Practical guide to skin prick tests in allergy to aeroallergens: some concerns.

We read with great interest the GALEN-ARIA position statement regarding skin prick test to aeroallergens (1). Although we appreciate the effort in terms of its contribution to the practice, there are certain points that we believe need to be at least re-evaluated. Our concerns are mainly based on the observations we made in the largest paediatric allergy referral centre of our country (Turkey) where we retrospectively analysed SPT results of children and adolescents (2– 18 years of age) with suspected respiratory allergies (2). We believe that our observations have critical importance as Turkey is within the geographical region of Europe (in Mediterranean region), more than four million Turks live in Europe and it is the seventh most commonly visited country (http:// en.wikipedia.org/wiki/World_Tourism_rankings) all around the world. These points are summarised below: In our study, we found that the diversity of sensitized allergens is wider in early years of life compared with that in the elder ages. For instance, we found that to cover 95% of sensitized children, the number of allergens needed are 12, 8 and 7 for preschool children (2–<6 year), school children (6– <12 year) and adolescents (12–18 year), respectively (2). Therefore, we do not agree to the suggestion of the position statement that in preschool children, the number of skin tests to inhalants should be reduced. In our study, we found that the proportion of aeroallergen sensitization in children with suggestive history of respiratory allergy increases as children grow older. For instance, 10– 20% of preschool children (2–<6 year), 30–60% of school children (6–<12 year) and 50–70% of adolescents (12– 18 year) were found to be sensitized to one of 30 aeroallergens tested (2). Low possibility of gathering a positive result, test-related discomfort (pain), low capability of tolerance of test-related stress in a young child are our major concerns for not performing skin prick test routinely during early years of life. Postponing for another visit at an elder age or replacing with specific IgE measurement are alternatives, which are the least painful and most cost-effective. Like Spain, Italy and Greece, our observations suggest Chenopodium, Plantago and Salsola Kali pollens may also part of routine aeroallergen panel (3–5). We believe the GALEN-ARIA position statement regarding skin prick test to aeroallergen is contributory and should be followed until evidence-based reviews with a stronger and deeper clinical and scientific appear.