Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

Marek L Kowalski 1, Ignacio Ansotegui 2, Werner Aberer 3, Mona Al-Ahmad 4, Mubeccel Akdis 5, Barbara K Ballmer-Weber 6, Kirsten Beyer 7, Miguel Blanca 8, Simon Brown 9, Chaweewan Bunnag 10, Arnaldo Capriles Hulett 11, Mariana Castells 12, Hiok Hee Chng 13, Frederic De Blay 14, Motohiro Ebisawa 15, Stanley Fineman 16, David B K Golden 17, Tari Haahtela 18, Michael Kaliner 19, Connie Katelaris 20, Bee Wah Lee 21, Joanna Makowska 22, Ulrich Muller 23, Joaquim Mullol 24, John Oppenheimer 25, Hae-Sim Park 26, James Parkerson 27, Giovanni Passalacqua 28, Ruby Pawankar 29, Harald Renz 30, Franziska Rueff 31, Mario Sanchez-Borges 32, Joaquin Sastre 33, Glenis Scadding 34, Scott Sicherer 35, Pongsakorn Tantilipikorn 10, James Tracy 36, Vera van Kempen 37, Barbara Bohle 38, G Walter Canonica 39, Luis Caraballo 40, Maximiliano Gomez 41, Komei Ito 42, Erika Jensen-Jarolim 43, Mark Larche 44, Giovanni Melioli 45, Lars K Poulsen 46, Rudolf Valenta 47, Torsten Zuberbier 48

Affiliations

12 October 2016

-

doi: 10.1186/s40413-016-0122-3

Abstract

One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation. Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures. Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended. This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.

References

 

  1. Pepys J. Skin testing. Br J Hosp Med (Lond) 1975;14:412–17.
  2. Piette V, Bourret E, Bousquet J, Demoly P. Prick tests to aeroallergens: is it possible simply to wipe the device between tests? Allergy. 2002;57:940–942. doi: 10.1034/j.1398-9995.2002.23536.x. - DOI - PubMed
  3. Masse MS, Granger Vallee A, Chiriac A, Dhivert-Donnadieu H, Bousquet-Rouanet L, Bousquet PJ, Demoly P. Comparison of five techniques of skin prick tests used routinely in Europe. Allergy. 2011;66:1415–1419. doi: 10.1111/j.1398-9995.2011.02679.x. - DOI - PubMed
  4. Brown WG, Halonen MJ, Kaltenborn WT, Barbee RA. The relationship of respiratory allergy, skin test reactivity, and serum IgE in a community population sample. J Allergy Clin Immunol. 1979;63:328–335. doi: 10.1016/0091-6749(79)90127-1. - DOI - PubMed
  5. Nelson HS, Rosloniec DM, McCall LI, Ikle D. Comparative performance of five commercial prick skin test devices. J Allergy Clin Immunol. 1993;92:750–756. doi: 10.1016/0091-6749(93)90019-C. - DOI - PubMed
  6. Oppenheimer J, Nelson HS. Skin testing. Ann Allergy Asthma Immunol. 2006;96:S6–12. doi: 10.1016/S1081-1206(10)60895-2. - DOI - PubMed
  7. Bock SA, Buckley J, Holst A, May CD. Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Clin Allergy. 1977;7:375–383. doi: 10.1111/j.1365-2222.1977.tb01466.x. - DOI - PubMed
  8. Skassa-Brociek W, Manderscheid JC, Michel FB, Bousquet J. Skin test reactivity to histamine from infancy to old age. J Allergy Clin Immunol. 1987;80:711–716. doi: 10.1016/0091-6749(87)90292-2. - DOI - PubMed
  9. Australasian Society of Clinical Immunology and Allergy. Skin Prick Testing for the diagnosis of allergic diseases – A Manual for Practitioners [http://www.allergy.org.au/health-professionals/papers/skin-prick-testing], 2006, Revised May 2013.
  10. Liccardi G, D’Amato G, Canonica GW, Salzillo A, Piccolo A, Passalacqua G. Systemic reactions from skin testing: literature review. J Investig Allergol Clin Immunol. 2006;16:75–78. - PubMed
  11. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST) J Allergy Clin Immunol. 1987;79:660–677. doi: 10.1016/S0091-6749(87)80164-1. - DOI - PubMed
  12. Bernstein DI, Wanner M, Borish L, Liss GM, Immunotherapy Committee AAoAA, Immunology Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001. J Allergy Clin Immunol. 2004;113:1129–1136. doi: 10.1016/j.jaci.2004.02.006. - DOI - PubMed
  13. Norrman G, Falth-Magnusson K. Adverse reactions to skin prick testing in children - prevalence and possible risk factors. Pediatr Allergy Immunol. 2009;20:273–278. doi: 10.1111/j.1399-3038.2008.00761.x. - DOI - PubMed
  14. Turkeltaub PC, Gergen PJ. The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements: data from the second National Health and Nutrition Examination Survey 1976-80 (NHANES II) J Allergy Clin Immunol. 1989;84:886–890. doi: 10.1016/0091-6749(89)90384-9. - DOI - PubMed
  15. Valyasevi MA, Maddox DE, Li JT. Systemic reactions to allergy skin tests. Ann Allergy Asthma Immunol. 1999;83:132–136. doi: 10.1016/S1081-1206(10)62624-5. - DOI - PubMed
  16. Swender DA, Chernin LR, Mitchell C, Sher T, Hostoffer R, Tcheurekdjian H. The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010. Allergy Rhinol (Providence) 2012;3:e55–60. doi: 10.2500/ar.2012.3.0034. - DOI - PMC - PubMed
  17. Devenney I, Falth-Magnusson K. Skin prick tests may give generalized allergic reactions in infants. Ann Allergy Asthma Immunol. 2000;85:457–460. doi: 10.1016/S1081-1206(10)62571-9. - DOI - PubMed
  18. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DB, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R, American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1–148. - PubMed
  19. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, Canonica GW, Carlsen KH, Cox L, Haahtela T, Lodrup Carlsen KC, Price D, Samolinski B, Simons FE, Wickman M, Annesi-Maesano I, Baena-Cagnani CE, Bergmann KC, Bindslev-Jensen C, Casale TB, Chiriac A, Cruz AA, Dubakiene R, Durham SR, Fokkens WJ, Gerth-van-Wijk R, Kalayci O, Kowalski ML, Mari A, Mullol J, Nazamova-Baranova L, O’Hehir RE, Ohta K, Panzner P, Passalacqua G, Ring J, Rogala B, Romano A, Ryan D, Schmid-Grendelmeier P, Todo-Bom A, Valenta R, Woehrl S, Yusuf OM, Zuberbier T, Demoly P, Global Allergy and Asthma European Network; Allergic Rhinitis and its Impact on Asthma Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67:18–24. doi: 10.1111/j.1398-9995.2011.02728.x. - DOI - PubMed
  20. Lockey RF, Turkeltaub PC, Olive CA, Baird-Warren IA, Olive ES, Bukantz SC. The Hymenoptera venom study II. Skin test results and safety of venom skin testing. J Allergy Clin Immunol. 1989;84:967–74. doi: 10.1016/0091-6749(89)90396-5. - DOI - PubMed
  21. Strohmeier B, Aberer W, Bokanovic D, Komericki P, Sturm GJ. Simultaneous intradermal testing with Hymenoptera venoms is safe and more efficient than sequential testing. Allergy. 2013;68:542–4. doi: 10.1111/all.12123. - DOI - PubMed
  22. Yocum MW, Gosselin VA, Yungunger JW. Safety and efficacy of an accelerated method for venom skin testing. J Allergy Clin Immunol. 1996;97:1424–5. doi: 10.1016/S0091-6749(96)70217-8. - DOI - PubMed
  23. Golden DBK, Moffitt J, Nicklas RA, Freeman T, Graft DF, Reisman RE, Tracy JM, Bernstein D, Blessing-Moore J, Cox L, Khan DA, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D, Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma and Immunology Stinging insect hypersensitivity: A practice parameter update 2011. J Allergy Clin Immunol. 2011;127:852–4. doi: 10.1016/j.jaci.2011.01.025. - DOI - PubMed
  24. Cox L, Williams B, Sicherer S, Oppenheimer J, Sher L, Hamilton R, Golden D, American College of Allergy, Asthma and Immunology Test Task Force; American Academy of Allergy, Asthma and Immunology Specific IgE Test Task Force Pearls and pitfalls of allergy diagnostic testing: report from the American College of Allergy Asthma and Immunology/American Academy of Allergy Asthma and Immunology Specific IgE Test Task Force. Ann Allergy Asthma Immunol. 2008;101:580–592. doi: 10.1016/S1081-1206(10)60220-7. - DOI - PubMed
  25. Kränke B, Aberer W. Skin testing for IgE-mediated drug allergy. Immunol Allergy Clin N Am. 2009;29:503–516. doi: 10.1016/j.iac.2009.04.003. - DOI - PubMed
  26. Barbaud A. Skin testing in delayed reactions to drugs. Immunol Allergy Clin N Am. 2009;29:517–35. doi: 10.1016/j.iac.2009.04.010. - DOI - PubMed
  27. Romano A, Viola M, Mondino C, Pettinato R, Di Fonso M, Papa G, Venuti A, Montuschi P. Diagnosing nonimmediate reactions to penicillins by in vivo tests. Int Arch Allergy Immunol. 2002;129:169–174. doi: 10.1159/000065876. - DOI - PubMed
  28. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nesser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I, ENDA/EAACI Drug Allergy Interest Group Skin test concentrations for systemically administered drugs – an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702–712. doi: 10.1111/all.12142. - DOI - PubMed
  29. Barbaud A, Reichert-Penetrat S, Trechot P, Jacquin-Petit MA, Ehlinger A, Noirez V, Faure GC, Schmutz JL, Béné MC. The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol. 1998;139:49–58. doi: 10.1046/j.1365-2133.1998.02313.x. - DOI - PubMed
  30. Romano A, Viola M, Gaeta F, Rumi G, Maggioletti M. Patch testing in non-immediate drug eruptions. Allergy, Asthma and Clin Immunol. 2008;4:66–74. doi: 10.1186/1710-1492-4-2-66. - DOI - PMC - PubMed
  31. Rive CM, Bourke J, Phillips EJ. Testing for drug hypersensitivity syndromes. Clin Biochem Rev. 2013;34:15–38. - PMC - PubMed
  32. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57:45–51. - PubMed
  33. Barbaud A, Gonçalo M, Bruynzeel D, Bircher A, European Society of Contact Dermatitis Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermatitis. 2001;45:321–328. doi: 10.1034/j.1600-0536.2001.450601.x. - DOI - PubMed
  34. Alanko K. Patch testing in cutaneous reactions caused by carbamazepine. Contact Dermatitis. 1993;29:254–257. doi: 10.1111/j.1600-0536.1993.tb03560.x. - DOI - PubMed
  35. Barbaud A, Trechot P, Weber-Muller F, Ulrich G, Commun N, Schmutz JL. Drug skin tests in cutaneous adverse drug reactions to pristinamycin: 29 cases with a study of cross-reactions between synergistins. Contact Dermatitis. 2004;50:22–26. doi: 10.1111/j.0105-1873.2004.00280.x. - DOI - PubMed
  36. Mashiah J, Brenner S. A systemic reaction to patch testing for the evaluation of acute generalized exanthematous pustulosis. Arch Dermatol. 2003;139:1181–1183. doi: 10.1001/archderm.139.9.1181. - DOI - PubMed
  37. van Kampen V, Merget R, Baur X. Occupational airway sensitizers: an overview on the respective literature. Am J Ind Med. 2000;38:164–218. doi: 10.1002/1097-0274(200008)38:2<164::AID-AJIM7>3.0.CO;2-2. - DOI - PubMed
  38. Baur X, Bakehe P. Allergens causing occupational asthma: an evidence-based evaluation of the literature. Int Arch Occup Environ Health. 2014;87:339–63. doi: 10.1007/s00420-013-0866-9. - DOI - PubMed
  39. van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Kotschy-Lang N, Müsken H, Mahler V, Schliemann S, Ochmann U, Sültz J, Worm M, Sander I, Zahradnik E, Brüning T, Merget R, Raulf-Heimsoth M. Evaluation of commercial skin prick test solutions for selected occupational allergens. Allergy. 2013;68:651–658. doi: 10.1111/all.12116. - DOI - PubMed
  40. Bergman A, Svedberg U, Nilsson E. Contact urticaria with anaphylactic reactions caused by occupational exposure to iridium salt. Contact Dermatitis. 1995;32:14–17. doi: 10.1111/j.1600-0536.1995.tb00833.x. - DOI - PubMed
  41. Van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Raulf-Heimsoth M. EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy. 2013;68:580–584. doi: 10.1111/all.12120. - DOI - PubMed
  42. Cabañes N, Igea JM, de la Hoz B, Agustín P, Blanco C, Domínguez J, Lázaro M, Lleonart R, Méndez J, Nieto A, Rodríguez A, Rubia N, Tabar A, Beitia JM, Dieguez MC, Martínez-Cócera C, Quirce S, Committee of Latex Allergy SEAIC. Latex allergy: Position Paper. J Investig Allergol Clin Immunol. 2012;22:313–30. - PubMed
  43. Chua X, Mohamed J, van Bever HP. Prevalence of latex allergy in spina bifida patients in Singapore. Asia Pac Allergy. 2013;3:96–99. doi: 10.5415/apallergy.2013.3.2.96. - DOI - PMC - PubMed
  44. Kelly KJ, Kurup V, Zacharisen M, Resnick A, Fink JN. Skin and serologic testing in the diagnosis of latex allergy. J Allergy Clin Immunol. 1993;91:1140–1145. doi: 10.1016/0091-6749(93)90316-8. - DOI - PubMed
  45. Hamilton RG, Adkinson NF., Jr Diagnosis of natural rubber latex allergy: multicenter latex skin testing efficacy study. Multicenter Latex Skin Testing Study Task Force. J Allergy Clin Immunol. 1998;102:482–490. doi: 10.1016/S0091-6749(98)70139-3. - DOI - PubMed
  46. Hamilton RG, Peterson EL, Ownby DR. Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy. J Allergy Clin Immunol. 2002;110(2 Suppl):S47–56. doi: 10.1067/mai.2002.125334. - DOI - PubMed
  47. Accetta Pedersen DJ, Klancnik M, Elms N, Wang ML, Hoffmann RG, Kurup VP, Kelly KJ. Analysis of available diagnostic tests for latex sensitization in an at-risk population. Ann Allergy Asthma Immunol. 2012;108:94–97. doi: 10.1016/j.anai.2011.11.009. - DOI - PubMed
  48. Nettis E, Dambra P, Traetta PL, Loria MP, Ferrannini A, Tursi A. Systemic reactions on SPT to latex. Allergy. 2001;56:355–356. doi: 10.1034/j.1398-9995.2001.00862.x. - DOI - PubMed
  49. Ravensberg AJ, Van Rensen EL, Grootendorst DC, de Kluijvert J, Diamant Z, Ricciardolo FL, Sterk PJ. Validated safety predictions of airway responses to house dust mite in asthma. Clin Exp Allergy. 2007;37:100–7. doi: 10.1111/j.1365-2222.2006.02617.x. - DOI - PubMed
  50. Taylor DA, Harris JG, O’Connor BJ. Comparison of incremental and bolus dose inhaled allergen challenge in asthmatic subjects. Clin Exp Allergy. 2000;30:56–63. doi: 10.1046/j.1365-2222.2000.00657.x. - DOI - PubMed

Page Navigation