Prognostic value of asymptomatic skin sensitization to aeroallergens

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Abstract
Asymptomatic skin sensitization to aeroallergens is frequently encountered in epidemiological studies and in everyday clinical life. Correct management of the condition is essential to avoid both progression into allergic disease and unnecessary intervention. Understanding immunological mechanisms in asymptomatic skin sensitization might provide new insights into the natural history and treatment of respiratory allergy. Research on asymptomatic skin sensitization is rare, and the present review unites previous studies with recent findings. It is a common condition affecting 8-30% of the population when using a local standard panel of aeroallergens. Clinically, immediate but not late-phase reactions are induced by allergen challenge. Absent eosinophil stimulation and migration and low IL-5 levels appear to be sentinel mechanisms. Prospective studies show that 30-60% become allergic, depending on allergens and follow-up period. No prospective intervention studies have been performed; however, allergen avoidance seems efficacious in reducing allergy development to occupational and domestic allergens. Asymptomatic skin sensitization due to an erroneously positive skin test must be ruled out before allergen avoidance measures are initiated. Surprisingly few papers exist on asymptomatic skin sensitization epidemiology and immunology, despite the intriguing question as to why symptoms do not develop in IgE-sensitized patients. It is a common condition and a risk factor for later development of respiratory allergic disease. Cross-sectional intervention studies suggest that allergy development is reduced by allergen avoidance. Immunologically, control of eosinophil stimulation and migration seems to be pivotal. How this control is maintained remains to be elucidated.