Provocation test

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Further test method for the diagnosis of allergic reactions of the early type and of intolerance reactions (pseudoallergies), if the skin tests, scratch test, prick test and intradermal test have remained negative or doubtful (e.g. mite crustacean mollusc syndrome) in case of a positive medical history.

General information
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  • Remember! In individual cases (e.g. presumed reaction to excipients) a provocation test to identify a therapeutically urgently needed active substance may be justified even in the presence of contraindications.

  • Contraindications for provocation tests with suspected triggers, in case of assumed cross-reactivity and for tests with alternative preparations:
    • An individual risk-benefit analysis is required in each case:
      • Pregnancy/breastfeeding
      • Hypersensitivity reaction that cannot be safely controlled with medication (e.g. severe bronchial asthma, agranulocytosis, toxic epidermal necrolysis, hepatopathy).
      • Diseases or medications taken by the patient that involve an increased risk even in the case of reactions that are basically controllable.
    • Contraindications for anaphylaxis:
      • Among others, severe cardiovascular diseases, severe bronchial asthma, use of beta-blockers.
      • Insufficient compliance, lack of patient understanding of the procedure.

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  • Depending on the clinical symptoms, the test is carried out either as a provocation test (allergen detection, negative list) or as a tolerance test (positive list) and the result is documented in an allergy or warning passport. The substance to be tested (drugs, food, standardized provocation solutions for pollen allergies, etc.) is exposed orally, parenterally, conjunctively ( conjunctival provocation test), nasally ( nasal provocation test) or bronchially ( methacholine provocation test) in an ascending dilution series, if necessary up to the full dose.
  • Notice! Provocation and tolerance tests of drugs, food and other allergens should only be carried out under constant medical supervision and provision of an emergency treatment unit, i.e. usually under in-patient conditions.

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Local and systemic allergic or pseudoallergic reactions up to anaphylactic shock may occur depending on the medical history and require appropriate precautions during testing.

Remember! In principle, the performance of provocation tests under stationary conditions is recommended!

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  1. Asada H et al (2003) Evaluation of provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal tonsillar infection in palmoplantar pustulosis. J Dermatol Sci 32: 105-113
  2. Kütting B et al (2001) The mite crustacean mollusc syndrome. dermatologist 52: 708-711
  3. Marogna M et al (2007) Long-lasting effects of sublingual immunotherapy for house dust mites in allergic rhinitis with bronchial hyperreactivity: A long-term (13-year) retrospective study in real life. Int Arch Allergy Immunol 142: 70-78
  4. Riechelmann H et al (2003) Comparison of conjunctival and nasal provocation test in allergic rhinitis to house dust mite. Int Arch Allergy Immunol 130: 51-59
  5. Ring J (1987) Diagnosis of drug-related intolerance reactions. dermatologist 38: 516-522
  6. Ring J (1988) Applied allergology. 2nd edition. MMW Publishing House, Munich


Last updated on: 29.10.2020