Sir.—We read with great interest the article by Ownby and Bailey.1 While we agree with the authors that there is no reason for including in vitro tests for allergen-specific IgE in the current diagnosis of reaginic-mediated inhalant allergy in children, we disagree with the interpretation of the results concerning the skin tests that led them to conclude that the intradermal technique is more sensitive than prick tests and the in vitro radioallergosorbent (RAST) and multiple allergosorbent (MAST) tests.
In our experience all patients with
negative prick tests and negative RAST reactions and positive intradermal test reactions show a negative challenge (conjunctival and/or nasal and/or bronchial provocation challenge with the suspected inhalant allergens). We therefore believe that these positive intradermal skin tests are false-positive reactions (low specificity of the test) and that the negative reaction of the prick test and the positive RAST or MAST reaction in some patients
LONGO G, STRINATI R, TEDESCO F. Diagnostic Sensitivity and Specificity of Prick vs Intradermal Skin Tests. Am J Dis Child. 1986;140(9):855-856. doi:10.1001/archpedi.1986.02140230025014