Documents from the SIAIP Commissions

Issue 1 - 2025

Allergy skin tests: an update on Skin Prick Test and Prick to Prick

Authors

Edited by SIAIP Diagnostic Commission , Giulio Dinardo , Fernanda Chiera , Stefania Arasi , Arianna Giannetti , Davide Caimmi , Carla Mastrorilli , Luca Pecoraro , Serena Gracci , Michele Miraglia del Giudice , Roberto Bernardini

Key words: Skin prick test, prick by prick, Prick to prick test, Allergy diagnosis, IgE-mediated hypersensitivity, Food allergy testing, Aeroallergens and skin testing, Allergen extracts and standardization, Diagnostic accuracy in allergy testing, Automated Skin Prick Test
DOI: 10.53151/2531-3916/2025-1109
Publication Date: 2025-03-27

Abstract

Skin prick testing (SPT) is an essential tool in allergy diagnostics, allowing the identification of IgE-mediated hypersensitivity reactions to specific foods or environmental allergens. Among its variations, the prick by prick (PTP) test plays a crucial role in food allergy diagnosis, particularly when commercial allergen extracts fail to capture heat-sensitive or enzymatically labile proteins. PTP testing involves pricking a fresh food sample before introducing the allergen into the skin, thus ensuring exposure to the full allergenic profile. This method enhances diagnostic sensitivity and specificity, reducing the likelihood of false-negative results. The choice of SPT devices, whether single-prick or multiple-prick, significantly impacts test accuracy, reproducibility, and patient comfort. While single-prick devices offer precise allergen application, multiple-prick devices improve efficiency in clinical settings. Despite its advantages, PTP testing lacks standardization, with results influenced by food properties, regional variations, and test administration techniques. Additionally, PTP is a cost-effective alternative in areas where commercial extracts are unavailable. When combined with serum-specific IgE testing and oral food challenges, PTP enhances clinical decision-making, minimizing unnecessary dietary restrictions. This review provides an update on SPT and PTP methodologies, highlighting their strengths, limitations, and future perspectives in allergy diagnostics. Standardization and improved training protocols remain key to optimizing the reliability of these essential tests.

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Authors

Edited by SIAIP Diagnostic Commission

Giulio Dinardo - Department of Woman, Child and General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, Naples, Italy

Fernanda Chiera - Department of Pediatrics, Giovanni Paolo II Hospital, Lamezia Terme, ASP Catanzaro, Italy

Stefania Arasi - Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

Arianna Giannetti - Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Davide Caimmi - Allergy Unit, CHU de Montpellier, Montpellier, France; IDESP, UMR 1318, INSERM, University of Montpellier, Montpellier, France

Carla Mastrorilli - Department of Pediatrics, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy

Luca Pecoraro - Pediatric Unit, Ospedale Vito Fazzi, ASL Lecce, Lecce, Italy

Serena Gracci - Pediatrics and Neonatology Unit, Maternal and Child Department, San Giuseppe Hospital, Empoli, Azienda USL Toscana Centro, Italy

Michele Miraglia del Giudice - Department of Woman, Child and General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, Naples, Italy

Roberto Bernardini - Pediatrics and Neonatology Unit, Maternal and Child Department, San Giuseppe Hospital, Empoli, Azienda USL Toscana Centro, Italy

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Copyright (c) 2025 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Diagnostic Commission, E. by S., Dinardo, G., Chiera, F. ., Arasi, S., Giannetti, A., Caimmi, D., Mastrorilli, C., Pecoraro, L., Gracci, S., Miraglia del Giudice, M., & Bernardini, R. (2025). Allergy skin tests: an update on Skin Prick Test and Prick to Prick. Italian Journal of Pediatric Allergy and Immunology, 39(1). https://doi.org/10.53151/2531-3916/2025-1109
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