PATCH TEST  tes tempel in Indonesia Unfortunately, the timing of the reactions to

 Purpose: for studying delayed contact different allergens does not necessarily follow the
hypersensitivity timing of the readings. Delayed readings, 1 week
 Indication: whenever allergic component of the after application, are highly recommended,
dermatitis is suspected; in patients with chronic or especially for some slow-reacting allergens, such as
nonresponsive eczematous dermatitis, stasis neomycin or corticosteroids, among others; even Ni
dermatitis, atopic dermatitis, nummular eczema and
may be a slow-reacting allergen
unclassified eczema, eczematous psoriasis, essential
pruritus and suspected drug eruptions
 Material and procedures: Patch testing involves the
application of specific allergens directly to the skin
under controlled conditions, causing a local allergic
reaction in a susceptible (sensitized) person.
Allergens are applied in hypoallergenic chambers,
which are mounted on adhesive tape and attached
to the upper back of the patients

 The classification and score grading of patch test

reactions depends on descriptive morphology.
Typical morphological features of an allergic test
response are erythema, edema, papules and vesicles
(or bullae). At least an erythematous infiltration
and/or papules should be present for a reaction to
be considered allergic, while reactions that show
only erythema without infiltration – called doubtful
reactions – are frequently nonspecific or correspond
to irritancy

 Validity of testing:
false-negative: the allergen concentration is too low
to elicit a response; the vehicle may not have
released a sufficient amount of the allergen; the test
site might have been inappropriate, or the patient's
skin is unresponsive by prior sun exposure,
concurrent immunosuppressive therapies or other
causes
false-positive: testing with allergens that are
 The readings of the patch test results are performed marginally irritant, such as metals, formaldehyde or
epoxi resin; testing with allergens at concentrations
48 h after application, approximately 30 min after
that exceed their irritancy thresholds; spill-over
the removal of the patches and again after 72 h
reaction from a nearby true-positive reaction, etc.
and/or preferably 96 h after application.

 Skin prick testing (SPT)  tes tusuk - the primary
mode of skin testing for immediate IgE-mediated
allergy
 Small amounts of allergen are introduced into the
epidermis and non-vascular superficial dermis and
interact with specific IgE bound to cutaneous mast
cells. Histamine and other mediators are released,
leading to a visible “wheal-and-flare” reaction
peaking after about 15 minutes
 The following conditions are generally accepted
indications for allergy skin prick testing:
 Rhinitis/rhinoconjunctivitis
 Asthma
 Atopic dermatitis
 Food reactions such as those manifested by
anaphylaxis, immediate acute urticaria, or acute
flare of eczema
 Suspected latex allergy
 Intradermal testing (IDT) - Relevant to both
immediate IgE-mediated allergy and delayed-type
hypersensitivity
 Intradermal skin testing has more specialised
applications such as testing for IgE-mediated drug
allergy, particularly penicillins, and venom allergy.
It carries a higher risk of anaphylaxis and is
generally restricted to a hospital or specialist
setting
 Conditions for which intradermal testing is
appropriate: Intradermal testing may be used in
the diagnosis of:
 Insect venom hypersensitivity
 Immediate allergy to beta-lactam drugs, other
drugs where validated protocols exist
 Immediate hypersensitivity to some vaccines
 Intradermal testing is recommended for
hospital or specialist use only. Intradermal
testing is not indicated for aeroallergens, and is
contraindicated in routine practice for food
allergy
 The strongest indications for skin prick testing are
where there is good evidence for the effectiveness
of allergen avoidance or allergen immunotherapy
 Skin prick tests are also frequently used for
epidemiological purposes or to define atopy in an
individual without specific disease diagnosis
considerations. A definition of atopy is “the
genetically determined tendency to produce
specific IgE to common environmental allergens”.
A positive reaction to one or more of a panel of the
most prevalent allergens to which the subject or
population is likely to be exposed defines the
subject as atopic
Intradermal skin testing
 Allergens are injected intradermally to produce a
small bleb, and the outcome measure is an
increase in the size of the wheal at 20 minutes.
Allergens need to be diluted (100 - 1,000 fold)
from the concentrations used for skin prick testing
Sources:
http://www.allergy.org.au/images/stories/pospapers/ASCIA_SPT_M
anual_November_2013.pdf,Oxford Handbook of Clinical and
Laboratory Investigation; medscape