Specific IgE is better than skin testing for detecting Aspergillus sensitization and allergic bronchopulmonary aspergillosis in asthma.

We read with interest the review by Schulman et al 1 in a recent issue of CHEST (January 2015) wherein the authors suggest the use of a skin test for screening sensitization to various allergens in preference to specifi c IgE antibody testing in patients with asthma. We agree with the authors that all patients with asthma should be screened for allergic sensitization against a particular allergen depending on its prevalence. However, we do not agree with the authors’ recommendation that skin testing is the preferred approach as this can potentially miss allergic sensitization against Aspergillus fumigatus . In a study comparing the performance of a skin test (intradermal) or specifi c IgE (against A fumigatus ) for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in 372 subjects with asthma, the sensitivity of an A fumigatus -specific IgE and Aspergillus skin test was 100% and 88% to 95%, respectively, in various models of latent class analysis. 2 Thus, if a skin test is used as a screening modality, one can potentially miss 5% to 12% cases of ABPA.