ARE PROTOCOLS FOR MEDICATION HOLDS SUFFICIENT FOR SKIN PRICK TESTING FOR OLDER ADULTS WITH ASTHMA?

摘要

Allergy skin prick testing (SPT) is commonly performed during the work-up of allergic asthma. We examined a cohort of older asthmatics who underwent allergy SPT following a standardized medication hold protocol in use at the University of Louisville. The protocol attempts to address the impact concurrent medication use has on skin prick test outcomes and are aimed at medications with anti-histaminic or anti-inflammatory activity. It is well documented that immune-senescence is common with advanced age. We were surprised to find a disproportionately low number of subjects with positive skin prick tests in our older aged asthmatics. This led us to explore the idea that additional medications which were not withheld by protocol (e.g., not typically recognized as suppressing immune function or allergy reactions) may effect skin prick interpretations. In one case, for example, a muscle relaxant related to amitriptyline was not held, although amitriptyline itself is typically withheld for 5 days prior to testing. Also, opioids and benzodiazepines have some immunosuppressive activity, yet are not singled out for withholding per SPT protocol. Given that older adults tend to have higher rates of both intra and inter-class polypharmacy that aim to treat comorbid conditions outside of asthma and allergy, we have looked at the potential role these medications play with this surprisingly low rate of negative allergy testing results. Our findings suggest that additional studies are needed to further understand the potential role additional classes of medications commonly used in older adults may play with interfering with skin prick testing protocols.