A physician faces many challenges in making a definitive diagnosis of asthma in young children. Although there are clinical and historical features consistent with asthma, identical features are present in many other diseases. Furthermore, there is no specific test for asthma. Other diseases must always be ruled out before a definitive diagnosis of asthma is made. Determining whether cough or wheeze is the primary symptom is important because asthma is primarily a wheezing disease. Sweat chloride testing, chest radiography, and allergy skin testing should be performed in children with persistent wheezing to rule out other causes and help support a diagnosis of asthma. Allergy skin testing provides particularly useful information for making a diagnosis of asthma in the preschool-aged child. A chart review of patients presenting consecutively to the Division of Allergy and Pulmonary Medicine provides insight and information on an approach to make an asthma diagnosis for this population.
Ten years ago a commentary appeared in Pediatrics entitled "Allergy Skin Testing: Science or Quackery?"1 This statement was a rejoinder to a commentary in Pediatrics in 19752 that included allergy skin testing in a list of laboratory procedures that are abused for financial gain. The gist of the reply was that allergy skin tests themselves were not the problem because they were valid bioassays for IgE antibody to specific antigens. Abuse and quackery set in when numerous, indiscriminately chosen skin tests were performed instead of an appropriate history, physical examination, and carefully selected tests based on that evaluation.
The allergy skin test was at that time and remains today the most sensitive test for specific allergic antibody in the skin, its presence there reflecting its presence in the blood and respiratory tract.
A commentary in Pediatrics in September 19751 condemned procedure-oriented fee schedules because they encouraged and rewarded the abuse of laboratory and elective surgical procedures. Allergy skin testing was included in this list. Letters to the American Academy of Pediatrics and telephone calls to the Chairman of the Section on Allergy of the Academy took issue with this inclusion. The commentary, however, was directed toward physicians and allergy laboratories who abuse skin testing rather than toward the procedure itself. It was directed to those who perform innumerable and casually selected skin tests as a substitute for an appropriate history, physical examination, and carefully selected tests based on that evaluation.
Penicillin Allergy Skin Testing as an Antibiotic Stewardship Intervention in Hematopoietic Cell Transplant Recipients
