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Diagnostic Testing and Immunotherapy for Allergy

Doris J. Rapp, MD
JAMA. 1988;260(3):341-342. doi:10.1001/jama.1988.03410030057023.
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To the Editor.—  I was rather surprised to see all the inaccuracies in the COUNCIL REPORT that was published in THE JOURNAL.In the second paragraph, the report states that provocation tests use "small volumes of allergens (usually ∓0.01 mL)". The usual volume is actually 0.05 mL rather than 0.01; however, 0.01 mL may occasionally be used.At the end of that same paragraph, it says, "The end point is a dose that produces either symptoms or a wheal that enlarges 2 mm or more in diameter within 15 minutes." That is not the end point. In provocation testing, this is the dilution that provokes symptoms. The provocation/neutralization end point is the dilution that eliminates a patient's symptoms, and this is called the neutralization dosage.In the fifth paragraph of the article, it says, "Many investigators have attempted to perform controlled studies of these procedures, but until now none of


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