Poon A W, Goodman C S, Rubin R J
Lewin Group, Fairfax, VA 22031, USA.
Am J Manag Care. 1998 Jul;4(7):969-85.
Controversy exists concerning the appropriate use of skin testing and in vitro testing for the diagnosis of allergy, particularly inhalant allergy. Earlier comparisons of skin testing and in vitro testing concluded that skin testing had superior accuracy at lower expense. In light of new developments with in vitro allergy testing, however, this issue should be reconsidered. A review of the recent scientific literature indicates that in vitro and skin testing are highly correlated. However, without the existence of an independent gold standard for inhalant allergy, it is not possible to determine which test is more accurate. The accuracy of either test can be compromised if conducted using different protocols or having insufficient quality control. Given their respective trajectories for technological advancement, quantification, and quality control, in vitro testing may offer the more standardized approach. 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, given the greater number of allergens typically used in skin testing. In summary, both skin testing and in vitro testing are acceptable as frontline diagnostic tools.
关于皮肤试验和体外试验在过敏诊断（尤其是吸入性过敏诊断）中的合理应用存在争议。早期对皮肤试验和体外试验的比较得出结论，皮肤试验在费用较低的情况下具有更高的准确性。然而，鉴于体外过敏试验的新进展，这个问题应该重新考虑。对近期科学文献的回顾表明，体外试验和皮肤试验高度相关。然而，由于不存在用于吸入性过敏的独立金标准，无法确定哪种试验更准确。如果使用不同的方案或质量控制不足，任何一种试验的准确性都可能受到影响。鉴于它们各自在技术进步、定量和质量控制方面的发展轨迹，体外试验可能提供更标准化的方法。虽然体外试验每次检测的成本仍然高于皮肤试验，但考虑到皮肤试验通常使用的过敏原数量更多，两种方法的人均成本似乎相当。总之，皮肤试验和体外试验作为一线诊断工具都是可以接受的。
