Quantitative skin testing for allergy: IDT and MQT

129 Pages·2006·1.71 MB·English

by  Bradley F. Marple

Quantitative Skin
Testing for Allergy
IDT and MQT
Second Edition

Quantitative Skin
Testing for Allergy
IDT and MQT
Second Edition
Bradley F. Marple, M.D.
Professor and Vice Chairman
Department of Otolaryngology–Head and Neck Surgery
T.C. Lupton Family Professorship in Patient Care
in honor of Dr. John Dowling McConnell and
Dr. David Andrew Pistenmaa
University of Texas Southwestern
Medical Center
Dallas, Texas
Richard L. Mabry, M.D., F.A.A.O.A., Sc.F.A.C.A.A.I.
Clinical Professor
Department of Otolaryngology–Head and Neck Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
University of Texas Medical Branch
Galveston, Texas
University of Texas Health Science Center
San Antonio, Texas
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LibraryofCongressCataloging-in-PublicationData
Quantitativeskintestingforallergy:IDTandMQT/[editedby]Bradley
FranklinMarple,RichardL.Mabry.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-58890-430-0(TMP:alk.paper)
ISBN-10:1-58890-430-X(TMP:alk.paper)
ISBN-13:978-3-13-142251-4(GTV:alk.paper)
ISBN-10:3-13-142251-3(GTV:alk.paper)
1.Skintests. 2.Allergy–Diagnosis. I.Marple,BradleyF. II.Mabry,RichardL.
[DNLM: 1.SkinTests–methods. 2.Hypersensitivity. 3.IntradermalTests–methods.QY260Q12006]
RC587.S6Q362006
616.97’075--dc22 2006010063
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Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
1 The Evolution ofSkinTesting in Otolaryngic Allergy. . . . . . . 1
Richard L. Mabry
2 Preparing the Office for SkinTesting . . . . . . . . . . . . . . . . . . . 4
Bryan D. Leatherman
3 AntigenChoice for SkinTesting.. . . . . . . . . . . . . . . . . . . . . . 17
Edwyn L. Boyd
4 Whealing Responses toIntradermal Testing: The Basis
for Intradermal Dilutional Testing(IDT). . . . . . . . . . . . . . . . 22
Richard L. Mabry
5 The Mechanics and Interpretation ofIDT. . . . . . . . . . . . . . . 28
Bradley F.Marpleand RichardL. Mabry
6 The Mechanics and Interpretation of
Multiple-PrickTesting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
John H.Krouse
7 Blending Methods: Modified QuantitativeTesting (MQT) . . 42
John H.Krouse
8 VialPreparation Basedon QuantitativeTesting. . . . . . . . . . 48
Richard C. HaydonIII
9 ImmunotherapyBased on QuantitativeTesting. . . . . . . . . . 65
StephenJ. Chadwick
10 PreventionandManagementofAnaphylaxis. . . . . . . . . . . . 75
Bruce R.Gordon
Appendix 1 GlossaryofCommonTermsUsed in
Otolaryngic Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
M.JenniferDerebery
Appendix 2 AeroallergenPanels . . . . . . . . . . . . . . . . . . . . . . . 97
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
vii

Preface
Overadecadeago,themonographSkinEndpointTitrationfirstappearedin
print.Itwasmeanttobeauser-friendlytoolthatwouldenablephysicians,
nurses, and allergy assistants to incorporate quantitative allergy skin
testingintotheirpractice.Thesuccessofthismonographwasattributable
toitssimpleandstraightforwardexplanationofastandardizedapproachto
quantitative testing. As with any enduring document, however, its utility
had become challenged by the evolution of our knowledge base and its
impactonthepracticeofmedicine.
Over the course of the past decade, several forces have come to bear
on the role that allergy plays in the practice of otolaryngology.
Demographic and practiceanalysesperformed by theAmerican Academy
of Otolaryngology–Head and Neck Surgery support a long history of
epidemiologic data strongly suggesting that allergy impacts virtually all
aspects of otolaryngology (indeed any specialty that deals with diseases
of the upper and lower respiratory tract). As such, the addition of allergy
to one’s practice appears to add value to patient care, enabling patients
to receive more comprehensive care. The epidemiologic data have been
the basis for recent national educational and practice certification
changes mandating that allergy be included in the education of residents
and fundamental to the practice of otolaryngology. This inclusion, in
turn, has served to drive renewed interest in allergy in academia, which
is necessary for increased research in the field. The end result is that the
past ten years have set the stage for a renaissance in our understanding
of skin testing methodologyand have opened the door to the emergence
ofnoveltechniques.
This book, like its predecessor, is designed to be user-friendly and
practical and is fundamentally based in the principles of evidence-based
medicine. By the very nature of the project, it is our intent to introduce
new approaches to skin testing while revisiting traditional techniques
to enable contrast and comparison. The reader is encouraged to consult
the references at the end of each chapter for further information and to
augment the information contained herein byattendance at courses that
provide more detailed information coupled with hands-on experience.
Theeditors and contributors will be the first to say that this text will not
ix