Skin Testing and Immunotherapy: Standardization in the Seattle Area

Abstract

Guidelines for the standardization of skin testing and subcutaneous allergen immunotherapy practice have been updated and published by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology over the past 4 years. Goals of standardization include uniformity in the practice of skin testing and documentation, consistency in terminology used in allergen immunotherapy vaccine labeling, and improved efficacy of allergen immunotherapy vaccines. The allergen skin test form should include sufficient information for physicians other than the prescribing physician to understand what tests were performed, how they were performed, and how to correctly imterpret results. Important factors to consider when formulating an imunotherapy vaccine include: crossreactivity of allergens, optimal dose of each consistuent allergen, and possible enzymatic degradation of allergens by proteolytic enzymes. In an effort to adhere to published recommendations and to lead other allergists and communities toward standardization, board-certified allergists in the Seattle area have worked to increase the uniformity within the local practice of allergy skin testing and immunotherapy. National recommendations were presented and discussed at several meetings of the Paul P. Van Arsdel, Jr. Journal Club at the University of Washington in Seattle. These discussions focused on published recommendations, available evidence-based data, local and regional aerobiology, and individualized clinical practice. Standardized skin test forms were customized to include clinically relevant local aeroallergens, after examination of regional aerobiology and allergen crossreactivity patterns. Data presented during the meetings are summarized in this article, including 5-year (1998–2002) pollen counts collected during the spring in the Seattle area by Northwest Asthma and Allergy Center and therapeutic doses of major allergens to be included in an allergen immunotherapy vaccine maintenance concentrate.