The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick TestsKonstantinou G.N. · Bousquet P.-J. · Zuberbier T. · Papadopoulos N.G.
aDepartment of Allergy and Allergy Research Center, Pediatric Hospital “P&A Kiriakou”, National and Kapodistrian University of Athens, member of the GA2LEN network, and bDepartment of Allergy and Clinical Immunology, 417 NIMTS Army Hospital, Athens, Greece; cExploration des Allergies, Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France; dDepartment of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, member of the GA2LEN network, Berlin, Germany
Background: Mean diameter or longest diameter are the 2 most frequently used parameters for wheal response assessment after skin prick testing (SPT). We aimed to compare these 2 parameters taking as gold standard the surface of the wheal skin response. Patients and Methods: Patients suspected of having an allergic reaction against inhalant allergens have been skin prick tested using the Pan-European GA2LEN SPT panel. Fifteen minutes later, macroscopically evident wheal and flare reactions were marked with a pen and transferred to paper with a transparent scotch tape. Each paper-transferred wheal was scanned with an ordinary scanner, and its surface-corresponding maximum perpendicular diameters and longest diameters were measured using a computer software application for image recognition, developed for this purpose. Correlation coefficients (Spearman’s ρ) between surfaces and respective mean (ρmean) or longest (ρlongest) diameters were calculated and subsequently compared. Results: 1,554 SPTs were performed in 74 patients. In 264, a macroscopically evident wheal and flare response was observed. Both mean and longest diameters correlated significantly with the wheal surfaces. However, ρlongest was statistically significantly larger than ρmean when the surface of the wheal was >17 mm2 (ρlongest > 0.860 vs. ρmean < 0.660; p < 0.05).Such a surface corresponds to a maximum diameter of approximately 7 mm and a mean diameter of approximately 6 mm. Thus, the larger the surface of the wheal, the more appropriate the usage of the longest diameter. Conclusions: The longest wheal diameter alone seems to be a better surrogate marker of the wheal surface in comparison with the mean diameter. In addition, it is easier and faster to measure. Therefore, we propose this as the optimal methodology to evaluate SPTs.