Q:

11/6/2012
What do you recommend in situations requiring skin testing specially intradermals on patients well controlled on beta-blockers. Practice parameter mentions beta-blocker/ ACE inhibitors as relatively contraindicated. Do we need to ask primary care physician to change or stop them before doing skin testing. Thanks.

A:

Thank you for your inquiry.

Actually, the decision as to whether or not to test someone on a beta-blocker is left to the discretion of the physician performing the test. I have talked with many physicians across the country; some require cessation of beta-blockers before skin testing and others do not. My personal practice has been to proceed with skin testing, including intradermals, but quite clearly, as you state in your inquiry, beta-blockers represent a “relative contraindication to the performance of skin tests and immunotherapy.” The key word is of course “relative”.

In summary, there is no dogmatic approach to this issue, and one is given leeway based on one’s own philosophy and comfort level in this regard.

Although angiotensin-converting enzyme inhibitors are clearly contraindicated in venom immunotherapy, there is no such admonition related to aeroallergen immunotherapy or skin testing.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology