In vivo diagnostic testing and immunotherapy for allergy. Report I, Part I, of the allergy panel. Council on Scientific Affairs.

The diagnosis and treatment of allergic disease constitute a particularly difficult and complex field in medicine, a field that has been complicated further by the promulgation and the use of unproved procedures and/or the inappropriate use of proved procedures. This report is the first in a series of reports prepared by a multidisciplinary panel appointed by the Council on Scientific Affairs of the American Medical Association. It discusses the necessity for proper clinical trials to generate reproducible results under similar conditions to adequately prove the validity of various diagnostic and therapeutic procedures. In vivo immunologic tests have been shown to be reliable and valid diagnostic tools and include skin tests with standardized allergenic extracts by prick, puncture, and intradermal techniques, skin end-point titration, and patch testing for contact allergic dermatitis. Other clinically useful physiologic tests include the exercise tolerance test, methacholine and/or histamine inhalation challenge test, and other inhalation tests utilizing either nasal or bronchial delivery. Oral challenge testing has also been utilized and includes open, single-blind, or double-blind techniques, depending on the requirements of the patient being studied. The second article is a continuation of the first report, and describes other challenge tests and unproved procedures. The third report of this series evaluates in vitro tests for allergy.