404

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.

Corrections

The "Clinical Quiz" in the September 1, 2005, issue (page 750) incorrectly identified Candida species as a dermatophyte in Question 3, pertaining to the article "Intertrigo and Common Secondary Skin Infections," on page 833. The correct answer to this rewritten question is A. Candida species. The question is reprinted below and the online version has been corrected.

Q3. Which one of the following organisms is most commonly associated with intertrigo?

The "Clinical Quiz" in the December 15, 2005, issue (page 2428) had an incorrectly worded question for Question 5, pertaining to the article "An Approach to the Postpartum Office Visit," on page 2491. The correct answer to this rewritten question is C. Ongoing support while breastfeeding. The question is reprinted below and the online version has been corrected.

Q5. According to the U.S. Preventive Services Task Force, which one of the following strategies has the best evidence for increased continuance of breastfeeding at six months ?

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