Skin testing is a basic diagnostic procedure widely used to explore immedia
te-type reactions to allergen preparations in vivo. Despite their reliabili
ty, if standardized extracts are used, skin tests suffer from limited repro
ducibility due to difficulties In preparing consistently standardized extra
cts from natural raw material. Starting from allergen-encoding cDNAs, large
amounts of highly pure allergens with a high batch-to-batch consistency sa
tisfying the quality requirements of medicinal products manufactured by rec
ombinant DNA technology can be produced. These reagents are expected to be
qualitatively superior to the commercially available allergen preparations
used for the in vitro and in vivo diagnosis of allergic conditions. In this
article the current literature available on skin testing with such recombi
nant allergens (rAllergens) is reviewed and critically analyzed. To date ma
ny different rAllergens of various pollens, moulds, mites, bee venom, latex
and celery have been used in skin testing in more than 1,600 allergic and
control individuals. Skin: prick tests as well as intradermal skin tests wi
th rAllergens prove to be highly specific and safe. The diagnostic sensitiv
ity of single rAllergens is generally lower than those obtained with allerg
en extracts, but can be considerably increased by using rAllergen panels co
vering the most important allergenic structures present in a given complex
allergenic extract. Moreover, quantitative skin testing with single rAllerg
ens allows interesting insights into correlations between the in vivo and i
n vitro sensitization to a given allergen. In conclusion, skin testing with
rAllergens offers a highly specific and safe additional diagnostic tool to
elucidate patient- and disease-specific sensitization patterns which will
be needed for the development of patient-tailored immunotherapeutic treatme
nts. Copyright (C) 2001 S. Karger AG, Basel.