SKIN PRICK TESTING: WHAT CAN WE STILL IMPROVE?

Which Allergens To Use?

22nd World Allergy CongressCancún, Mexico

Richard W. Weber, M.D.National Jewish HealthDenver, Colorado USA

DISCLOSURES• SPEAKERS BUREAUS: ASTRAZENECA,

GENENTECH• RESEARCH GRANTS: NOVARTIS,

GLAXOSMITHKLINE, PFIZER, MERCK• ASSOCIATE EDITOR: ANNALS OF ALLERGY,

ASTHMA & IMMUNOLOGY• ASSOCIATIONS: AAAAI, ACAAI, CAAS• NO CONFLICTS OF INTEREST PERTAINING TO

SUBJECT MATTER OF THIS TALK

General Principles• Pollens

– Know what’s prevalent in your region– Know what cross-reacts so not to unnecessarily duplicate

and expand testing items– Consider unique exposures of the patient, if any

• Indoor Arthropods & Epidermals– Most have species-specific and cross-reactive allergens, so

degree of cross-reactivity is variable

• Fungi– Insufficient data to make strong recommendations– Alternaria, Stemphylium & Cladosporium have some cross-

reactive allergens, as do Penicillium and Aspergillus

Family/Subfamily Genus/Species Common Name Comments

Pooideae Poa pratensis Kentucky blue 1. Strong cross-allergenicity based on marked homology of group 1, 2/3, and 5 major allergens2. Timothy and sweet vernal may each have unique allergens

Phleum pratense Timothy

Dactylis glomerata Orchard

Festuca rubra Fescue

Anthoxanthum odorata Sweet vernal

Lolium perenne Perennial ryegrass

Phalaris canariensis Canary

Chloridoideae Cynodon dactylis Bermuda 1. Cross-reactivity between members, Bermuda strongest inhibitor2. Lack of group 2 and 5 allergens accounts for little cross-allergenicity with Pooideae

Buchloe dactyloides Buffalo

Distichlis stricta Salt

Bouteloua gracilis Grama

Panicoideae Sorghum halepense Johnson 1. Lack of group 2 and 5 allergens accounts for little cross-allergenicity with Pooideae2. More cross-reactivity with Pooideae than Chloridoideae

Zea mays Corn

Paspalum notatum Bahia

Saccharum officinarum Sugarcane

Juncaceae Juncus effusus Soft rush 1. Cross-allergenicity within families2. No cross-reactivity with PoaceaeCyperaceae Cyperus esculentus Yellow nutsedge

Carex aquatilis Sedge

Typhaceae Typha latifolia Cattail

Typha angustifolia Narrowleaf cattail

Areceae Phoenix dactylifera Date palm

Family/Subfamily Genus/Species Common Name Comments

Cupressaceae Juniperus ashei Mountain cedar 1. Strong cross-allergenicity within family based on marked homology of group 1 and 2 major allergens2. Weak cross-allergenicity with angiosperms may be due to group 4 calcium binding proteins

Juniperus oxycedrus Prickly juniper

Cupressus arizonica Arizona cypress

Chamaecyparis lawsonia Port Orford cypress

Thuja plicata Western red cedar

Taxodioideae Cryptomeria japonica Japanese red cedar

Taxodium distichum Bald cypress

Sequoia sempervirens Coast redwood

Pinaceae Pinus sylvestris Scotch pine 1. Weak cross-allergenicity with angiosperms may be due to calcium binding proteinsPinus radiata Monterey pine

Pinus strobus White pine

Picea abies Norway spruce

Tsuga canadensis Eastern hemlock

Pseudotsuga menziesii Douglas fir

Family/Subfamily Genus/Species Common Name Comments

Sapindaceae Acer negundo Box elder Disparity between A. negundo and other AcerAcer rubrum Red maple

Malvaceae Tilia Basswood (linden)

Brassicaceae Brassica napus Oilseed rape

Euphorbiaceae Mercurialis annua Annual mercury

Salicaceae Salix nigra Black willow Strong skin test correlations

Populus deltoides Eastern cottonwood

Populus tremuloides Aspen

Fabaceae Prospois julifora Mesquite

Elaeagnaceae Elaeagnus angustifolia Russian olive Questionable cross-reactivity with Oleaceae

Urticaceae Urtica dioica Nettle Little cross-reactivity

Parietaria judaica Pellitory

Ulmaceae Ulmus americana American elm

Celtidaceae Celtis occidentalis Hackberry

Moraceae Morus rubra Red mulberry

Juglandaceae Juglans nigra Black walnut Strong to moderate skin test correlationsCarya ovata Shagbark hickory

Carya illinoensis Pecan

Betulaceae Betula verrucosa Silver birch 1. Strong cross-allergenicity between Betulaceae members based on homology of group 1 and 2 allergens2. Fairly strong cross-allergenicity between Betulaceae and Fagaceae members based on homology of group 1 and 2 allergens

Alnus glutinosa European alder

Corylus avellana Hazelnut (filbert)

Carpinus betulus Hornbeam

Ostrya virginiana Eastern hophornbeam

Fagaceae Fagus sylatica European beech

Quercus alba White oak

Quercus rubra Red oak

Family/Subfamily Genus/Species Common Name Comments

Basal Tricolpates

Plantanaceae Platanus acerifolia Planetree

Caryophyllanae

Amaranthaceae Amaranthus palmeri Palmer’s amaranth 1. Strong cross-allergenicity between amaranths2. Strong cross-allergenicity between Atriplex species3. Chenopodioideae members show greater diversity, with variable degrees of reactivity4. Russian thistle may possess unique allergens

Amaranthus retroflexus Redroot pigweed

Chenopodioideae Chenopodium album Lamb’s quarter

Kochia scoparia Burning bush

Salsola pestifer Russian thistle

Atriplex canescens Wingscale

Atriplex wrightii Annual saltbush

Polygonaceae Rumex acetosella Sheep sorrel

Asteridae

Plantaginaceae Plantago lanceolata English plantain

Oleaceae Olea europaea Olive 1. Strong cross-allergenicity between Oleaceae members due to homology of group 1 allergens2. Group 3 calcium-binding proteins cross-react within and across families

Fraxinus excelsior European ash

Ligustrum vulgare Privet

Syringa vulgaris Lilac

Asteraceae Ambrosia artemisiifolia Short ragweed 1. Strong cross-allergenicity between short, giant, western, and false ragweeds2. Strong cross-allergenicity between Artemisia species3. Minor to little cross-reactivity between ragweeds and mugwort, marshelder, or cocklebur

Ambrosia trifida Giant ragweed

Ambrosia psilotachya Western ragweed

Ambrosia acanthicarpa False ragweed

Ambrosia tenuifolia Slender ragweed

Ambrosia bidentata Southern ragweed

Ambrosia ambrosioides Canyon ragweed

Xanthium communis Cocklebur

Iva xanthifolia Burweed marshelder

Helianthus annuus Sunflower

Artemisia vulgaris Mugwort

Artemisia tridentata Giant sagebrush