Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis

Abstract

Background: Allergic rhinitis is the most common form of allergy worldwide. The accuracy of skin testing for allergic rhinitis is still debated. Our primary objective was to evaluate the diagnostic accuracy of skin-prick testing for allergic rhinitis using the nasal provocation as the reference standard. We also evaluated the diagnostic accuracy of intradermal testing as a secondary objective.

Methods: We searched EBM Reviews from 2005 to March 2015; Embase from 1980 to March 2015; and Ovid MEDLINE(R) from 1946 to until March 2015. We included any study with at least 10 subjects including children. We excluded non-English studies. We performed data extraction and quality assessment using the QUADAS-2 tool.

Results: We meta-analysed seven studies assessing the accuracy of skin-prick testing using the bivariate random-effects model, including a total of 430 patients. The pooled estimate for sensitivity and specificity for skin-prick testing was 85 and 77 % respectively. We did not pool results for intradermal testing due to few number of studies (n = 4), each with very small sample size. Of these, two evaluated the accuracy of intradermal testing in confirming skin-prick testing results, with sensitivity ranging from 27 to 50 % and specificity ranging from 60 to 100 %. The other two evaluated the accuracy of intradermal testing as a stand-alone test for diagnosing allergic rhinitis with sensitivity ranging from 60 to 79 % and specificity ranging from 68 to 69 %.

Conclusions: Findings from this review suggest that skin-prick testing is accurate in discriminating subjects with or without allergic rhinitis.

Keywords: Allergic rhinitis; Diagnostic accuracy; Intradermal testing; Meta-analysis; Review; Skin-prick testing.

Fig. 1

PRISMA flow diagram of studies identified, included and excluded

Fig. 2

Summary receiver operating characteristic curve (sROC) of seven studies evaluating the accuracy of skin-testing for allergic rhinitis, plotted using a bivariate normal distribution model. Estimate of the pooled pair of sensitivity and specificity is 88.4 and 77.1 %

Fig. 3

Summary receiver operating characteristic curve (sROC) showing the sensitivity of results for the accuracy of skin-testing for allergic rhinitis, when we include Krouse et al. [14]. Estimate of the pooled pair of sensitivity and specificity only fluctuates a little to 85.0 and 77.3 %

Fig. 4

Forest plots for studies evaluating the accuracy of skin prick tests. Estimates from Krouse et al. [14]^a deviate considerably from the rest (its inclusion attenuates the negative correlation between sensitivity and specificity)

Fig. 5

Forest plots for studies evaluating the accuracy of skin prick tests. Krouse et al. [14]^a is excluded

Fig. 6

Reviewer’s judgment about the risk of bias in each included study that assessed the accuracy of skin-prick testing. See Appendix 2 for a detail explanation of domains for risk of bias and applicability concern

Fig. 7

Reviewer’s judgment about the risk of bias in each included study that assessed the accuracy of intradermal testing. See Appendix 2 for a detail explanation of domains for risk of bias and applicability concern

Fig. 8

Methodological quality of the included studies. See Appendix 2 for a detail explanation of domains for risk of bias and applicability concern