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By Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)

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Helping patients lead an unrestricted life. Postgrad Med 1993; 93: 124-128. Bock SA, SarnpsonHA. Food allergy in infancy. Pediatr Clin NorthAm 1994; 41: 1047-1067. Bousquet J, Michel F-B. In vivo methods for study of allergy, skin tests, techniques, and interpretation. In: Middleton E, Reed CE, Ellis EF, et al. eds. Allergy Principles and Practice, 4th ed. 573-594. St. 573-594. Engler DB, GrantJA. Allergic rhinitis: a practical approach. Hosp Pract (Off Ed) 1991; 26: 105-108, 111, 112. Tinkleman D, Conner B.

This distinction can be very important in some legal proceedings. For as yet unknown reasons, tryptase does not appear to be elevated during fatal or near-fatal anaphylactic reactions from foods. In the future, assays for histamine-releasing factor and other mediators may make the diagnosis of allergic disease easier and more precise. SUGGESTED READING Adinoff AD, Rosloniec DM, McCall LL, Nelson HS. A comparison of six epicutaneous devices in the performance of immediate hypersensitivity skin testing.

A drop of allergen extract is placed on cleansed skin. A puncture device is then pushed into the skin though the drop of extract. 5 mm into the skin. Further penetration is prevented by the instrument's shape. The bifurcated needle, originally designed for smallpox vaccination, can also be used for puncture testing. The bifurcated needle is pressed fIrmly against the skin, through a drop of extract, and the needle is rocked back and forth or side to side. A single needle or puncture device can be used for multiple prick skin tests on the same patient, if all residual extract is cleaned from the needle between each drop of extract.

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