ࡱ>  ac`efgh !"% bjbjJJ ;(xAd(xAd;"""""3"3"3"8k"O#3"!W $:E$E$E$E$ %>^%r% dVfVfVfVfVfVfV$Y\\VQ"~% % %~%~%V""E$E$V111~%^"E$"E$dV1~%dV116I(LE$#5b+JPVV0!WJ<\j,\8LL(\"DM ~%~%1~%~%~%~%~%VV/~%~%~%!W~%~%~%~%\~%~%~%~%~%~%~%~%~% :  About the Measure DomainRespiratoryMeasureAllergy Skin Prick TestDefinitionAllergy skin prick testing is a method to diagnose allergies by provoking a small, controlled allergic response. About the ProtocolDescription of ProtocolA microscopic amount of an allergen is introduced into a persons skin by pricking the skin with a plastic pick. The health care professional closely watches the skin for signs of a reaction, usually swelling and redness of the site. Results are usually seen within 1520 minutes.Protocol textAllergen Extracts Each participant is tested to a core battery of allergens. The core allergens include: A1 Negative control (glycerin) GNCS A2 Standardized Cat: TE3 A3 Dog epithelium) E7 A4 Mouse E20 A5 Rat E25 A6 Mold mix #1 (alternaria, aspergillus, helmithosporium, cladosporium, penicillium): MO1 A7 American/German cockroach insect mix: BO12 A8 Positive control (Histamine 10 mg/ml *) CHS B1 Standardized Southern Grass mix (9 grass mix plus Bermuda, Johnson): P19 B2 Eastern 8 tree mix (ash, beech, birch, cottonwood, hickory, oak, elm, maple): P48 B3 Mountain cedar 83 B4 National weed mix (cocklebur, lambs quarter, rough pigweed, giant & short ragweed): P3 B5 Standardized Mite mix (Dermatophagoides pteronyssinus/farinae): BO3 B6 Cow Milk: F293 B7 Egg, Chicken, Whole: F271 B8 Peanut: F171 Skin Test Confounders Please note that classical and non-sedating antihistamines, H2 blockers, such as ranitidine/cimetidine and certain herbal supplements and antidepressants (especially the tricyclics) may interfere with skin testing. If possible, and under direction of the study participants PMD, the skin test confounder should be stopped prior to testing for an appropriate length of time. See Appendix 1 for a list of drugs that interfere with skin testing and the recommended periods of withholding prior to skin testing. Percutaneous skin testing procedure Supplies Needed: Multi-Test II skin test applicators (two) Multi-Test Dipwell tray Isopropyl alcohol or alcohol swabs Black marking pen Transparent tape, 5/8" wide or wider Kleenex, paper toweling or other blotter Timer Millimeter ruler EpiPen autoinjectors (adult and/or pediatric) or 1:1000 epinephrine ampule/vial for subcutaneous or intramuscular injection use Placing the Skin Test: Make sure a physician is readily available in the event that the skin testing procedure produces a systemic reaction. Take a medication history to make sure that the study participant is eligible for skin testing and that the appropriate wash out period has occurred. See Appendix 1 for a list of medications that may interfere with skin testing. If a specific allergen will not be used (i.e. study participant has a known allergy to a specific food allergen), the Multi-Test arm should be broken off. Percutaneous puncture skin testing is to be performed using the MultiTest II skin test applicators on the back of children < 5 years of age and on the back or forearm(s) of children > 5 years of age and adults. Always avoid placing the skin test in the spinal area. Avoid hairy areas whenever possible since the reactions may be more difficult to interpret.  EMBED PBrush  Cleanse the skin with alcohol and allow to dry. Place the Multi-Test II skin test applicator into the Dipwell Tray. It will only fit in one direction because of the T-bar of the applicator. Multi-Test applicator A will have allergens A1-A8 and Multi-Test applicator B will have allergens B1-B8. Carefully, while holding the Dipwell Tray level, inspect that all applicator heads are submerged in allergen. It is ideal to make sure that the Dipwell Tray is fully loaded with enough allergen before introducing the Multi-Test II skin test applicators. However, that may be difficult to estimate until the applicator is in position. Carefully, add more allergen to the well if the applicator head is not submerged. Carefully remove Multi-Test II applicator from the Dipwell Tray. DO NOT SHAKE. Point the T-bar end of the Multi-Test II applicator toward a constant reference point such as the head of the study participant being tested and press the fully loaded applicator A into the skin with sufficient pressure to allow adequate penetration of the points. With proper pressure, a distinct puncture pattern from the points will be observed at each test site. If the skin is taut, less pressure is required to gain proper penetration of points. With proper pressure, bleeding rarely occurs. In some cases, the contour of the testing area may be such that slight rocking of the Multi-Test II applicator will be required to gain adequate and uniform penetration of points from all test heads. Repeat with Multi-Test applicator B. Make an identification mark on the skin noting the placement of the skin test allergens. If necessary, the allergens may be blotted to avoid dripping. Discard Multi-Test II applicators after one use using universal precautions. DO NOT REUSE!! Set a timer for 20 minutes. For safety reasons, the study participant should not be left alone during this interval. If a very large reaction begins, that specific allergen should be washed off the skin, not just blotted. The wheal should still be measured at 20 minutes regardless of whether the allergen was washed off. Appendix 1. Drugs to Hold Prior to Skin Testing The following drugs are known or suspected to interfere with skin testing. Advise the participant to withhold medication for the specified period of time. Antihistamines First-generation antihistamines (withhold 3 days before testing) 4-Way Cold Tablets (Bristol-Myers Squibb) A.R.M. Allergy Relief Medicine (Ascher) Actifed (GlaxoSmithKline) Actifed Cold & Allergy Tablets (GlaxoSmithKline) Actifed Cold & Sinus Caplets (GlaxoSmithKline) Allerest PE (PrestigeBrands) Ambenyl cough syrup (Parke-Davis) Atarax (Pfizer Inc.) Atrohist (UCB, Inc.) Benadryl (Pfizer Inc.) Benadryl Allergy Chewables (Pfizer Inc.) Benadryl Allergy Kapseal (Pfizer Inc.) Benadryl Allergy Liquid Medication (Pfizer Inc.) Benadryl Allergy Sinus Headache Caplets & Gelcaps (Pfizer Inc.) Benadryl Allergy Ultratabs Tablets (Pfizer Inc.) Benadryl Allergy/Cold Tablets (Pfizer Inc.) Benadryl Allergy/Congestion Liquid Medication (Pfizer Inc.) Benadryl Allergy/Congestion Tablets (Pfizer Inc.) Benadryl Dye-Free Allergy Liquid Medication (Pfizer Inc.) Benadryl Dye-Free Allergy Liqui-Gels Softgels (Pfizer Inc.) Bromfed (Victory Pharmaceuticals) Children's Tylenol Allergy-D Liquid and Chewable Tablets (Ortho-McNeil-Janssen Pharmaceuticals, Inc.) Children's Tylenol Cold Liquid and Chewable Tablets (Ortho-McNeil-Janssen Pharmaceuticals, Inc.) Children's Tylenol Cold Plus Cough Suspension Liquid and Chewable Tablets (Ortho-McNeil-Janssen Pharmaceuticals, Inc.) Children's Tylenol Flu Suspension Liquid (Ortho-McNeil-Janssen Pharmaceuticals, Inc.) Chlor-Trimeton Allergy Decongestant tablets (Schering Plough HealthCare Products) Chlor-Trimeton Allergy Tablets (Johnson & Johnson) Codimal (Schwarz Pharma) Comhist (Lee Pharm) Comtrex (Bristol-Myers Squibb) Contac Severe Cold & Flu Caplets Maximum Strength (Meda Pharmaceuticals Inc.) Contact (Energique, Inc.) Coricidin (Merck & Co.) Coricidin HBP Cold & Flu Tablets (Merck & Co.) Coricidin HBP Cough & Cold Tablets (Merck & Co.) Coricidin HBP Nighttime Cold & Flu Tablets (Merck & Co.) CTM (Discontinued) Deconamine (Sandoz Inc.) Dimetane Expectorant DC (Whitehall-Robins) Dimetane DX (Whitehall-Robins) Dimetapp (Pfizer, Inc.) Childrens Dimetapp Cold & Cough (Pfizer, Inc.) Dimetapp Cold and Fever Suspension (Pfizer Inc.) Diphenhydramine HCL (Eon Labs, Inc.) Dristan (Pfizer, Inc.) Drixoral Cold & Allergy (Merck & Co.) Drixoral Cold & Flu (Merck & Co.) Extendryl (Cornerstone BioPharma, Inc.) Fedahist (Schwarz Pharma) Hismanal (Ortho-McNeil-Janssen Pharmaceuticals, Inc.) (withhold 3 months) Isoclor (Novartis) Kronofed (Ferndale Laboratories) Marax (Rugby Laboratories) Nolahist (Discontinued) Nolamine (Amarin Pharmaceuticals) Optimine (Key Pharmaceuticals) PBZ (Novartis) PediaCare Cough-Cold Liquid (Johnson & Johnson) PediaCare NightRest Cough-Cold Liquid (McNeil Consumer) Pediatric Vicks 44M Cough & Cold Relief (Procter & Gamble) Percogesic (Medtech Products Inc.) Percogesic Aspirin-Free Coated Tablets (Medtech Products Inc.) Percogesic Extra Strength (Medtech Products Inc.) Periactin Phenergan (Wyeth Pharmaceuticals) Polaramine (Bayer HealthCare Pharmaceuticals Inc.) Robitussin Nighttime Honey Flu (Wyeth Pharmaceuticals) Rondec (Alliant Pharmaceuticals) Ru-Tuss (Sage Pharm. Inc.) Ryna Liquid (MedPointe) Ryna-C Liquid (MedPointe) Rynatan (Meda Pharmaceuticals Inc.) Sinarest (Centaur Pharmaceuticals Pvt.Ltd.) Singlet Caplets (GlaxoSmithKline) Sinulin (Amarin Pharmaceuticals) Sinutab Sinus Allergy Medication, Maximum Strength Formula, Tablets & Caplets (Warner-Lambert) Sudafed Cold & Allergy Tablets (Johnson & Johnson) Tacaryl (Westwood-Squibb Pharmaceuticals) Tavist (Novartis) Tavist Allergy 12-Hour Tablets (Novartis) Teldrin (Novartis) Temaril (Allergan Pharmaceuticals) TheraFlu Flu and Cold Medicine (Novartis) TheraFlu Maximum Strength Flu and Cold Medicine for Sore Throat (Novartis) TheraFlu Maximum Strength NightTime Flu, Cold & Cough Caplets (Novartis) TheraFlu Maximum Strength NightTime Flu, Cold & Cough Hot Liquid (Novartis) TheraFlu Maximum Strength Sore Throat and Cough Flu, Cold and Cough Hot Liquid (Novartis) TheraFlu, Cold and Cough Medicine (Novartis) Triaminic (Novartis) Triaminic Cold & Allergy Soft chews (Novartis) Triaminic Cold & Cough Soft chews (Novartis) Triaminic Night Time (Novartis) Triaminic Severe Cold & Fever (Novartis) Triaminic Triaminicol Cold & Cough (Novartis) Trinalin (Schering) Tussionex (Aventis Pharmaceuticals) Tylenol Allergy Sinus NightTime, Maximum Strength Caplets (McNeil Consumer) Tylenol Allergy Sinus, Maximum Strength Caplets, Gelcaps, and Geltabs (McNeil Consumer) Tylenol Cold Complete Formula, Multi-Symptom Tablets and Caplets (McNeil Consumer) Tylenol Flu NightTime Maximum Strength Gelcaps (McNeil Consumer) Tylenol Flu NightTime Maximum Strength Powder (McNeil Consumer) Tylenol PM Pain Reliever/Sleep Aid, Extra Strength Caplets, Geltabs and Gelcaps (McNeil Consumer) Tylenol Severe Allergy Caplets (McNeil Consumer) Tylenol Sinus NightTime, Maximum Strength Caplets (McNeil Consumer) Vicks 44M Cough, Cold & Flu Relief (Proctor & Gamble) Vicks Childrens NyQuil Cold & Cough (Proctor & Gamble) Vistaril (Pfizer Inc.) Second-generation antihistamines (withhold 7 days before testing) Allegra (fexofenadine) (Aventis Pharmaceuticals) Clarinex (desloratadine) (Merck & Co.) Claritin (loratadine) now over the counter (MSD Consumer Care) Zyrtec (cetirizine) (Johnson & Johnson) Topical nasal antihistamines (withhold 5 days before testing) Astelin (azelastine) (MedPointe) Antidepressants Except for doxepin, withhold antidepressants for 3 days before testing. Withhold doxepin (topical and oral) for 7 days. Serotonin-uptake inhibitors can be continued since they do not inhibit skin tests. Adapin (Fisons Pharmaceuticals) Amitriptyline (Mylan Pharmaceuticals Inc.) Asendin (Wyeth Pharmaceuticals) Clomipramine (Mylan Pharmaceuticals Inc.) Desipramine (Sandoz Inc.) Desyrel (Bristol-Myers Squibb) Doxepin (withhold 7 days) (Mylan Pharmaceuticals Inc.) Elavil (Merck Sharp & Dohme) Endep (Roche Laboratories) Etrafon (Schering) Imipramine (Sun Pharmaceutical Industries) Limbitrol (Valeant Pharmaceuticals) Ludiomil (Novartis) Maprotiline (Mylan Pharmaceuticals Inc.) Norpramin (Aventis Pharmaceuticals) Nortriptyline (Teva Pharmaceuticals USA, Inc.) Pamelor (Mallinckrodt, Inc.) Pertofrane (Aventis Pharmaceuticals) Protriptyline (West-Ward Pharmaceuticals Corp.) Sinequan (Pfizer Inc.) Surmontil (Aventis Pharmaceuticals) Tofranil (Mallinckrodt, Inc.) Triavil (Merck Sharp & Dohme) Trimipramine (Actavis Pharma, Inc.) Vivactil (Odyssey Pharmaceuticals) H2 Antagonists Withhold 3 days before testing. Axid (nizatidine) (Pfizer Inc.) Pepcid (famotidine) (Valeant Pharmaceuticals) Tagamet (cimetidine) (Medtech Products Inc.) Zantac (ranitidine) (GlaxoSmithKline) Beta-Blockers If a participant is currently taking beta-blockers for comorbidities such as hypertension, headaches, tremor, or glaucoma, they should not undergo skin testing. If anaphylaxis occurs, rescue with epinephrine may be less effective. Atenolol (Tenormin) (Teva Pharmaceuticals USA, Inc.) Betapace (sotalol) (Bayer HealthCare Pharmaceuticals Inc.) Cordrol (carteolol) (Sandoz Inc.) Coreg (carvedilol) (GlaxoSmithKline) Corgard (nadolol) (Pfizer Inc.) Kerlone (betaxolol) (Sanofi-Aventis) Levatol (penbutolol) (Auxilium Pharmaceuticals) Metoprolol (Lopressor, Toprol) (Teva Pharmaceuticals USA, Inc.) Propranolol (Inderal) (West-Ward Pharmaceuticals Corp.) Sectral (acebutolol) (Promius Pharma, LLC) Timolol (Blocadren) (Mylan Pharmaceuticals Inc.) Timoptic (eye drops for glaucoma) (Valeant Pharmaceuticals) Trandate, Normodyne (labetalol) (Prometheus Laboratories Inc.) Visken (pindolol) (Novartis) Zebeta (bisoprolol) (Teva Pharmaceuticals USA, Inc.) Herbal Supplements Withhold 3 days before testing. Astragalus Feverfew Green Tea Licorice Milk Thistle Saw Palmetto St. John s WortParticipantChildren < 2 years of age can be tested for indoor allergens (animals and dust mites) Children e" 2 years through adults can be tested for all allergensSourceAsthmaNet General Manual of Operations. March 1, 2012Language of SourceEnglishPersonnel and Training RequiredAll staff that perform allergy skin testing procedures must read the entire protocol and be certified by others to perform the procedures.Equipment NeedsMulti-Test II skin test applicators (two) (Lincoln Diagnostics, Inc.) Multi-Test Dipwell tray (Lincoln Diagnostics, Inc.) Isopropyl alcohol or alcohol swabs Black marking pen Transparent tape, 5/8" wide or wider Kleenex (Kimberly-Clark Worldwide, Inc.), paper towels, or other blotter Timer Millimeter ruler EpiPen autoinjectors (adult and/or pediatric) (Mylan Pharmaceuticals Inc.) or 1:1000 epinephrine ampule/vial for subcutaneous or intramuscular injection useProtocol TypePhysical measurementGeneral ReferencesBibi, H., Shoseyov, D., Feigenbaum, D., Nir, P., Shiachi, R., Scharff, S., & Peled, R. (2002). Comparison of positive allergy skin tests among asthmatic children from rural and urban areas living within small geographic area. Annals of Allergy, Asthma, and Immunology, 88(4), 416 420. Dolen, W. K. (2001). Skin testing and immunoassays for allergen-specific IgE. Clinical Reviews in Allergy & Immunology, 21(2"3), 229 239.Process and ReviewThe  HYPERLINK "http://phenx.org/node/118" \t "_blank" Expert Review Panel #6 (ERP 6) reviewed the measures in the Respiratory domain. 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