An important decision for your practice will be the selection of allergenstobestockedinyourofficeforskintesting.Anappropriatediagnosticpanel willreflectnot onlytherelevantallergens inyourregion butalsothe unique profiles of patients who regularly visit your practice. Somepatients travel frequently or live in multiple locations. In these cases,significant allergens from each region the patient is exposed to should beconsidered.
The number and diversity of allergens tested in allergy offices throughout North America varies greatly. According to Thommen’s classic postulates (1931) the following criteria should be considered when establishing an allergen’s importance in any given region:
- The species concerned must be widely and abundantly distributed
- The pollen/spores must be sufficiently buoyant to become airborne
- The pollen/spores must be produced in sufficiently large quantities
- The pollen/spores must contain an excitant or toxins (antigen) to cause hay fever (rhinitis) and/or asthma
- A patient must display symptoms at a time when the pollen or spores are present in larger quantities in the air in order for any type of pollen or spore to be regarded as the causative agent in a particular case of hay fever or asthma.
From recent research, From recent research, regarding Postulate 3, it should be noted that pollen counts do not necessarily correlate with the prevalence of allergy or skin test reactivity in an allergic population. Simply relying on pollen count data may be insufficient for determining which allergens are most clinically significant to your region.
In addition, some allergens show significant cross-reactivity, which may impact the selection of extracts for your panel. It is generally not advised to use allergen mixes for skin testing except where a significant level of cross-reactivity has been established (e.g., Northern Pasture Grasses or House Dust Mites). For more information, please see the section on the Importance of Cross-Reactivity.
- Northern Pasture Grasses (e.g. Timothy, Orchard, etc.)
- Southern Grasses:
- English Plantain
- Lambs Quarters
- Russian Thistle
- House Dust Mite
- Cow’s Milk
- Fish (Cod, Salmon)
- Tree Nuts (Almond, Walnut)
- Fire Ant
- Yellow Hornet
- Yellow Jacket
- White-Faced Hornet