WAO Medical Book Review
Quantitative Skin Testing for Allergy: IDT and MQT
By: Bradley F. Marple and Richard L. Mabry
List price: € 29.95 EUR (about $42.00 USD)
Available from: Thieme
Dr. David C Sutherland, FRACP
Nineways Specialist Clinic, Broadmeadow, NSW, Australia
This slim paperback on quantitative skin testing is set out in a logical fashion, with a reasonably comprehensive index and two appendices, the first of which is a glossary that does not describe commonly used immunological terms with an acceptable degree of precision.
The authors set out to provide a simple guide for otorhinolaryngologists who wish to undertake quantitative skin testing for allergies. These objectives are met. However, such testing is not evidence-based and would not be recommended by clinicians in the field. The work is based on two assumptions. The first is that there is a separate sub-discipline referred to by the authors as "otolaryngic allergy." This notion would not gain wide acceptance outside this particular group of enthusiasts. The second is that the form of testing advocated (intradermal dilutional testing based on the Rinkel method or end point titration) confers quantitative information useful in the diagnosis and management of allergic disease. The authors offer no evidence for such claims, and there is none in the peer reviewed scientific literature. This is conceded by one of the contributors: "In this era of evidence-based medicine, it is unfortunate that much of our information is still based on the reported anecdotal experience of Herbert Rinkel. Fortunately, he proved to be a very astute observer, and most of his recommendations have stood the test of time thus far."
The book is designed for otorhinolaryngologists who wish to include this form of skin testing in their diagnostic repertoire.
The authors have provided a simple and readily understood guide to the quantitative skin test practices they espouse. Unfortunately, these practices are not evidence based, and so cannot be recommended. Apart from problems with precision in the definition of immunological terms in appendix one, the immunology is deficient in other ways. For example, mast cell activation is referred to as "mast cell dissolution" (page 24), and the list of drugs said to interfere with skin testing includes "decongestants (topical or systemic), bronchodilators, corticosteroids (topical or systemic)...." It has been well demonstrated that these agents do not interfere with skin prick testing. There are a few black-and-white photographs relating to the setting up of a practice for skin testing, but the book lacks other illustrations. Tables have a grey background and are not particularly easy to read.
This book would be of interest to medical historians, particularly those studying the impediments to the widespread adoption of evidence-based medicine. Others would be better served by obtaining a free download of the manual on skin prick testing prepared by the Australasian Society of Clinical Immunology and Allergy (www.allergy.org.au). No doubt other learned societies have similar position papers.