Allergen Prick-Puncture Skin Testing in the Elderly
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CURRENT OPINION
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Allergen Prick-Puncture Skin Testing in the Elderly Monroe J. King and Richard F. Lockey Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
Abstract
Many older patients present with rhinitis, conjunctivitis, asthma or itching that the patient attributes to allergies. Yet physicians often dismiss allergy in the elderly as irrelevant. Testing elderly patients for allergies is sometimes challenging as changes in the skin may cause difficulty in applying skin tests, and the response of the skin may be difficult to measure. The prick puncture skin test is the preferred method of immediate-type allergy testing, but careful examination of the skin prior to skin testing is important. If the area of skin where allergen skin tests are routinely placed is either atrophic or severely sun damaged, a sun-protected area should be sought. If no suitable area of skin can be identified, in vitro allergen testing should be considered. Skin-test results must be interpreted with care in the elderly. Positive skin tests to an allergen must correlate with a history of exacerbation to the allergen. By identifying specific allergens to which the elderly patient is sensitive, avoidance measures or specific allergen vaccination can be recommended, improving the quality of life and decreasing the need for medications.
Allergy is an abnormal immune response to environmental agents resulting in adverse reactions, which may include anaphylaxis, rhinitis, conjunctivitis, asthma and eczema. The term atopy, as proposed by Coca and Cook in 1923, is used to describe a subgroup of clinical ‘allergies’ involving reaginic or skin-sensitising antibodies (IgE) that are subject to hereditary influences.[1] Today, the terms allergy and atopy are often used interchangeably to describe immediate-type (IgE) allergy. Clinicians generally require the identification of specific IgE antibodies by either skin, in vitro or provocation testing before diagnosing allergies. Many older patients present to physicians with rhinitis, conjunctivitis, asthma or itching that they attribute to allergies, yet have negative responses to allergy skin testing. The purpose of this review is to
summarise the current literature and ongoing studies to better understand the role of allergy in the elderly, especially as measured by the prick-puncture skin test (PPST) response. 1. History and Background of Allergy Skin Testing Blackley, who was the first to perform allergy tests, described the application of pollen to the abraded skin to demonstrate allergy in 1873.[2] Noon[3] and Freeman[4] described scratch tests in 1911 and they remained popular in the US until the 1960s. Mantoux[5] introduced intradermal tests in 1908, which were later adapted for allergy testing by Cooke, offering the advantage of introducing more
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allergen into the dermis. PPSTs were first described by Lewis and Grant in 1924.[6] All immediate-type
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