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Skin testing is a widely accepted method for identifying inhalant allergies. Intradermal (ID) testing is often performed after negative skin prick testing (SPT) when a practitioner has a high level of clinical suspicion for a particular allergen.A retrospective chart review study was performed over a 5-year period in patients with negative SPT for airborne allergens who also underwent ID testing based on a high level of suspicion for clinical allergy.Eighty-seven patients had negative SPT and went on to receive an average of 7 ID tests per patient. A total of 592 ID tests were performed after negative SPT. Of these, 20.8% (123/592) had a positive ID result with negative SPT. The allergens with the greatest percentage of positive ID results with negative SPTs were dog, cat, D. farinae, and D. pteronyssinus (33.3%, 34.3%, 39.4%, and 39.6%, respectively). The allergens least likely to test positive on ID testing after negative SPT were red maple, Cladosporium, and Alternaria (0%, 6.3%, and 6.5%, respectively).Approximately 20% of all negative results on SPT will have a positive ID test, more likely for indoor allergens. If a high suspicion for allergy exists in a patient with a negative SPT result, it may be useful to proceed with ID testing. However, the clinical significance of a positive ID test after negative SPT still needs to be elucidated.

Oral Mucosal Immunotherapy is a novel method of delivering allergenic extracts to the tolerogenic oropharyngeal mucosa using a compounded toothpaste vehicle. This article describes three cases where individuals with seasonal allergic rhinitis demonstrated symptom improvement as well as decreased skin reactivity after using Oral Mucosal Immunotherapy in a pre-seasonal and co-seasonal fashion.

We describe a severe systemic reaction that occurred following injection augmentation with calcium hydroxylapatite vocal fold filler. The reaction occurred within 30 minutes of the procedure and consisted of diffuse itching, hives, edematous face and eyelids, and voice changes indicating glottic edema. It is classified as a grade 3 systemic reaction. Consideration is given to possible etiologies and at risk patients are discussed. We recommend a postprocedure observation time of at least 30 minutes to monitor for such reactions.