Allergic Rhinitis:​Rapid Evidence Review

Jackie Weaver-Agostoni, DO, MPH, UPMC Shadyside Family Medicine Residency

Program, Pittsburgh, Pennsylvania;​University of Pittsburgh, Pittsburgh, Pennsylvania
Zachary Kosak, MD, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Stacy Bartlett, MD, University of Pittsburgh, Pittsburgh, Pennsylvania

Allergic rhinitis, the fifth most common chronic disease in the United States, is an immunoglobulin E–mediated process.
A family history of allergic rhinitis, asthma, or atopic dermatitis increases a patient’s risk of being diagnosed with allergic
rhinitis. People in the United States are commonly sensitized to grass, dust mites, and ragweed allergens. Dust mite–proof
mattress covers do not prevent allergic rhinitis in children two years and
younger. Diagnosis is clinical and based on history, physical examination, and
at least one symptom of nasal congestion, runny or itchy nose, or sneezing.
History should include whether the symptoms are seasonal or perennial, symp-
tom triggers, and severity. Common examination findings are clear rhinorrhea,
pale nasal mucosa, swollen nasal turbinates, watery eye discharge, conjunctival
swelling, and allergic shiners (i.e., dark circles under the eyes). Serum or skin
testing for specific allergens should be performed when there is inadequate
response to empiric treatment, if diagnosis is uncertain, or to guide initiation or

Illustration by Jennifer Fairman

titration of therapy. Intranasal corticosteroids are first-line treatment for allergic
rhinitis. Second-line therapies include antihistamines and leukotriene recep-
tor antagonists and neither shows superiority. If allergy testing is performed,
trigger-directed immunotherapy can be effectively delivered subcutaneously or sublingually. High-efficiency particulate
air (HEPA) filters are not effective at decreasing allergy symptoms. Approximately 1 in 10 patients with allergic rhinitis will
develop asthma. (Am Fam Physician. 2023;​107(5):466-473. Copyright © 2023 American Academy of Family Physicians.)

Allergic rhinitis is the most common chronic • Allergic rhinitis is caused by IgE-mediated
disease of childhood and the fifth most common reactions against inhaled allergens. IgE-­​
chronic disease in the United States.1,2 It is an mediated cross-linking activates mast cells and
immunoglobulin E (IgE)–mediated process, and a basophils, releasing histamine and leukotrienes
clinical diagnosis is made based on common signs that cause edema, vasodilation, nasal obstruc-
and symptoms, physical examination findings, tion, and central nervous system reflexes that
and family and social history. This rapid evidence cause sneezing.1
review highlights current literature and research • In the United States, patients with allergic
on the diagnosis and treatment of allergic rhinitis. rhinitis are commonly sensitized to grass, dust
mites, and ragweed allergens.4
Epidemiology and Pathophysiology • Allergic rhinitis is the most common medical
• Approximately 15% to 30% of people in the reason employees miss time from work and is
United States have allergic rhinitis. Estimates of associated with the largest productivity loss for
the direct economic burden range from $2 billion employers.5
to $5 billion annually.2,3 • In children and adolescents, allergic rhinitis
is associated with increased school absenteeism,
CME This clinical content conforms to AAFP criteria for
irritability, inattention, and sleep disruption.2,3,6
CME. See CME Quiz on page 458.
Prevention
Author disclosure:​ No relevant financial relationships.
• Dust mite–proof mattress covers do not prevent
Patient information:​A handout on this topic is available
with the online version of this article. allergic rhinitis symptoms in children two years
and younger.7

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 ALLERGIC RHINITIS

SORT:​KEY RECOMMENDATIONS FOR PRACTICE

Evidence
Clinical recommendation rating Comments

It is reasonable to diagnose and begin empiric treatment for C Guideline recommendation from the American
allergic rhinitis based on history and physical examination alone. 2 Academy of Otolaryngology–Head and Neck Sur-
gery Foundation

If needed, skin allergen testing should be performed instead of A Consistent, good-quality patient-centered evidence,
blood serum testing for most patients because it is more sensi- including a meta-analysis
tive, less expensive, and provides immediate results.17-21

Sinonasal imaging should not be performed routinely unless C Guideline recommendation from the American
there are other clinical indications (e.g., evidence of acute or Academy of Otolaryngology–Head and Neck Sur-
chronic sinusitis, nasal polyps, suspicion for neoplasm). 2,9 gery Foundation

Intranasal corticosteroids are first-line treatment for allergic A Consistent results from randomized controlled trials
rhinitis. 25-29 for continuous and as-needed use

High-efficiency particulate air (HEPA) filters are ineffective at A Consistent, well-designed studies, including a ran-
decreasing allergy symptoms.41,42 domized, double-blind, clinical controlled trial

A = consistent, good-quality patient-oriented evidence;​ B = inconsistent or limited-quality patient-oriented evidence;​ C = consensus, disease-
oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to [Link] [Link].
org/afpsort.

• Exclusively breastfeeding infants at three, six,

and 12 months of age does not reduce the rate of TABLE 1
allergic rhinitis symptoms at six years of age.8
Accuracy of Medical History for the Diagnosis
Diagnosis of Allergic Rhinitis
HISTORY Positive Negative
• The American Academy of Otolaryngology– likelihood likelihood
Question ratio ratio
Head and Neck Surgery Foundation’s allergic
rhinitis guideline was endorsed by the American Are allergic nasal symptoms from pollen 6.7 0.15
Academy of Family Physicians in 2014 and reaf- or animals?
firmed in April 2020.2,9 Are symptoms from animals? 4.2 0.34
• Diagnosis of allergic rhinitis is based on patient
history, physical examination, and at least one of Do any family members have asthma, 3.4 0.70
eczema, or allergic rhinitis?
the following symptoms:​nasal congestion, runny
or itchy nose, or sneezing.2 Table 1 shows the accu- Do house dust, house dust mites, or pollen 3.3 0.39
racy of medical history for the diagnosis of aller- provoke or increase nasal symptoms?
gic rhinitis.10 Do you think you are allergic? 3.1 0.33
• Other symptoms include itchy or watery eyes,
sniffling, and postnasal drip. History should Are nasal symptoms accompanied by itchy 2.5 0.51
watery eyes?
include whether the symptoms are seasonal or
perennial, symptom triggers, and severity. Fam- Do you have seasonal exacerbation? 1.6 0.59
ily history of allergic rhinitis, asthma, or atopic
Nasal symptoms in the past year, including 1.4 0.14
dermatitis makes the diagnosis more likely.2,10,11 sneezing, runny nose, or blocked nose,
• Triggers unlikely to be related to allergic rhini- when you did not have a cold or flu?
tis (e.g., smoke, fumes, chemicals), unilateral nasal
Adapted with permission from Gendo K, Larson EB. Evidence-based diagnos-
symptoms, and the use of medications known to tic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004;​
cause nasal symptoms (e.g., antihypertensives 140(4):​280.
such as beta blockers, calcium channel blockers,

May 2023 ◆ Volume 107, Number 5 [Link]/afp American Family Physician 467
 ALLERGIC RHINITIS

TABLE 2

Diagnostic Testing for Allergic Rhinitis

Procedure Contraindications Clinical considerations Benefits Drawbacks

Skin test
(1) Apply small amount of antigen Extensive dermatologic First line unless con- Higher sensitivity Risk of anaphy-
to epidermis (usually forearm or disease, pregnancy, use traindicated or patient and less expensive laxis, patient
back) of medications that blunt preference discomfort
(2) Monitor for wheal formation allergic response (e.g., anti-
at each site after 15 to 20 minutes histamines, beta blockers)

Serum test
(1) Obtain serum sample — Use if high risk of ana- Higher specificity Immunoassay
(2) Perform immunoassay to phylaxis or unable to and less risk of ana- variability
quantify amount of allergen- discontinue medications phylaxis;​ provides
bound immunoglobulin E that are contraindicated quantitative results
in the skin test to guide treatment

Information from reference 13.

and angiotensin-converting enzyme inhibitors;​psychotro- • Skin testing is more sensitive (80% to 90%) compared with
pic agents;​rebound effects from topical decongestants) sug- blood serum testing (average sensitivity = 70% to 75%), less
gest another possible diagnosis.12,13 expensive, and provides immediate results.17-20 Blood serum
testing is more specific (80% to 100%).21
PHYSICAL EXAMINATION • Blood testing should be used if there are contraindications
• Physical examination findings are often nonspecific but to skin testing (e.g., high risk of anaphylaxis, severe dermato-
increase the likelihood of allergic rhinitis when combined logic conditions) or if the patient prefers it to skin testing.2,9
with history.12 • Insufficient evidence exists to support other types of test-
• Common examination findings include clear rhinorrhea, ing (e.g., nasal allergen challenges, acoustic rhinometry).12
pale nasal mucosa, swelling of the nasal turbinates, watery • Do not routinely perform sinonasal imaging unless there
eye discharge, conjunctival swelling, and allergic shiners are other clinical indications (e.g., evidence of acute or
(i.e., dark circles under the eyes).12 chronic sinusitis, nasal polyps, suspicion for neoplasm).2,9
• Interrater reliability of the clinical assessment of turbinate
hypertrophy (kappa = 0.31, range = 0 to 1.0) and turbinate Treatment
color (kappa = 0.38) is modest.14 MEDICATION
• Table 3 shows different treatment options for aller-
DIAGNOSTIC TESTING gic rhinitis. Table 4 outlines the adverse effects of these
• It is reasonable to diagnose and begin empiric treat- medications.22-24
ment for allergic rhinitis based on history and physical • Intranasal corticosteroids are first-line treatment for aller-
examination.2,9 gic rhinitis, even when used on an as-needed basis, with clear
• Allergy testing should be performed when there is inad- superiority over other medical therapies. One randomized
equate response to empiric treatment, when diagnosis is controlled trial (RCT) showed no significant difference in
uncertain, or to guide initiation or titration of therapy.2 mean change of total nasal symptom score after six weeks
• Serum and skin tests are the two main types of allergy between regular and intermittent use. Another randomized,
testing15 (Table 213). open-label, parallel-group study comparing fluticasone with
• Blood serum tests determine the level of allergen-specific loratadine showed that the median total symptom score
IgE in a serum sample.1 However, IgE levels do not neces- using an allergic rhinitis–specific scale was significantly
sarily correlate with clinical severity. In one study, the high- lower, meaning fewer symptoms, in the fluticasone group
est levels of IgE induced the weakest biologic reactions (i.e., compared with the loratadine group (4 vs. 7 points out of a
mean wheal diameter of skin reaction).16 total of 7).25-29

468 American Family Physician [Link]/afp Volume 107, Number 5 ◆ May 2023
 ALLERGIC RHINITIS
TABLE 3

Treatment for Allergic Rhinitis

Type of therapy Mechanism of action Minimum age for use Cost* FDA pregnancy category

Intranasal corticosteroids
Beclomethasone (Qnasl) Inhibits multiple 4 years — ($250) for one inhaler May use during preg-
Budesonide inflammatory 6 years $9 (—) for one nasal spray nancy;​no human data but
cytokines considered low risk
Ciclesonide (Omnaris) 6 years — ($300) for one nasal spray
Flunisolide 6 years $25 (—) for one nasal spray
Fluticasone furoate 2 years $5 ($20) for one nasal spray
(Flonase Sensimist)
Fluticasone propionate 4 years $5 (—) for one nasal spray
Mometasone 2 years $30 (—) for one nasal spray
Triamcinolone 2 years $21 (—) for one nasal spray

Oral antihistamines
Cetirizine (Zyrtec) First-generation 6 months $2 ($20) for 30 tablets May use during pregnancy
Chlorpheniramine antihistamines 6 years $1 (—) for 30 tablets based on limited human
nonselectively data
Desloratadine (Clarinex) 6 months for peren- $8 ($230) for 30 tablets
antagonize central
nial use and 2 years
and peripheral his-
for seasonal use
tamine H1 receptors;​
Diphenhydramine second-generation 6 years $4 (—) for 30 tablets
Fexofenadine antihistamines 12 years $5 (—) for 30 tablets
Levocetirizine selectively antago- 6 months for sea- $5 (—) for 30 tablets
nize peripheral H1 sonal use and 6 years
receptors for perennial use
Loratadine 2 years $4 (—) for 30 tablets

Intranasal antihistamines
Azelastine Antagonizes central 5 years for seasonal $15 (—) for one nasal spray May use during preg-
and peripheral use and 6 years for nancy;​no human data
H1 receptors perennial use although fetal harm not
(nonselective expected based on limited
antihistamine) systemic absorption (40%)

Combination intranasal corticosteroid and antihistamine

Azelastine/fluticasone Inhibits multiple 6 years $70 ($120) for one nasal May use during preg-
(Dymista) inflammatory spray nancy;​no human data,
Mometasone/olopata- cytokines;​ antag- 12 years — ($250) for one nasal although fetal harm not
dine (Ryaltris) onizes central and spray expected based on limited
peripheral H1 recep- systemic absorption
tors (nonselective
antihistamine)
Oral decongestants
Pseudoephedrine Stimulates 6 years $4 (—) for 30 tablets Avoid use in first tri-
smooth muscle mester;​weigh risks and
alpha-adrenergic benefits in second and
receptors, produc- third trimesters;​limited
ing vasoconstriction human data suggest risk
and reducing nasal of teratogenicity includ-
congestion ing gastroschisis, small
(sympathomimetic) intestinal atresia, and
hemifacial microsomia;​
risk of vasoconstriction
based on animal data and
mechanism of action
continues

FDA = U.S. Food and Drug Administration.

*—Estimated lowest GoodRx price for a 30-day supply. Actual cost will vary with insurance and by region. Generic price listed first;​brand name
price in parentheses. Information obtained at [Link] [Link] (accessed November 14, 2022;​zip code:​66211).

May 2023 ◆ Volume 107, Number 5 [Link]/afp American Family Physician 469
 ALLERGIC RHINITIS
TABLE 3 (continued)

Treatment for Allergic Rhinitis

Type of therapy Mechanism of action Minimum age for use Cost* FDA pregnancy category

Intranasal cromolyns and anticholinergics

Cromolyn Inhibits mast cell 2 years $7 (—) for one nasal spray May use during preg-
degranulation (mast nancy;​no human data,
cell stabilizer) although fetal harm not
expected based on limited
systemic absorption (< 7%)
Ipratropium Antagonizes acetyl- 5 years for seasonal $14 (—) for one nasal spray May use during pregnancy;​
choline receptors, use and 6 years for no human data, although
inhibiting nasal perennial use fetal harm not expected
serous/seromucous based on limited systemic
gland secretions absorption (< 20%)

Leukotriene receptor antagonists

Montelukast Selectively binds to 6 months for peren- $15 (—) for 30 tablets Weigh risks and bene-
cysteinyl leukotriene nial use, 2 years for fits during pregnancy;​
receptors, decreas- seasonal use no known risk based on
ing inflammation limited human and animal
and swelling data

Sublingual immunotherapy
Timothy grass pollen Exact mecha- 5 years — ($320) for 30 tablets Weigh risks and benefits
allergen extract, cross- nism unknown:​ during pregnancy;​no
reactive with six other alters immune human data, although risk
grass pollens (Grastek) response and of fetal harm not expected
House dust mite aller- promotes tolerance 18 years — ($315) for 30 tablets based on human data with
gen extract (Odactra) through repeated other allergen immuno-
allergen-specific therapy agents
Five-grass pollen 5 years Only available at specialty
exposure
extract (Oralair) pharmacies
Peanut allergen oral 4 years — ($1,100) for one dose
powder (Palforzia) pack at maintenance dose
Short ragweed pollen 5 years — ($305) for 30 tablets
extract (Ragwitek)

FDA = U.S. Food and Drug Administration.

*—Estimated lowest GoodRx price for a 30-day supply. Actual cost will vary with insurance and by region. Generic price listed first;​brand name
price in parentheses. Information obtained at [Link] [Link] (accessed November 14, 2022;​zip code:​66211).

• There are fewer studies supporting the use of intranasal review and meta-analysis concluded that montelukast did
corticosteroids for allergic rhinitis in children, and they are not improve nasal symptom scores in a clinically significant
lower quality (three RCTs, 79 participants) than those in manner. Topical nasal corticosteroids were significantly
adults.30,31 more effective than montelukast (8.4% greater improvement
• Avoid using intranasal corticosteroids, particularly in symptom scores;​95% CI, 6% to 11%). Combining montelu-
those metabolized via CYP3A4, such as fluticasone and kast with an antihistamine controlled symptoms better than
budesonide, in patients with HIV who are being treated with either alone, and two studies showed similar clinical effec-
ritonavir or cobicistat (Tybost). Medication interactions can tiveness to nasal corticosteroids. One RCT showed equivalent
increase steroid levels and risk of systemic corticosteroid effectiveness with montelukast and loratadine, although nei-
effects, including Cushing syndrome and serious infec- ther was as effective as intranasal corticosteroids.34,35
tion. Mometasone should be used cautiously with ritonavir • Oral antihistamines are inferior to intranasal corticoste-
because of pharmacokinetic similarities to fluticasone.32 roids in relieving nasal symptoms (standardized mean dif-
• One double-blind, parallel, three-group study showed ference [SMD] = −0.70;​95% CI, −0.93 to −0.47) and quality
that treating allergic rhinitis with intranasal corticoste- of life (SMD = −0.90;​95% CI, −1.18 to −0.62), but there is
roids improved control of asthma symptoms and decreased no significant difference for ocular symptoms.36 Studies on
morbidity.33 nasal antihistamines are lacking.
• Montelukast alone is ineffective to treat allergic rhinitis, but • Normal saline nasal irrigation is more effective than saline
it may be considered as an adjunct therapy.34,35 A systematic spray in decreasing nasal or sinus symptoms, and low-quality

470 American Family Physician [Link]/afp Volume 107, Number 5 ◆ May 2023
 ALLERGIC RHINITIS

evidence shows that it may decrease patient-reported disease and chronic idiopathic urticaria. It has not been studied
severity with no adverse effects compared with no saline irri- compared with other treatment strategies.38
gation at three months in adults and children. There was an • Biologics such as timothy grass pollen allergen extract
approximate decrease of 3 points on a 10-point visual analog (Grastek) and house dust mite allergen extract (Odactra) are
scale for nasal symptoms.22,37 costly and not recommended for uncomplicated allergic rhini-
• Omalizumab (Xolair), an anti-IgE antibody, effectively tis. Sublingual immunotherapy, when indicated, is moderately
treats allergic rhinitis, but it is approved by the U.S. Food and effective for treating allergic rhinitis based on symptom scores
Drug Administration only for allergic asthma, nasal polyps, (SMD = −0.49;​95% CI, −0.64 to −0.34). Grass pollen sublin-
gual immunotherapy demonstrated
more adverse events than placebo (61.3%
TABLE 4
vs. 20.9%).23,24 No head-to-head studies
between subcutaneous and sublingual
Adverse Effects of Allergy Treatments
immunotherapy exist;​choice depends
Type of therapy Adverse effects on patient preference or availability.39
Intranasal Bitter aftertaste, candidiasis, dry throat, epistaxis, headache, • For most adults, oral sublingual
corticosteroids nasal irritation, nasal septum perforation, pharyngitis, rhinor- treatment with grass pollen extract is
rhea;​minimal systemic absorption (50%) not effective at decreasing symptoms
Growth suppression in children has not been demonstrated related to grass pollen allergy.23 For a
with chronic use of nasal steroids22
patient with an isolated grass pollen
Oral antihistamines Dizziness, drowsiness, dry mouth, fatigue, headache allergy, daily sublingual treatment with
Anticholinergic properties of first-generation antihistamines grass pollen extract is somewhat effec-
cause antidyskinetic, antiemetic, and sedative effects tive in reducing rhinoconjunctivitis.32
Cetirizine (Zyrtec) and chlorpheniramine can cause sedation • Oral and nasal decongestants lack
in children without a subjective feeling of drowsiness23 rigorous studies for allergic rhinitis,
Diphenhydramine can cause paradoxical hyperactivity in but one low-quality study showed sim-
children
ilar improvement in symptoms with
Diphenhydramine and loratadine do not cause sedation or
pseudoephedrine and montelukast,
affect school performance in children24
although pseudoephedrine was mar-
Intranasal Bitter aftertaste, headache, nasal irritation, sneezing, upper ginally better for nasal congestion.40
antihistamines respiratory tract infection symptoms, xerostomia • Allergist referral should be con-
Combination intra- Bitter aftertaste, candidiasis, dry throat, epistaxis, headache, sidered if diagnosis is questionable,
nasal corticosteroid nasal irritation, nasal septum perforation, pharyngitis, rhinor- first- and second-line treatments are
and antihistamine rhea, sneezing, upper respiratory tract infection symptoms, ineffective, or the patient is interested
xerostomia;​minimal systemic absorption (50%)
in pursuing immunotherapy.
Growth suppression in children has not been demonstrated
with chronic use of nasal steroids22
OTHER TREATMENTS
Oral decongestants Anxiety, central nervous system stimulation, dizziness, ele- • High-efficiency particulate air
vated blood pressure, headache, palpitations, tremor, urinary
(HEPA) filters are ineffective at decreas-
retention
ing allergy symptoms.41,42
Intranasal Dry mouth and throat, epistaxis, nasal irritation, taste • Bed, pillow, and quilt covers do not
anticholinergics changes, upper respiratory tract infection symptoms significantly decrease symptoms or
Intranasal cromolyns Bad taste, epistaxis, nasal burning, sneezing the need for medication in adults with
allergic rhinitis or asthma who are
Leukotriene receptor Abdominal pain, headache, reflux, upper respiratory tract
allergic to dust mites.43,44
antagonists infection symptoms;​FDA boxed warning for rare but serious
neuropsychiatric disorders • The usefulness of inferior turbinate
surgery to treat allergic rhinitis after
Immunotherapy Headache, itching, lip swelling, throat irritation;​possible failed medical treatment has not been
severe hypersensitivity reactions
determined.45
FDA = U.S. Food and Drug Administration. • Homeopathic immunotherapy is
Information from references 22-24. ineffective for house dust mite allergy
in adults with asthma.46

May 2023 ◆ Volume 107, Number 5 [Link]/afp American Family Physician 471
 ALLERGIC RHINITIS

• One RCT of 125 patients showed that butterbur was non- 5. Lamb CE, Ratner PH, Johnson CE, et al. Economic impact of workplace
productivity losses due to allergic rhinitis compared with select medical
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tutes of Health only if pyrrolizidine alkaloids are removed.46 and allergic rhinoconjunctivitis on adolescents:​a literature review. Ann
Allergy Asthma Immunol. 2018;​1 21(1):​43-52.e3.
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Prognosis of Asthma and Mite Allergy (PIAMA) Study. Placebo-controlled trial of
• One study showed that 9.7% of patients with allergic rhi- house dust mite–impermeable mattress covers:​effect on symptoms in
early childhood. Am J Respir Crit Care Med. 2002;​166(3):​307-313.
nitis will develop asthma.47
8. Kramer MS, Matush L, Vanilovich I, et al.;​Promotion of Breastfeeding
• It was believed that sensitization to potential allergens Intervention Trial (PROBIT) Study Group. Effect of prolonged and exclu-
throughout life improved allergic rhinitis symptoms, but sive breast feeding on risk of allergy and asthma:​cluster randomised
recent literature shows that allergic rhinitis tends to be misdi- trial. BMJ. 2007;​335(7624):​815.
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agnosed and is problematic for older and younger patients.48 Allergic rhinitis. April 2020. Accessed June 6, 2022. [Link] ww.
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JACKIE WEAVER-AGOSTONI, DO, MPH, FACOFP, DipABLM, 14. Eren E, Aktaş A, Arslanoğlu S, et al. Diagnosis of allergic rhinitis:​inter-
is director of the UPMC Shadyside Family Medicine Residency rater reliability and predictive value of nasal endoscopic examination:​
a prospective observational study [published correction appears in Clin
Program, Pittsburgh, Pa., and a clinical associate professor
Otolaryngol. 2015;​40(1):​75]. Clin Otolaryngol. 2013;​38(6):​481-486.
in the Department of Family Medicine at the University of
15. Health Quality Ontario. Skin testing for allergic rhinitis:​a health technol-
Pittsburgh.
ogy assessment. Ont Health Technol Assess Ser. 2016;​16(10):​1-45.
16. Niederberger V, Stübner P, Spitzauer S, et al. Skin test results but not
ZACHARY KOSAK, MD, is an assistant professor in the Depart-
serology reflect immediate type respiratory sensitivity:​a study per-
ment of Family Medicine and Community Health at the Perel- formed with recombinant allergen molecules. J Invest Dermatol. 2001;​
man School of Medicine at the University of Pennsylvania. 117(4):​848-851.
At the time this article was wrtitten, he was a resident in the 17. Wong AG, Lomas JM. Allergy testing and immunotherapy. Pediatr Rev.
UPMC Shadyside Family Medicine Residency Program. 2019;​40(5):​219-228.
18. Platt MP, Wulu JA. Rational approach to allergy testing. Otolaryngol Clin
STACY BARTLETT, MD, is an assistant professor in the Depart- North Am. 2017;​50(6):​1 103-1110.
ment of Family Medicine at the University of Pittsburgh. 19. Consumer Health Choices. Allergy tests:​when you need them—
and when you don’t. July 2012. Accessed June 20, 2022. [Link]
Address correspondence to Jackie Weaver-Agostoni, DO, [Link]/catalog/allergy-​tests-aaaai/
MPH, UPMC Shadyside, 5215 Centre Ave., Pittsburgh, PA 20. Choi IS, Koh YI, Koh J, et al. Sensitivity of the skin prick test and speci-
15232 (email:​agostonijs@​[Link]). Reprints are not avail- ficity of the serum-specific IgE test for airway responsiveness to house
able from the authors. dust mites in asthma. J Asthma. 2005;​42(3):​197-202.
21. Platt MP, Wulu JA. Rational approach to allergy testing. Otolaryngol Clin
North Am. 2017;​50(6):​1 103-1110.
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