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In vitro and skin testing for allergy: comparable clinical utility and costs

The American Journal of Managed Care, Vol. 4, No. 7, July 1998

Summary
A recent review of scientific literature indicates that in vitro and skin testing for allergy are highly correlated. Although the cost per test of in vitro testing remains greater than that of skin testing, the per-patient costs of the two modalities appear to be comparable. In summary, both skin testing and
in vitro testing are acceptable as frontline diagnostic tools.

  • Although the absence of a gold standard confounds absolute sensitivity and specificity of these tests, the scientific literature demonstrates that skin testing and in vitro testing are highly correlated.

  • The correlation between the Pharmacia CAP System™ and skin testing ranges from 87 percent to 95 percent.

  • Variations in skin testing practice may lead to large differences in diagnostic conclusions.

  • The per-patient costs of in vitro and skin testing appear to be comparable due to the greater number of allergens typically used in skin testing.

  • The actual difference in total diagnostic charge between patients receiving skin tests versus in vitro tests is a much smaller difference than has been reported.

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