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Diagnostic Testing and Immunotherapy for Allergy-Reply

JAMA. 1988;260(3):342. doi:10.1001/jama.1988.03410030057024.
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In Reply.—  Dr Rapp correctly notes that reported trials of injection provocation/neutralization have frequently employed a provocation-dose volume of 0.05 mL. However, volumes have varied in different trials, and Dr Rapp employed 0.01 mL for the provocation-dose volume in her most recent publication, referenced in our report.1The actual dose of immunogenic allergen is the critical factor and this dose is equal to the product of the volume times the concentration of immunogenic allergen in the solution. Therefore, the amount of immunogenic allergen in the solution must be measured in some reproducible fashion and maintained in a known range during the course of the study to permit comparable, consistent dosing.It is evident that "carefully designed and controlled studies by unbiased and properly experienced researchers" are required to accurately assess the value of provocation/neutralization testing and treatment. Our criteria for a properly conducted trial are described in our report.

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