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(Chest. 2002;122:821-825.)
© 2002 American College of Chest Physicians

Value of a Negative Aeroallergen Skin-Prick Test Result in the Diagnosis of Asthma in Young Adults*

Correlative Study With Methacholine Challenge Testing

Yael Graif, MD; Mordechai Yigla, MD; Naveh Tov, MD and Mordechai R. Kramer, MD, FCCP

* From the Allergy and Pulmonary Clinic (Dr. Graif), Israel Defense Forces, Tel Aviv; Division of Pulmonary Medicine (Drs. Tov and Yigla), Rambam Medical Center, Haifa; and Pulmonary Institute (Dr. Kramer), Rabin Medical Center, Petah-Tiqva, Israel.

Correspondence to: Yael Graif, MD, Allergy and Clinical Immunology Unit, Rabin Medical Center, 100 Jabotinsky St, Petach Tikva 49100, Israel; e-mail: graif{at}post.tau.ac.il

Background: None of the existing tests for the diagnosis of asthma are considered to be definitive. Certain circumstances require prompt diagnosis, and a test able to predict the absence of asthma would be very useful.

Objective: To evaluate the contribution of a skin-prick test (SPT) to the diagnostic workup of subjects with suspected asthma.

Patients and methods: The study included three groups of subjects aged 18 to 24 years: group A, asthmatic patients (n = 175); group B, control subjects (n = 100); and group C, subjects with suspected asthma (n = 150) with normal spirometry findings and a negative exercise challenge test result. All underwent an SPT to a battery of common aeroallergens, and group C underwent a methacholine challenge test (MCT) in addition. The sensitivity, specificity, positive predictive value, and negative predictive values (NPV) of the SPT were calculated using provocative concentrations of methacholine causing a 20% fall in FEV1 (PC20) of < 4 mg/mL and < 8 mg/mL as diagnostic cutoff values for asthma in the MCT. Bayes’ formula was used to determine posttest probabilities of having asthma, both for positive and negative SPT results.

Results: A positive SPT result to at least one allergen was found in 95.5%, 54%, and 69% of patients in the three groups, respectively. The sensitivity, specificity, and NPV of the SPT were 90.7%, 52.0%, and 84.8%, respectively, with a cutoff value of PC20 < 8 mg/mL. The lower cutoff, PC20 < 4 mg/mL, increased the sensitivity and NPV to 98.2% and 97.8%, respectively. A negative SPT result decreased the probability of having asthma by 10-fold to 20-fold in subjects whose pretest probability was low to moderate.

Conclusions: Incorporating an SPT into the workup of subjects with suspected asthma can reduce the cost of this process significantly. The SPT may be used as a simple, fast, safe, inexpensive, and reliable method to predict the absence of asthma in young adults.

Key Words: bronchial asthma • bronchial hyperresponsiveness • skin-prick test






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