Skin prick testing in patients using beta-blockers: a retrospective analysis

Charts from 2004-2008 in a single allergy clinic were reviewed for any patients taking a beta-blocker when skin tested. Data was examined for skin test reactivity, type of skin test, concomitant asthma diagnosis, allergens tested, and adverse events.One hundred and ninety-one patients were taking beta-blockers when skin testing occurred. Seventy-two patients had positive skin tests. No tests resulted in an adverse event.This data demonstrates the relative safety of administrating of skin prick tests to patients on beta-blocker treatment. Larger prospective studies are needed to substantiate the findings of this study.Beta antagonists, commonly known as beta-blockers, are a commonly prescribed class of medications. Beta-blockers are used in the treatment of congestive heart failure, coronary heart disease, cardiac arrhythmia, hypertension, tremor, glaucoma, and migraine headache. Importantly, beta-blockers significantly reduce both morbidity and mortality rates in congestive heart failure, in acute coronary syndrome, and post myocardial infarction [1-3]. However, beta-blockade may place atopic subjects at an increased risk of an anaphylactic reaction. Case reports suggest that when systemic allergic reactions occur secondary to immunotherapy, drugs, foods, and insects stings, they may be of greater severity in patients taking beta-blockers [4-11].Due to the potential of beta-blockers to amplify the effects of anaphylaxis, these drugs are relatively contraindicated during allergy skin testing. The American Academy of Allergy Asthma & Immunology (AAAAI) outlines this in its position statement, stating that "Systemic reactions to skin testing are rare. Nevertheless, special precautions, when these are appropriate, should be taken when the patient who needs sensitivity testing for IgE-mediated disease cannot stop treatment with a beta-blocking agent [12]." However, in our literature review on the topic, no case reports or prospective studies report adverse events in pati