Suggested evaluations for the five major allergen groups
| Allergen | Recommendations | Methodsa |
|---|---|---|
| Food | National Institute of Allergy and Infectious Diseases states food allergy testing is not indicated for evaluation of mild atopic dermatitis or isolated respiratory symptoms, eg, rhinitis or asthma | Skin-prick testing and serum antigen-specific IgE testing, with caveats |
| Serum immunoglobulin E (IgE) testing is not indicated for food intolerances, which are not mediated by IgE (see Table 2 for differing characteristics) | ||
| Serum IgE testing and skin-prick testing are recommended to confirm suspected allergens; not suitable for indiscriminate screening | ||
| Serum IgE testing and skin-prick testing do not predict reaction severity | ||
| Positive serum IgE testing indicates sensitization but not necessarily clinical allergy | ||
| Serum IgE test results may be negative despite clinical reactivity | ||
| Inhalants | Includes pollen, fungus, epidermis, dust mites | Skin-prick testing |
| Serum IgE tests with defined quantifiable threshold levels can predict positive respiratory responses after allergen exposure | ||
| Skin-prick testing is more sensitive for identifying inhalant allergens and is the preferred method of confirming inhalant allergies | ||
| Latex | The only method for assessing latex allergy approved by the US Food and Drug Administration is serum IgE testing | Serum antigen-specific IgE testing |
| Serum IgE tests can be used to confirm latex allergy, but a negative result does not exclude sensitization | ||
| Drugs | There are no validated diagnostic tests of sufficient sensitivity for evaluation of IgE-mediated allergy to antibiotics other than penicillin | Skin-prick testing for penicillin reaction, serum antigen-specific IgE testing for others |
| For most drugs apart from penicillin, a serum IgE cutoff of 0.35 kU/L is used for allergy evaluation | ||
| Venom | Predictive inconsistencies exist for both skin-prick testing and IgE testing | Skin-prick testing and serum antigen-specific IgE testing |
| Patients with a history of venom reaction should be evaluated by both skin-prick testing and serum IgE testing | ||
| It is important to perform both skin-prick testing and serum IgE testing in patients with a clear history of severe reaction to insect stings when one test has a negative result | ||
| Any nonzero value of venom IgE is considered positive, despite the 0.35 kU/L cutoff | ||
| Performing venom skin-prick testing within the refractory period of the insect sting will result in a high chance of false-negative results | ||
| Serum IgE testing performed within a short period after the insect sting has a high chance of false-negative results, as serum IgE rises slowly after the sting |
↵a Diagnostically invalid tests: cytotoxic tests; provocation-neutralization; electrodermal testing; applied kinesiology; iridology; hair analysis; food-specific IgG, IgG4, IgG/IgG4 antibody tests.