Skip to main content

Allergic rhinitis diagnosis: skin-prick test versus laboratory diagnostic methods



To verify the specificity, sensitivity, and accuracy of the skin-prick tests (SPTs) in allergic rhinitis (AR) compared with blood tests and nasal smears.

Study design

It is a cohort, prospective, nonrandomized study.

Patients and methods

A total of 180 patients were enrolled. Group A included 135 patients having AR symptoms for more than 1 year. Group B included 45 patients without AR symptoms candidate for septoplasty surgery who served as controls. All patients were subjected to detailed history, scoring for AR, endoscopic examination, complete blood count, nasal smear eosinophilia, and SPT.


SPT was positive in 94.1% (n=127) of allergic patients and 20% (n=9) of the controls at least for one allergen. Most of cases were allergic to mixed pollens (66.7%), cotton dust (41.5%), and housefly particles and house dust mite (28.9% equally). The absolute eosinophil count was positive in 70.4% of allergic patients (n=95) and 33.3% of the control (n=15). Nasal smear eosinophilia was positive in 82.9% (n=112) of allergic patients and 20% (n=9) of the controls. SPT possesses high sensitivity and specificity that reached 94.1 and 80%, respectively, and 90.6% accuracy. However, absolute eosinophil count showed the lowest results, where sensitivity and specificity reached 70.4 and 66.7%, respectively, and 69.4% accuracy.


SPT is accurate for diagnosing AR and possesses high sensitivity and specificity; however, adding a nasal swap test will raise the sensitivity, specificity, and accuracy of diagnosis.


  1. 1

    Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol 2014; 4 (Suppl 2):S18–S20.

    Article  Google Scholar 

  2. 2

    Eifan AO, Durham SR. Pathogenesis of rhinitis. Clin Exp Allergy 2016; 46:1139–1151.

    Article  CAS  Google Scholar 

  3. 3

    Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res 2010; 2:65–76.

    Article  Google Scholar 

  4. 4

    Pawankar R, Mori S, Kimura S, Chika O, Satoko K. Overview on the pathomechanisms of allergic rhinitis. Asia Pac Assoc Allergy Asthma Clin Immunol 2011; 1:157–167.

    Article  Google Scholar 

  5. 5

    Wheatley LM, Togias A. Allergic rhinitis. N Engl J Med 2015; 372:456–463.

    Article  CAS  Google Scholar 

  6. 6

    Long A, McFadden C, DeVine D, Chew P, Kupelnick B, Lau J. Management of allergic and nonallergic rhinitis. Rockville: Agency for Healthcare Research and Quality, Services DoHaH; 2002. 54.

  7. 7

    Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1–148.

    Article  CAS  Google Scholar 

  8. 8

    Eaton KE. Accuracy of prick skin tests for ingestant hypersensitivity diagnosis. J Nutr Environ Med 2004; 14:79–82.

    Article  Google Scholar 

  9. 9

    Soares-Weiser K, Takwoingi Y, Panesar SS, Muraro A, Werfel T, Hoffmann Sommergruber K, et al. The diagnosis of food allergy: a systematic review and meta-analysis. Allergy 2013; 69:76–86.

    Article  Google Scholar 

  10. 10

    Kwong KYC, Jean T, Redjal N. Variability in measurement of allergen skin testing results among allergy-immunology specialists. J Allergy Ther 2014; 5:1–5.

    Google Scholar 

  11. 11

    Gungor A, Houser SM, Aquino BF, Akbar I, Moinuddin R, Mamikoglu B, et al. A comparison of skin endpoint titration and skin-prick testing in the diagnosis of allergic rhinitis. Ear Nose Throat J 2004; 83:54–60.

    Article  Google Scholar 

  12. 12

    Moher D, Liberati A, Tetzlaff J, Altmann DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151:264–269.

    Article  Google Scholar 

  13. 13

    Saleh HA, Durham SR. Perennial rhinitis. BMJ 2007; 335:502–507.

    Article  Google Scholar 

  14. 14

    Heinzerling L, Mari A, Bergmann K-C. , Bresciani M, Burbach G, Durham UDS, et al. The skin prick test –European standards. Clin Transl Allergy 2013; 3:3.

    Article  Google Scholar 

  15. 15

    Volcheck GW. Which diagnostic tests for common allergies? Where to start when you face an allergy puzzle. Postgrad Med 2001; 109:71–72.

    Article  CAS  Google Scholar 

  16. 16

    Rueff F, Bergmann KC, Brockow K, Fuchs T, Grubl A, Jung K, et al. Skin tests for diagnostics of allergic immediate-type reactions. Guideline of the German Society for Allergology and Clinical Immunology. Pneumologie 2011; 65:484–495.

    PubMed  CAS  Google Scholar 

  17. 17

    Bernstein IL, Storms WW. Practice parameters for allergy diagnostic testing. Joint Task Force on Practice Parameters for the Diagnosis and Treatment of Asthma. The American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1995; 75 (6 Part 2):543–625.

    PubMed  CAS  Google Scholar 

  18. 18

    Vocks E, Stander K, Rakoski J, Ring J. Suppression of immediate-type hypersensitivity elicitation in the skin prick test by ultraviolet B irradiation. Photodermatol Photoimmunol Photomed 1999; 15:236–240.

    Article  CAS  Google Scholar 

  19. 19

    Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D,Bousquet J. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy 2002; 57:107–114.

    Article  CAS  Google Scholar 

  20. 20

    Kumar N, Bylappa K, Ramesh AC, Reddy S. A study of eosinophil count in nasal and blood smear in allergic respiratory diseases in a rural setup. Intern J Med Update 2012; 7:40–46.

    Google Scholar 

  21. 21

    Venkateswarlu V, Mohan MK. A comparative study of nasal smear eosinophil versus eosinophil count in patients with allergic rhinitis. MRIMS J Health Sci 2015; 3:36–38.

    Google Scholar 

  22. 22

    Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004; 24:758–764.

    Article  CAS  Google Scholar 

  23. 23

    Ebruster H. The prick test, a recent cutaneous test for the diagnosis of allergic disorders. Wien Klin Wochenschr 1959; 71:551–554.

    PubMed  CAS  Google Scholar 

  24. 24

    Demoly P, Bousquet J, Romano A. In vivo methods for the study of allergy. In Adkinson NJ, Yunginger J, Busse W, Bochner B, Holgate S, Simons F eds. Middleton’s allergy –principles and practice. 6th ed. Philadelphia: Mosby 2003 430–439.

  25. 25

    Crobach MJ, Hermans J, Kaptein AA, Ridderikhoff J, Petri H, Mulder JD. The diagnosis of allergic rhinitis: how to combine the medical history with the results of radioallergosorbent tests and skin prick tests. Scand J Prim Health Care 1998; 16:30–36.

    Article  CAS  Google Scholar 

  26. 26

    Nevis IF, Binkley K, Kabali C. Diagnostic accuracy of skin prick testing for allergic rhinitis: a systematic review and meta analysis. Allergy Asthma Clin Immunol 2016; 12:20.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Hany S. Mostafa MSc, MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mostafa, H.S., Qotb, M., Hussein, M.A. et al. Allergic rhinitis diagnosis: skin-prick test versus laboratory diagnostic methods. Egypt J Otolaryngol 35, 262–268 (2019).

Download citation


  • absolute eosinophilic count
  • allergic rhinitis
  • nasal smear eosinophilia
  • skin-prick test