What we miss if standard panel is used for skin prick testing?

BACKGROUND Although standard skin prick test (SPT) panels are crucial for routine investigation of sensitization in daily clinical practice, it has limitations in terms of missing allergens. OBJECTIVE To find out sensitization rates (SR)s to additional panel of allergens and their relative contributions in allergic diseases. METHODS SPTs with a battery of aeroallergens [tree pollen (A.glutinosa, C.arizonica, J.communis, T.platyphyllos, R.pseudoacacia), weed pollen (R.acetosa, U.dioica, A.artemisifolia), smut mix, yeast mix, storage mites (SM) (B.tropicalis, L.destructor, T.putrescentiae, A.siro), mouse and budgerigar epithelia], were performed to 318 participants (6-18 years) who were previously identified to be sensitized to at least one of the aeroallergens found in standard battery. RESULTS Forty percent of participants were sensitized to at least one additional aerollergen. Three most frequent sensitizations were to B.tropicalis (11.3%), R.pseudoacacia (9.7%) and L.destructor (8.2%). SR for tree pollen increased from 6.9% to 19.8%, for mites increased from 26.3% to 31.6% and for moulds increased from 5.3% to 9.4% with addition of respective group of other allergens to battery. Furthermore, higher rates for additional tree pollen sensitization was found among patients with "only AR" (21%) compared to patients with "only asthma" (4.6%, p =0.006), contrarily higher rates for SM sensitization was found among patients with "only asthma" (20%) compared to patients with "only AR" (3.2%, p =0.003) CONCLUSIONS: Though some of sensitizations may occur due to cross-reactivity, almost 40% of sensitized children were also co-sensitized to the additional allergens tested. Physicians should consider further steps when a negative or inconsistent result is achieved through a standard skin test panel.