British Journal of Anaesthesia, Vol 79, Issue 1 59-63, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. M. Fisher and C. J. Bowey
We have tested the hypothesis that intradermal testing is a more effective
method for determining the drug responsible for anaesthetic anaphylactic
reactions than prick testing in 212 consecutive patients, aged more than 10
yr, referred to an anaesthetic allergy clinic over a 4-yr period. The study
was a prospective, non-randomized design. Intradermal testing was conducted
using a previously described method and diluted drugs, and prick testing
using undiluted drugs (with the exception of opioid analgesics which were
diluted 1:10). The tests were performed on individual patients' forearms on
the same occasion. Patients were followed-up to determine the results of
subsequent anaesthesia and the difference between tests was analysed using
kappa and tau statistics. There was 93% agreement overall between the
paired tests. Which test detected the drug responsible was dependent on
diagnostic criteria for positivity. The differences between the tests were
not statistically significant. Using both tests improved predictability by
67% (tau = 0.67, P < 0.001). We conclude that in the absence of data to
support one test being superior, other factors influence the choice of
test. Prick testing was cheaper, and the reduction in pain and trauma with
prick testing makes it more suitable for children. However, there are no
data available on the safety of subsequent anaesthesia based on the results
of prick testing alone, and reliability with time has not been assessed.
Intradermal testing may be easier for the infrequent user. Skin testing is
valuable in the investigation of anaesthetic anaphylaxis whichever test is
chosen. When there is doubt both tests should be performed.
CLINICAL INVESTIGATIONS
Intradermal compared with prick testing in the diagnosis of anaesthetic allergy
University of Sydney, Intensive Therapy Unit, Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia 2065; Intensive Therapy Unit, Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia 2065
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