Environmental Allergy Testing in Children

Alternative Testing Methods

The European Respiratory Society recommends using blood testing when antihistamines cannot be discontinued for medical reasons, as serum-specific IgE measurements are not affected by antihistamine use, with a sensitivity of 0.58-0.90 and specificity of 0.56-0.65 compared to skin prick testing 1, 2
Blood testing is a viable alternative to skin prick testing in patients taking antihistamines or other medications that interfere with test interpretation, according to the European Respiratory Society 1, 2

The European Respiratory Society strongly advises against using skin-prick tests or serum IgE as diagnostic tests for asthma in children aged 5-16 years due to low specificity (0.23-0.40 for skin tests), but recommends their use for phenotyping and planning allergen avoidance strategies after diagnosis 1, 2, 4
Allergy tests, including skin prick testing and serum-specific IgE, should not be used as primary diagnostic tools for asthma in children, as they have limited specificity and may lead to over-diagnosis 3, 4, 5

A positive allergy test indicates sensitization, not necessarily clinical allergy, and correlation with clinical history is essential to establish diagnosis, as noted by the European Respiratory Society 1, 2
The European Respiratory Society recommends correlating all positive results with clinical history before making treatment decisions, to avoid false positives and over-diagnosis 1, 2

Skin prick testing is not practical in children with extensive eczema, dermographism, or urticaria, and in these situations, the European Respiratory Society recommends proceeding directly to serum-specific IgE testing instead of attempting skin testing 1, 2