By Mark H. Moss MD, Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)
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Extra resources for Allergic Diseases: Diagnosis and Treatment
Food testing (prick testing only) is infrequently indicated. Except for penicillin testing, skin testing to drugs is not well understood. This testing is usually done in a hospital setting when acceptable substitutes for penicillin cannot be found. Patients may also be skin tested to hymenoptera, or stinging insect, venom, to determine if anaphylactoid reactions are IgE mediated. No matter how strong a history suggests allergy, testing must be done to confirm atopy. An important caveat is that a positive skin test does not prove that allergy is causing the patient's symptoms.
History should attempt to delineate the asthma as mild, moderate, or severe. Degree of severity will ultimately dictate choice and intensity of treatment. Emergency room visits or hospitalization for asthma in the past year or use of oral steroids in the last 6 mo identify the more severe asthmatic. Psychosocial problems, lower socioeconomic status, and history of previous intubation are potential risk factors for increased asthma morbidity and mortality. Questions to determine the extent of asthma control include type and amount of inflammatory medication used, type of delivery system and quality of inhaler technique, frequency of respiratory symptoms and need for ~-agonists, interference with daily activities or sleep, and diurnal peak flow variability if known.
24 Chapter 2 I Approach to the Allergic Patient 25 The most important ancillary test to confirm the diagnosis of allergy is the skin test, which is the "gold standard" in this regard. The skin test results must be interpreted in light of the history to determine the importance of a positive test. tests, based on size of the wheal and flare of a given test, is done in 15 min. Negative (saline) and positive (histamine) controls are placed at the same time, the latter to ensure that antihistamines are not present and blocking reactions.