Pediatric Allergy Testing: At What Age Is It Worth It?

Background: Concordance between symptoms of allergic rhinitis and allergy testing varies in young children. The aim was to determine at what age serum specific IgE testing becomes clinically useful for the diagnosis of allergic rhinitis due to decreased rates of non-reactivity. Methods: This was a retrospective chart review of pediatric patients (0-18 years of age) with allergic rhinitis symptoms in an academic pediatric otolaryngology practice from 2020 to 2024. All patients underwent a standardized serum specific IgE testing panel and sensitivities to the aeroallergens on the tested panel were interpreted in a binary manner. Demographics such as age and sex were also collected. Results: A total of 606 patients met inclusion criteria. There were 31 patients who underwent allergy testing at <3 years and 575 patients who underwent allergy testing at ≥3 years. The prevalence of allergy testing with a negative result was 93.6% in the younger age group and 49.0% in the older group. Children age < 3 years demonstrated 15.1 (95% CI: 3.56-63.7) increased odds of negative allergy testing ( P < .001). In the 295 patients with positive allergy testing, the odds of poly-sensitization (≥4 allergens positive) increased with age (OR: 1.09, 95% CI: 1.03-1.15, P = .004). Discussion: In early childhood, allergy testing results are not highly predictive for symptoms of allergic rhinitis. Concordance increases in an age dependent manner and becomes more reliable by age 3. These results can help promote cost-effective use of allergy testing in young pediatric patients with suspected allergic rhinitis by not testing prior to age 3. Level of evidence: 4