Intraoperative intradermal skin testing

INTRODUCTION The management of inhalant allergy is an integral part of otolaryngology practice. The diagnosis of allergy includes a thorough history, physical examination, and often times in vivo (intradermal skin) or in vitro testing. In our practice, cooperative children and adults undergo serial intradermal dilution skin testing. We have a large subset of patients who are challenging to test such as young children or developmentally delayed individuals. Indeed, this is one indication for choosing to use specific immunoglobulin E blood tests such as radioallergosorbent testing. However, obtaining a blood sample from a young or challenging patient may be difficult. It may be easier to perform allergy testing under anesthesia in the operating room in patients who carry surgical indications. Often, our younger patients have comorbidities such as recurrent or chronic otitis media, sleep-disordered breathing with tonsillar/adenotonsillar hypertrophy, or recurrent tonsillitis that may carry indications for surgery. The operating room then presents itself as an ideal environment for allergy testing individuals who would be challenging in an outpatient setting. In our practice over the past 20 years, we have found that intraoperative intradermal skin testing (I-IDST) is a very effective method to assess the patient’s allergic disease. After reviewing the literature, we found only one published case series of allergy testing in the operating room. Hall et al. reported on 92 patients who underwent intradermal skin testing with concurrent bilateral myringotomy with tube placement (n 1⁄4 12), adenoidectomy with bilateral myringotomy with tube placement (n 1⁄4 74), or adenotonsillectomy with bilateral myringotomy with tube placement (n 1⁄4 6). There were no episodes of anaphylaxis or systemic reactions to the allergy testing. Twenty consecutive patients underwent intradermal testing in the office 1 week later. Of the 380 end points retested in this subgroup, only 10 end points were found to differ from the original testing. Of those 10 end points, none differed by more than one dilution. This study demonstrated the safety and reproducibility of intraoperative intradermal skin testing. In an additional report, Renfro performed intradermal skin testing of 442 of 570 children undergoing general anesthesia. Of 324 patients undergoing bilateral myringotomy with tube placement, 322 had positive skin test results. Her skin testing was repeated in seven patients with good correlation. Our aim was to present our experience with intraoperative intradermal skin testing with a representative population sample over the past 20 years.