Occupational Asthma Reference

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, 2003;68:580-584,

Keywords: skin prick test, cow, baker, latex, standardisation, IgE

Known Authors

Frederic de Blay, Hopital Universitaires de Strasbourg Frederic de Blay

Joaquin Sastre, Fundacion Jimenez Diaz, Madrid Joaquin Sastre

Giana Moscato, Fondazione Salvatore Maugeri, Pavia Giana Moscato

Santiago Quirce, Madrid Santiago Quirce

Ilenia Folletti, Perugia Ilenia Folletti

Jolanta Walusiak, Lodz Jolanta Walusiak

Monika Raulf-Heimsoth, Bochum Monika Raulf-Heimsoth

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Abstract

Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA (Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists.

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Comments

This study looks at a wide range of skin prick test allergens available in Europe for flour (wheat, rye, Soy) Cow, storage mites and latex. The tests were carried out on 116 bakers, 47 farmers and 33 latex exposed workers, all with work-related rhinitis and/or asthma symptoms. Specific IgE usuing the Phadia ImmunoCap was used as the reference standard rather than the diagnosis based on specific challenge tests. A posive sIgE was >= 0.35kU/l.
Eack skin tests was applied twice in each individual, both were positive in 82% when at least one was positive. i.e. a negative spt may me due to problems with the technique (as well as the antigen). There were substantial differences between antigens from different manufacturers, particularly for rye flour, storage mites and cow. The overall specificity (against sIgE) was 80-100%, but sensitivity was low, particularly for wheat and soy (<60%). The threshold which could be considered positive was often >1.5mm, particularly for flour antigens.
5/6/2013

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