1/9/2013
Are there any recommendations in regards to the safety of skin testing to a food in a patient (especially a younger child) with a history of anaphylaxis to that food? I have colleagues that will perform initial evaluation by serologic testing in lieu of skin prick in this setting particularly for foods such as peanut or shellfish. According to the food allergy parameters there is a low rate of systemic reactions when skin prick testing with foods. Therefore, is it safe to proceed with skin prick testing to a food such as peanut in a child with a history of anaphylaxis to that food?

Thank you for your inquiry.

The question you asked is certainly a cogent one, but unfortunately, there is no definitive answer. I have copied for you below a statement taken from what is an excellent review of this issue. I believe that this is as definitive a statement that can be made to answer your question. The decision as to whether or not to perform a skin test or an in vitro test remains one of clinical judgment, and is left up to the individual physician performing the evaluation. All that we can say is that reactions to skin testing are very rare, but can occur.

I have copied below a link to the review from which the quote is taken. This article is available to you free of charge online via this link. This review of the literature presents the data that is available regarding previous anaphylactic reactions to skin testing and the rationale for the summary statement as copied for you below directly from the article.

"Based on the literature, the risk of fatality due to SPT is extremely remote, and severe anaphylactic reactions are rare. Nevertheless, this risk cannot be completely excluded, especially in highly susceptible subjects. Physicians who perform SPT should be aware of this and apply simple precautional rules." SOURCE: Systemic reactions from skin testing: literature review. J Investig Allergol Clin Immunol 2006; Vol. 16(2): 75-78

Thank you again for your inquiry and we hope this response is helpful to you in putting the issue into perspective, but unfortunately, in the final analysis, decisions regarding skin testing versus in vitro testing remain one of individual clinical judgment.

Sincerely,
Phil Lieberman, M.D.