Clinical value of bronchial provocation testing in childhood asthma.

Previous studies have shown a positive relationship between the results of skin tests, radioallergosorbent tests, and bronchial provocation testing. The purpose of this study was to compare the results of skin and bronchial provocation testing to determine the extent to which the results of provocation testing could be predicted from puncture and intracutaneous skin tests. In the 1,596 provocation tests performed in 276 patients, more than 90% of patients with a wheal greater than or equal to 5 mm in diameter on skin testing by puncture technique using 1:20 w/v allergen extract experienced positive reactions on provocation testing for most antigens. If the wheal produced by puncture testing was less than 5 mm in diameter, a large wheal on intracutaneous testing only slightly increased the likelihood of a positive challenge, but if the wheal on intracutaneous testing was less than 5 mm, a positive challenge did not occur. It is concluded that the results of provocation tests may often be predicted from simple skin testing, and that in clinical use, provocation testing is likely to be useful primarily in patients for whom skin testing indicates moderate sensitization to allergens.