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Clinical relevance is associated with allergen-specific wheal size in skin prick testing

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Abstract
Background: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2)LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. Objective: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. Methods: The GA(2)LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. Results: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size3mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10mm depending on the allergen. Conclusion: These reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.
Keywords
allergy diagnostics, common allergens, sensitization, skin prick test, INHALANT ALLERGENS, HYPERSENSITIVITY, EUROPE, ASTHMA, SENSITIZATION, ALLERGOLOGY, NETWORK, IMMUNOLOGY

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MLA
Haahtela, T et al. “Clinical Relevance Is Associated with Allergen-specific Wheal Size in Skin Prick Testing.” CLINICAL AND EXPERIMENTAL ALLERGY 44.3 (2014): 407–416. Print.
APA
Haahtela, T., Burbach, G., Bachert, C., Bindslev-Jensen, C., Bonini, S., Bousquet, J., Bousquet-Rouanet, L., et al. (2014). Clinical relevance is associated with allergen-specific wheal size in skin prick testing. CLINICAL AND EXPERIMENTAL ALLERGY, 44(3), 407–416.
Chicago author-date
Haahtela, T, GJ Burbach, Claus Bachert, C Bindslev-Jensen, S Bonini, J Bousquet, L Bousquet-Rouanet, et al. 2014. “Clinical Relevance Is Associated with Allergen-specific Wheal Size in Skin Prick Testing.” Clinical and Experimental Allergy 44 (3): 407–416.
Chicago author-date (all authors)
Haahtela, T, GJ Burbach, Claus Bachert, C Bindslev-Jensen, S Bonini, J Bousquet, L Bousquet-Rouanet, PJ Bousquet, M Bresciani, A Bruno, GW Canonica, U Darsow, P Demoly, SR Durham, WJ Fokkens, S Giavi, M Gjomarkaj, C Gramiccioni, ML Kowalski, G Losonczy, M Orosz, NG Papadopoulos, G Stingl, A Todo-Bom, E von Mutius, A Kohli, S Wohrl, S Jarvenpaa, H Kautiainen, L Petman, O Selroos, T Zuberbier, and LM Heinzerling. 2014. “Clinical Relevance Is Associated with Allergen-specific Wheal Size in Skin Prick Testing.” Clinical and Experimental Allergy 44 (3): 407–416.
Vancouver
1.
Haahtela T, Burbach G, Bachert C, Bindslev-Jensen C, Bonini S, Bousquet J, et al. Clinical relevance is associated with allergen-specific wheal size in skin prick testing. CLINICAL AND EXPERIMENTAL ALLERGY. 2014;44(3):407–16.
IEEE
[1]
T. Haahtela et al., “Clinical relevance is associated with allergen-specific wheal size in skin prick testing,” CLINICAL AND EXPERIMENTAL ALLERGY, vol. 44, no. 3, pp. 407–416, 2014.
@article{6863289,
  abstract     = {Background: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2)LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. 
Objective: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. 
Methods: The GA(2)LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. 
Results: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size3mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10mm depending on the allergen. 
Conclusion: These reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.},
  author       = {Haahtela, T and Burbach, GJ and Bachert, Claus and Bindslev-Jensen, C and Bonini, S and Bousquet, J and Bousquet-Rouanet, L and Bousquet, PJ and Bresciani, M and Bruno, A and Canonica, GW and Darsow, U and Demoly, P and Durham, SR and Fokkens, WJ and Giavi, S and Gjomarkaj, M and Gramiccioni, C and Kowalski, ML and Losonczy, G and Orosz, M and Papadopoulos, NG and Stingl, G and Todo-Bom, A and von Mutius, E and Kohli, A and Wohrl, S and Jarvenpaa, S and Kautiainen, H and Petman, L and Selroos, O and Zuberbier, T and Heinzerling, LM},
  issn         = {0954-7894},
  journal      = {CLINICAL AND EXPERIMENTAL ALLERGY},
  keywords     = {allergy diagnostics,common allergens,sensitization,skin prick test,INHALANT ALLERGENS,HYPERSENSITIVITY,EUROPE,ASTHMA,SENSITIZATION,ALLERGOLOGY,NETWORK,IMMUNOLOGY},
  language     = {eng},
  number       = {3},
  pages        = {407--416},
  title        = {Clinical relevance is associated with allergen-specific wheal size in skin prick testing},
  url          = {http://dx.doi.org/10.1111/cea.12240},
  volume       = {44},
  year         = {2014},
}

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