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Adjusting wheal size measures to correct atopy misclassification

Zhang, Hongmei, Karmaus, Wilfried, Gan, Jianjun, Bao, Weichao, Zhao, Yan D., Rahardja, Dewi, Holloway, John W., Scott, Martha and Arshad, Syed Hasan (2011) Adjusting wheal size measures to correct atopy misclassification International Journal of General Medicine, 2011, (4), pp. 597-606. (doi:10.2147/IJGM.S22193). (PMID:3680811).

Record type: Article


Purpose: Skin prick testing (SPT) is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. Wheal sizes on SPT are used to identify atopic cases, and the cut-off value for a positive test is commonly set at 3 mm. However, the measured wheal sizes do not solely reflect the magnitude of skin reaction to allergens, but also skin reactivity (reflected in the size of histamine reaction) and other random or non-random factors. We sought to estimate wheal sizes exclusively due to skin response to allergens and propose gender-specific cutoff points of atopy.

Methods: We developed a Bayesian method to adjust observed wheal sizes by excluding histamine and other factor effects, based on which revised cutoff points are proposed for males and females, respectively. The method is then applied to and intensively evaluated using a study population aged 18, at a location on the Isle of Wight in the United Kingdom. To evaluate the proposed approach, two sample t-tests for population means and proportion tests are applied.

Results: Four common aeroallergens, house dust mite (HDM), grass pollen, dog dander, and alternaria are considered in the study. Based on 3 mm cutoff, males tend to be more atopic than females (P-values are between 0.00087 and 0.062). After applying the proposed methods to adjust wheal sizes, our findings suggest that misclassifications of atopy occur more often in males. Revised allergen-specific cutoff values are proposed for each gender.

Conclusion: To reduce the gender discrepancy, we may have two potentially convenient solutions. One way is to apply allergen-specific and gender-specific cutoff values following the proposed method. Alternatively, we can revise the concentration of allergens in the SPT solutions but keep the cutoff values unchanged, which may be more convenient to clinicians.

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More information

Published date: August 2011
Keywords: spt, atopy, bayesian method, joint modeling, misclassification
Organisations: Clinical & Experimental Sciences


Local EPrints ID: 197157
ISSN: 1178-7074
PURE UUID: 9d130614-80a8-4099-92e2-19ab97441651
ORCID for John W. Holloway: ORCID iD

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Date deposited: 19 Sep 2011 13:30
Last modified: 18 Jul 2017 11:21

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Author: Hongmei Zhang
Author: Wilfried Karmaus
Author: Jianjun Gan
Author: Weichao Bao
Author: Yan D. Zhao
Author: Dewi Rahardja
Author: Martha Scott

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