Intradermal test

The intradermal test involves the intracutaneous injection of 0.01-0.05 ml of allergen extract through a 26/27-gauge needle. Similar positive and negative controls are also used. This method carries more risk of systemic reactions than the prick-puncture method. It frequently produces local reactions, making it a less 'comfortable' test. The local reactions also have implications for the accuracy of the test, with an ensuing high rate of false positives. There are reports of systemic reactions, including fatalities. Its safety can be improved by preceding the test with prick-puncture tests, using serial tenfold dilutions of the usual test concentration, in particular if subjects have a history of anaphylactic reactions. The presence of a physician is recommended, with resuscitation equipment including pre-loaded adrenaline.25

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