BACKGROUND: Allergic rhinitis is the most common type of allergy worldwide. The 
accuracy of skin testing for allergic rhinitis is still debated. This health 
technology assessment had two objectives: to determine the diagnostic accuracy 
of skin-prick and intradermal testing in patients with suspected allergic 
rhinitis and to estimate the costs to the Ontario health system of skin testing 
for allergic rhinitis.
METHODS: We searched All Ovid MEDLINE, Embase, and Cochrane Database of 
Systematic Reviews, Database of Abstracts of Reviews of Effects, CRD Health 
Technology Assessment Database, Cochrane Central Register of Controlled Trials, 
and NHS Economic Evaluation Database for studies that evaluated the diagnostic 
accuracy of skin-prick and intradermal testing for allergic rhinitis using nasal 
provocation as the reference standard. For the clinical evidence review, data 
extraction and quality assessment were performed using the QUADAS-2 tool. We 
used the bivariate random-effects model for meta-analysis. For the economic 
evidence review, we assessed studies using a modified checklist developed by the 
(United Kingdom) National Institute for Health and Care Excellence. We estimated 
the annual cost of skin testing for allergic rhinitis in Ontario for 2015 to 
2017 using provincial data on testing volumes and costs.
RESULTS: We meta-analyzed seven studies with a total of 430 patients that 
assessed the accuracy of skin-prick testing. The pooled pair of sensitivity and 
specificity for skin-prick testing was 85% and 77%, respectively. We did not 
perform a meta-analysis for the diagnostic accuracy of intradermal testing due 
to the small number of studies (n = 4). Of these, two evaluated the accuracy of 
intradermal testing in confirming negative skin-prick testing results, with 
sensitivity ranging from 27% to 50% and specificity ranging from 60% to 100%. 
The other two studies evaluated the accuracy of intradermal testing as a 
stand-alone tool for diagnosing allergic rhinitis, with sensitivity ranging from 
60% to 79% and specificity ranging from 68% to 69%. We estimated the budget 
impact of continuing to publicly fund skin testing for allergic rhinitis in 
Ontario to be between $2.5 million and $3.0 million per year.
CONCLUSIONS: Skin-prick testing is moderately accurate in identifying subjects 
with or without allergic rhinitis. The diagnostic accuracy of intradermal 
testing could not be well established from this review. Our best estimate is 
that publicly funding skin testing for allergic rhinitis costs the Ontario 
government approximately $2.5 million to $3.0 million per year.