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Objective: Working with animals is characterized by exposure to particulate, biological or chemical matter, and respiratory complaints are common. The aim of our cross-sectional study was to assess the prevalence of respiratory symptoms and diagnoses among veterinary staff., Methods: Participants working in veterinary practices were examined and a detailed questionnaire was used to collect data. IgE tests to common and animal allergens were performed to specify sensitization. Associations with respiratory outcomes were analysed using logistic regression models while controlling for potential confounders., Results: Atopy was seen in 31% of the 109 female participants. Symptoms of rhinoconjunctivitis were the most frequent complaints (n = 92; 84%). In 18% the diagnosis was confirmed by physicians. Symptoms of upper and lower airways were highly correlated and an asthma diagnosis was confirmed in 11% of participants. Modelling revealed that sensitization against cats/dogs was a significant risk factor for respiratory symptoms of upper [odds ratio (OR) 4.61; 95% confidence interval (CI) 1.13-18.81] and lower airways (OR 5.14; 95% CI 1.25-21.13), physician-confirmed rhinoconjunctivitis (OR 13.43; 95% CI 1.69-106.5) and asthma (OR 9.02; 95% CI 1.16-70.39) in assistant staff of small-animal practices., Conclusions: In several cases, rhinoconjunctivitis worsened after entering the profession. Atopy and specific sensitization to cats/dogs were risk factors for health impairments. Thus, to implement preventive measures, veterinary practice staff should be educated that upper respiratory tract symptoms are not harmless and should be diagnosed and treated early., (© 2021. The Author(s).)

Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Skin prick test is the most widely used test for the diagnosis of IgE-mediated conditions. Commercial extracts are used for its performance, but in the case of fruits and vegetables it is preferable using fresh food. Although both tests possess a good safety profile, hypersensitivity reactions have been recorded., Clinical Case: Forty-seven-year old woman with a history of persistent allergic rhinitis, sensitized to the pollen of grasses, olive and salsola; she was referred to an allergology department due to anaphylaxis triggered by the consumption of avocado, cantaloupe, carrots and watermelon. Minutes after skin prick test with standardized extract and skin prick with fresh foods, she developed dyspnea, pruritus, erythema, dizziness and sibilance; she was administered 0.5 mg of intramuscular adrenalin and 4 salbutamol inhalations and placed in the Trendelemburg position. Dyspnea persisted, and vital signs monitoring showed heart and respiratory rates increase and, hence, salbutamol was applied again, together with 2 L/min of oxygen delivered by nasal cannula, intravenous fluids and 100 mg intravenous hydrocortisone; improvement was observed at 40 minutes. The patient was hospitalized for 48 hours., Conclusions: Although skin tests are safe, the risk of hypersensitivity and anaphylactic reactions should not be ruled out, especially in susceptible patients.

Background: Skin prick testing (SPT) has been regarded as a safe procedure with few systemic reactions., Objective: To evaluate the rate of systemic reactions and their associations after SPT in the largest population to date., Methods: In this study reactions were recorded prospectively in a specialist UK allergy clinic for 6 years (2007-2013). An estimated 31,000 patients underwent SPT., Results: Twenty-four patients (age range 7 months to 56 years, mean 23.5 years, 17 female patients, 12 with asthma) had systemic reactions. The rate of systemic reactions to SPT was 0.077%. The likely allergens causing the reaction were foods (18; peanut, 7; walnut, 1; Brazil nut, 2; pistachio, 1; lupin, 1; cow's milk, 2; shrimp, 1; spinach, 1; legume, 1; soy, 1), aeroallergens (4; rabbit, 1; rat, 1; ragwort, 1; grass pollen, 1), wasp venom (1), and Tazocin (1). The causative SPT wheal was larger than 8 mm in 75%. The reaction to Tazocin was severe, with anaphylaxis occurring minutes after SPT. Reactions were treated immediately in the clinic and did not require further medical care., Conclusion: In this largest single-center study, the rate of systemic reactions after SPT was 77 per 100,000 patients. It is the first study to identify foods as a common and important cause (75%), with nuts posing the highest risk. This study reports the first systemic reaction to venom SPT and the first anaphylactic reaction after drug SPT. There was an association with a history of severe reactions and large skin test reaction. There are risks, albeit small, when undertaking SPT., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Paediatric age, active eczema and high number of allergens tested in poly-sensitized patients have been pinpointed as possible risk factors of systemic reactions by skin prick testing. As far as atopic eczema concerns, the higher penetration of the allergens into the skin because of the scraping or micro-injuries is an intuitive rationalization. Purpose of the present study is to provide documentary evidence that adverse reactions elicited by anomalous absorption of allergens can occur also in adult patients with apparently normal skin., Methods: Report of some exemplifying clinical and experimental observations. Measuring the inoculum volume into impaired skin and its variability in relation to the variation of the chemical-physical characteristic of the solutions used for the tests by means of a method of direct assay based on the use of a gamma-camera., Results: Localized impairments of the skin permeability can cause a significant increase in inoculum volume by prick-test. Critical amounts of allergens can be introduced into the skin because of the possibility of direct absorption, also without pricking, of allergy diagnostic solutions. The greater water content of the solutions used for prick-testing can significantly increase the inoculum volume., Conclusions: This study adds clinical and experimental evidences that localized impairments of permeability can occur in adult patients with apparently normal skin. Special precautions should be taken when a change of the drops' normal shape and cohesion is seen, because allergy prick-testing in such areas is potentially associated with increased risk of large local or systemic reactions.

Severe hypersensitivity reactions to red meat with delay of several hours in patients with IgE to alpha-gal (galactose-alpha-1,3-galactose) have been reported. The diagnosis of meat allergy is difficult, because of the limited sensitivity of skin prick tests and specific IgE tests to meat extracts. These circumstances have been explained by the delayed expression of alpha-gal due to digestive processes. Because of the low sensitivity of skin prick tests to meat, we studied the possibility to perform skin prick tests with cetuximab, which carries the alpha-gal epitope. Skin prick and intradermal tests with cetuximab were clearly positive in 2 of 2 patients. As a further diagnostic step, we performed basophil activation tests with cetuximab. Skin prick tests and basophil activation test using cetuximab may be a more sensitive alternative in patients with an assumed allergy to meat., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Skin testing remains the preferred method for most allergists for establishing the presence of allergen sensitization. This study examined the performance of a new single-site skin test device that incorporates initial pressure to reduce the sensation of pain. Comparators were a conventional skin testing system and a smallpox needle. Twenty subjects were tested on the back, four sites with histamine and four sites with saline with each of the three skin testing devices. The single-site skin test device was applied with downward pressure, the conventional skin testing system, and smallpox needle (SPN) by pricking at a 45°angle. Outcomes were size and reproducibility of the skin test reactions and discomfort, as graded by the subject. The whealing responses to histamine were larger with the conventional skin testing system than with the single-site skin test device and both produced larger wheals than the SPN. The conventional skin testing system also produced greater intrasubject variability. Only the conventional skin testing system produced wheals of >3 mm with saline. There was no significant difference in perception of pain, which was low with all three devices. All three devices were well tolerated, without a significant difference in perception of discomfort. Testing with histamine revealed differences in wheal size and reproducibility among the three devices and testing with saline revealed differing likelihood of inducing a significantly sized wheal.

Background: Work-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment., Objectives: To evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA)., Methods: The study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test., Results: Occupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients., Conclusion: Work-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA., (Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Laboratory testing of various diagnostic extracts has shown lower potencies for several European and Mexican extracts relative to the US Food and Drug Administration (FDA) reference (10,000 BAU/mL). Quantitative skin prick testing (QSPT) with Dermatophagoides pteronyssinus extracts have previously shown a similar picture., Objective: To compare European and Mexican Bermuda grass (BG) and cat diagnostic extracts against an FDA-validated extract using QSPT., Methods: Six diagnostic BG and cat extracts (1 reference FDA extract, 3 European extracts, 1 imported nonstandardized extract from the United States, and 1 Mexican extract) were tested with quadruplicate QSPT, as a concentrate and as 2 serial 2-fold dilutions, in cat and BG allergic individuals., Results: BG showed good dose response in wheal size for the concentrate (1:2-1:4 dilutions; steep part of the curve). Cat showed poorer dose response. The Wilcoxon test for linked random samples was used to investigate whether the distribution of the reference differed from each of the test extracts to a statistically significant degree (2-sided asymptotic significance, α = .05). All BG and 2 cat extracts were statistically less potent than the 10,000 BAU/mL US reference. European BG extracts were 7,700, 4,100, and 1,600 BAU/mL, and cat extracts were 12,500, 4,400, and 5,100 BAU/mL., Conclusions: The potency of some diagnostic extracts of BG and cat used in Europe, Mexico, and the United States differs, with the US extracts being generally more potent. On the basis of provocation tests, optimal diagnostic concentrations should be determined. Similar comparisons using other manufacturers and therapeutic extracts might be interesting., (Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Skin testing is the diagnostic cornerstone for allergies and is considered extremely safe. It is usually performed with the prick and the prick-to-prick method. The aim of this study is to report the first two pediatric cases of systemic allergic reactions during skin prick tests (SPT) with commercial food allergens. Both patients had a history of fish allergy. A 5-year-old girl, with a history of atopic dermatitis and asthma, reported an episode of urticaria and angioedema due to ingestion of fish, which had occurred 2 years before consultation. Ten minutes after having completed SPT to fish extracts, which had resulted positive, she suffered from generalized pruritus, nausea, stomach pain, and loss of consciousness. A 9-year-old boy, with a history of asthma and two episodes of acute urticaria and angioedema upon eating fish during infancy, reported a recent episode of oropharyngeal pruritus after tasting salmon. He was evaluated for fish allergy with SPT but developed conjunctivitis and acute urticaria during the first 10 min of the test. Anaphylaxis appears to be a rare side effect of skin testing in pediatric patients. Children with a history of asthma and atopic dermatitis are more likely to react.

Skin testing is a reliable and safe way to diagnose IgE-mediated allergies, with rare side-effects. Two cases of systemic allergic reactions during skin testing to food allergens are hereby reported. A 28-year-old male reported allergic reactions, mild to moderate in severity, each time he tasted fish in the frame of his professional duties. During SPT and prick-to-prick to raw and cooked fishes, he presented urticaria and tachycardia. A 59-year-old male had a long history of urticaria-angioedema and asthma attacks, following the consumption of mammalian meat. He was skin-tested to various meats and during the 5 last minutes of the test he developed generalized urticaria, allergic rhinitis and conjunctivitis. They were both advised to completely avoid the relative allergens. In conclusion, skin testing, particularly prick-to-prick, may cause anaphylaxis. Tests should be performed only by physicians with proper training in allergy, experienced in treating promptly and properly episodes of anaphylaxis.

Background: Immunotherapy is the only curative treatment recommended for allergic rhinoconjunctivitis and asthma, in which small amounts of allergen are administered sublingually or subcutaneously until the maximum tolerated dose has been reached. However, local or systemic adverse reactions (AR) -rarely even fatal- an occur. In Mexico there is no nationwide data on adverse reactions., Objective: To document the frequency of adverse reactions secondary to skin tests (ST) or immunotherapy (IT) in the allergist's office in Mexico, paying special attention to fatal and near fatal allergic reactions., Participants and Methods: We mailed a survey to all members of the Mexican Colleges of Allergy (CMICA) and Pediatric Allergy (CoMPedIA)., Results: A response rate of 59 (16%) for the adverse reactions part of the questionnaire was obtained from the College members. We found a near fatal reaction rate of 0.005 cases per year per allergy practice for skin testing and the same number -0.005 cases- for immunotherapy. This can be extrapolated to a total of 1.5 cases per year in the whole country of Mexico. No fatalities were reported., Conclusions: In Mexico the frequency of severe or near fatal adverse reactions to immunotherapy or skin tests is low and no fatal case has been reported till today.

Background: Parents of atopic children frequently report, and are alarmed by, contact reactions to foods. Some schools restrict foods due to concerns regarding possible systemic reactions following contact in allergic children., Objective: We aimed to determine the frequency with which peanut-sensitive children exhibited contact sensitivity to peanut butter and to assess the significance of such reactions., Methods: One gram of peanut butter was applied directly to the skin of 281 children who were skin prick test (SPT) positive to peanut (immediate skin application food test; I-SAFT). The test was considered positive if one or more weals were present when the patch was removed after 15 min. A subset of children then underwent an open-label oral challenge with graded amounts of peanut protein., Results: During 3515 clinic visits, 330 I-SAFT tests for peanut contact sensitivity were performed; 136 (41%) were positive. The mean SPT diameter was 10 mm in the I-SAFT-positive children and 8.5 mm in the I-SAFT-negative children (t-test, P<0.0001). No child had a systemic reaction following topical application of peanut butter. Eighty-four children had 85 oral challenges after blinded, placebo-controlled I-SAFT testing. Challenge was positive in 26/32 of those with a positive I-SAFT and negative in only 6/32. Challenge was also positive in 26/53 but negative in 27/53 of those with a negative I-SAFT (sensitivity 50%, specificity 82%, chi2, P=0.003)., Conclusion: A minority of children sensitized to peanut (positive SPT) develop localized urticaria from prolonged skin contact with peanut butter. No tested subjects, including ones with systemic reactions upon oral challenge, developed a systemic reaction to prolonged skin exposure to peanut. Therefore, systemic reactions resulting from this mode of contact with peanut butter appear highly unlikely.

Prick-tests to foods are usually carried out as the first step in the diagnosis of food allergy. Severe anaphylaxis accounts for 4.9 % of allergies in children and occurs more frequently in adults, raising the possibility of systemic reactions to prick-tests in highly sensitized people. Several studies published in the literature have used commercial extracts. As for airborne allergens, concentrations causing a skin reaction of 15 mm do not present a risk of systemic reactions. Prick-tests to native foods--prick-in-prick tests--have been less extensively studied. The CICBAA1 data, from 1,138 food allergic patients of all ages, cover 34,905 prick-in-prick tests to foods. The wheal of these prick-tests has been regulary registered. The risk of systemic reactions can be evaluated at 0.008 %. There were no severe reactions and anti-histamine and corticosteroid therapy were sufficient. These results are similar to those of the large study in 2000 carried out by Devenney in neonates (0.005%). A review of the literature reveals only a few severe reactions in adults. The authors draw attention to the necessary precautions: temporary contra-indication for skin prick-tests in children and adults with grade 3 or 4 asthma, with particular attention to such foods as all kinds of nuts, fish, etc.

It has been over a century since allergy skin testing and immunotherapy were first utilized. Both have withstood the test of time and numerous challenges such as cromolyn, antihistamines, and leukotriene modifiers that have threatened to make them obsolete, to continue to play a prominent role in the diagnosis and treatment of the allergic patient. Considerable advances in the understanding of immunotherapy mechanisms and effective allergen dosing as well as improved extract quality have been made in recent years. However, there appears to be a lag in the widespread implementation of these advances into clinical practice, where a broad wide range of practice patterns exists. The wide diversity of allergy practice patterns is likely because of the absence of a uniform curriculum in allergy and immunology training programs. Recently, practice parameters have been developed by the American Academy of Allergy, Asthma and Immunology' Immunotherapy Committee and the Joint Task Force on Practice Parameters, an organization that represents the American Academy of Allergy, Asthma, and Immunology and American College of Allergy, Asthma, and Immunology, aimed at promoting a consistent, objective scientific approach to allergy skin testing and immunotherapy. Standardized allergy skin test and immunotherapy forms were designed to incorporate these guidelines. The following article summarizes the recommendations of the practice parameters and reviews some of the clinical evidence that lends support to these guidelines, which are intended to enhance the safety and efficacy of allergy skin testing and immunotherapy.

Objective: The frequency and severity of systemic reaction (SR) from skin test (ST) and specific immunotherapy (SIT) in Mexico, have not been published before. In order to know that frequency and severity, a prospective study was performed in the Allergy Clinic at General Hospital of Matamoros from August, 1991 to July, 1996. SR from ST and SIT were monitored. Symptoms were recorded with respect to the time of onset, involvement of respiratory tract or skin and presence of hypotension., Results: 65,397 injections were given to 1,149 patients; there were 25 SR in 20 patients (1:2,615 injections or 1:57 patients). Time of onset was between 10 and 30 minutes. SR were present more frequently during maintenance. There was a 3:1 rate in female patients and a predominance in the 15 to 24 age group., Conclusions: In Matamoros, Tamps., Mexico, frequency and severity of SR from ST and SIT is not different from published data. Small children are not in higher risk. Immunotherapy is a safe therapeutic procedure on expert hands.

Skin testing is a basic diagnostic procedure widely used to explore immediate-type reactions to allergen preparations in vivo. Despite their reliability, if standardized extracts are used, skin tests suffer from limited reproducibility due to difficulties in preparing consistently standardized extracts from natural raw material. Starting from allergen-encoding cDNAs, large amounts of highly pure allergens with a high batch-to-batch consistency satisfying the quality requirements of medicinal products manufactured by recombinant DNA technology can be produced. These reagents are expected to be qualitatively superior to the commercially available allergen preparations used for the in vitro and in vivo diagnosis of allergic conditions. In this article the current literature available on skin testing with such recombinant allergens (rAllergens) is reviewed and critically analyzed. To date many different rAllergens of various pollens, moulds, mites, bee venom, latex and celery have been used in skin testing in more than 1,600 allergic and control individuals. Skin prick tests as well as intradermal skin tests with rAllergens prove to be highly specific and safe. The diagnostic sensitivity of single rAllergens is generally lower than those obtained with allergen extracts, but can be considerably increased by using rAllergen panels covering the most important allergenic structures present in a given complex allergenic extract. Moreover, quantitative skin testing with single rAllergens allows interesting insights into correlations between the in vivo and in vitro sensitization to a given allergen. In conclusion, skin testing with rAllergens offers a highly specific and safe additional diagnostic tool to elucidate patient- and disease-specific sensitization patterns which will be needed for the development of patient-tailored immunotherapeutic treatments., (Copyright 2001 S. Karger AG, Basel)

Background: The use of a topical anesthetic cream containing prilocaine and lidocaine (EMLA) has been considered to reduce the pain of diagnostic allergy skin testing, but the effects of the cream on interpretation of skin tests is unclear., Objective: To determine the effects of the cream for pain reduction using prick and ID skin tests and for possible alteration of wheal and flare responses to allergen, saline, and histamine., Methods: In a randomized, double-masked, placebo-controlled design, 20 adult volunteers with a history of positive allergen tests had EMLA and placebo cream placed according to the manufacturer's recommendations on the volar aspect of the arms. Paired skin tests were placed and subjects rated the tests on a pain scale from 0 to 5 and average wheal and flare diameters were determined., Results: Mean pain scores (+/-SEM) were significantly reduced from 2.5 +/- 0.7 to 1.1 +/- 0.6 for prick tests (n = 20, P < .001) and from 3.2 +/- 0.9 to 1.13 +/- 0.9 for intradermal (ID) tests (n = 58, P < .001). The wheal sizes for allergen prick tests, allergen ID tests, and histamine ID tests were identical in comparing placebo to EMLA-treated skin. Flare responses were reduced on the actively treated skin, on average, as follows: allergen skin tests- 52% (P < .001), and histamine- 40% (P < .001). In nine tests there was complete suppression of the flare response, all on the EMLA treated skin., Conclusions: EMLA significantly reduced the pain associated with diagnostic allergy skin testing and with no effect on the size of the wheal response. It reduces the flare response, in some cases inhibiting it completely, which must be taken into consideration in interpreting results.

Background: Previous studies have identified two allergic fractions (Cr-PI and Cr-PII) from crude American cockroach extract, from which the 72- and 78-kilodalton (kD) components of Cr-PI have been identified as major allergens., Objective: The objective of this study was to identify important allergens in Cr-PII and produce monoclonal antibodies., Methods: Sera of cockroach-sensitive atopic patients were examined for IgE binding to Cr-PII proteins and monoclonal antibodies were generated by fusion between spleen cells of BALB/c mice immunized with Cr-PII and FO cells., Results: Immunoblotting revealed that eight allergenic compounds in Cr-PII are able to bind specific IgE. Allergens of 18, 28, 32 and 45 kD bound 16.7% (2/12), 100% (12/12), 83.3% (11/12), and 100% (12/12) of the atopic sera tested, respectively. Cell fusion resulted in three stable subclones secreting monoclonal antibodies, and none of the monoclonal antibodies recognized any epitopes of German cockroach and Cr-PI of American cockroach. One monoclonal antibody reacted strongly with the 28- and 32-kD allergens of Cr-PII, and two monoclonal antibodies were able to bind the 18- and 12-kD components of Cr-PII with similar epitope specificities. All the epitopes defined by monoclonal antibodies are recognized by human IgE as demonstrated by a fluoroallergosorbent test (FAST) inhibition assay. Five commercial cockroach extracts were compared for Cr-PII levels by monoclonal antibody-base ELISA, and all extracts were found to contain detectable Cr-PII., Conclusion: The 28-, 32-, and 45-kD components of Cr-PII may be considered as additional important allergens of American cockroach and monoclonal antibodies can be used to identify and define American cockroach allergens.

It is reported on 3 patients of medical profession who suffered from anaphylactic complications after the patch test with penicilline G, aminophenazone and promethazinhydrochloride. The triggering of the IgE mediated allergy is explained by the quick and complete epidermal penetration of the haptens because their low molecular weight and optimal solubility. It could be proved by the positive mast cell degranulation test, whereas the IgE level was elevated in serum only in one case, but in tissue in no case. Prophylactically, if the careful exploration is positive, the open patch test is indicated. It should carried out in the clinic or ambulance with consecutive observation of the patients for 60 min and with the possibility of the treatment of shock.

A sample (N = 16,204) of the U.S. population, 6 to 74 years of age, was examined in NHANES II with a variety of routine medical procedures, including prick-puncture allergen skin testing (AST), venipuncture, and body measurements. Eight unstandardized extracts licensed by the Food and Drug Administration, a positive and negative control, were used. AST was performed to screen the population for immediate hypersensitivity responses to common aeroallergens. No anaphylactic reactions after AST were observed. One asthmatic reaction occurred during venipuncture. Other adverse reactions (ARs) were limited to syncope, near syncope, and malaise. The rates for any AR were venipuncture, 0.49% (95% confidence interval [CI], 0.38% to 0.60%); AST, 0.04% (95% CI, 0.01%-0.08%); body measures, 0.006% (95% CI, 0 to 0.018%). Sex or fasting status had little effect on the occurrence of AR. The age group 20 to 49 years had the highest occurrence of any AR to venipuncture (0.87%; 95% CI, 0.633% to 1.107%). The risk of prick-puncture AST with eight extracts licensed by the Food and Drug Administration is low and similar to other routine medical procedures.