Article open access publication

Clinical relevance is associated with allergen‐specific wheal size in skin prick testing

Clinical & Experimental Allergy, Wiley, ISSN 1365-2222

Volume 44, 3, 2014

DOI:10.1111/cea.12240, Dimensions: pub.1011768386, PMC: PMC4215109, PMID: 24283409,



  1. (1) Helsinki University Central Hospital, grid.15485.3d
  2. (2) Charité, grid.6363.0
  3. (3) Ghent University Hospital, grid.410566.0
  4. (4) Odense University Hospital, grid.7143.1, Southern Denmark Region
  5. (5) National Research Council, grid.5326.2
  6. (6) University Hospital of Montpellier, grid.157868.5
  7. (7) University of Genoa, grid.5606.5
  8. (8) Technical University of Munich, grid.6936.a
  9. (9) Royal Brompton Hospital, grid.439338.6
  10. (10) Academic Medical Center, grid.5650.6
  11. (11) National and Kapodistrian University Allergy Department 2nd Paediatric Clinic Athens Greece
  12. (12) Medical University of Lodz, grid.8267.b
  13. (13) Semmelweis University, grid.11804.3c
  14. (14) Medical University of Vienna, grid.22937.3d
  15. (15) University of Coimbra, grid.8051.c
  16. (16) Ludwig Maximilian University of Munich, grid.5252.0
  17. (17) University Children's Hospital Zurich, grid.412341.1
  18. (18) University Hospital Erlangen, grid.411668.c


BACKGROUND: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. OBJECTIVE: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. METHODS: The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. RESULTS: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. CONCLUSION: These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.


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University of Southern Denmark

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Times Cited: 91

Field Citation Ratio (FCR): 17.66

Relative Citation ratio (RCR): 2.71

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