IN-VITRO AND SKIN TESTING FOR ALLERGY - COMPARABLE CLINICAL UTILITY AND COSTS

Controversy exists concerning the appropriate use of skin testing and in vitro testing for the diagnosis of allergy, particularly inhalant a llergy. Earlier comparisons of skin testing and in vitro testing concl uded that skin testing had superior accuracy at lower expense. In ligh t of new developments with in vitro allergy testing, however, this iss ue should be reconsidered. A review of the recent scientific literatur e indicates that in vitro and skin testing are highly correlated. Howe ver, without the existence of an independent gold standard for inhalan t allergy, it is not possible to determine which test is move accurate . The accuracy of either test can be compromised if conducted using di fferent protocols or having insufficient quality control. Given their respective trajectories for technological advancement, quantification and quality control, in vitro testing may offer the more standardized approach. Although the cost per test of in vitro testing remains great er than that of skin testing, the per-patient costs of the two modalit ies appear to be comparable, given the greater number of allergens typ ically used in skin testing, In summary, both skin testing and in vitr o testing are acceptable as frontline diagnostic tools.