Skin prick testing is the workhorse of an allergy practice, and its record is read long after the test: at the follow-up, by a covering colleague, at an immunotherapy decision and, sometimes, by a payer. This page sets out what the 2008 AAAAI/ACAAI diagnostic testing parameter says a skin test record should contain, and where SPT documentation tends to break down.[1]
What a complete SPT record contains
The 2008 parameter lists the minimum contents of a skin-testing form (Summary Statement 157 and narrative):[1]
| Element | Why it matters |
|---|---|
| Date of testing, and the name or initials of the person who performed it | Reliability depends on the tester's skill and technique |
| Method (prick, puncture or intracutaneous) | Wheal size varies significantly from one device to another |
| Each allergen by an unambiguous common name, with mixes itemized (components and ratio) | So the next clinician knows exactly what was tested |
| The concentration at which each allergen was tested | Results are only comparable at known concentrations |
| Positive-control agent and concentration, and the composition of the negative control | The controls are what the allergen sites are read against |
| Positive and negative control results in mm | Shows the test was interpretable on that day |
| Wheal and erythema sizes in mm for each allergen | The parameter recommends millimeters, not 0–4+ grades |
| Extract source, manufacturer lot number and expiration date (may be kept in separate records) | Extract potency and stability affect results |
The parameter also documents that reactivity differs between the back and the forearm, and within each area, so recording the test site is good practice for interpretation. That is an inference from the parameter, not an item on its minimum list.[1]
Timing and reading
SPT peak reactivity is at 15 to 20 minutes. At that point the parameter says to record both wheal and erythema (flare) diameters, or areas, in millimeters and compare them with the positive and negative controls.[1] One common way to report size is the mean wheal diameter, (D + d)/2, where D is the largest diameter and d the largest diameter at right angles to it.[1]
Qualitative scoring (0 to 4+, or simply positive or negative) is "no longer used by many clinicians" because physicians vary in how they score it, and the parameter's form section says numerical grades "are not recommended".[1] Many practices still classify results; the record should show the classification as the practice's own rule applied to the measured millimeters, not instead of them.
A positive SPT shows sensitization, not a diagnosis. Results are read together with the history; for foods, "the SPT alone cannot be considered diagnostic".[1][3]
Controls
- Place positive (histamine) and negative (saline, or 50% glycerinated HSA–saline) controls at the same time as the allergen tests.[1]
- A 10 mg/mL histamine dihydrochloride control is the preferred SPT positive control; read it at about 15 minutes.[1]
- Histamine wheals are significantly larger in darkly pigmented skin, one reason the control matters.[1]
- Avoid devices that produce wheals larger than 3 mm at negative-control sites.[1]
- In drug testing, the positive and negative controls must read positive and negative for the results to be valid.[2]
Where SPT records go wrong
- Re-typing. Values written on a paper grid and typed into the chart later are where transcription errors creep in.
- Grades without millimeters. A "2+" tells the next reader little about the wheal or the control it was read against.
- Missing erythema. The parameter asks for wheal and erythema; the flare is often left blank.
- No interfering-medication check. Antihistamines differ in how long they suppress wheal and flare; the general principle is 2 to 3 days off first- and second-generation antihistamines, with longer-acting exceptions such as cetirizine, hydroxyzine and loratadine, and doxepin may suppress for up to 6 days.[1]
- The note and the test disagree. When the testing room and the visit note live in different places, the note quotes a result the sheet doesn't show.
How Medora supports the SPT workflow
- The allergist orders the panel in the patient's record; controls come first on the results sheet.
- The nurse photographs the panel and the photos are stored with the chart.
- Staff enter or confirm every value, wheal and erythema in millimeters, with who tested and when; nothing is recorded without a person.
- The allergist reviews and signs.
- Because Medora keeps one patient context, the clinician sees the skin-test results the nurse recorded (wheal sizes, controls, grades) alongside the drafted visit note.
- Medora Copilot has visit templates built for skin testing (SPT, intradermal and patch), so the testing visit note starts in allergy language.
Skin testing is priced per practice; it is not published, so talk to us. Medora Scribe (Copilot) is $99 per provider per month after a 14-day free trial, and no card is needed to start. See skin testing in Medora.
Frequently asked questions
What should a skin prick test record include?
Per the 2008 AAAAI/ACAAI parameter: date, who tested, method, each allergen and its concentration, the positive and negative controls with results in mm, wheal and erythema in mm for each allergen, and extract lot and expiration (which may be kept separately).
When is a skin prick test read?
SPT peak reactivity is at 15 to 20 minutes, when the 2008 parameter says to record both wheal and erythema in millimeters and compare them with the controls.
Should SPT results be graded 0 to 4+?
The 2008 parameter says numerical grades are not recommended and that millimeter measurements should be recorded. A practice can still classify results, as its own rule applied to the measured millimeters.
Does Medora record skin prick test results?
Yes. In Medora the allergist orders the panel, controls come first on the results sheet, photos are stored with the chart, staff enter or confirm every value, and the allergist signs.
How much does Medora skin testing cost?
Skin testing is priced per practice and is not published; talk to us on the demo page. Medora Scribe (Copilot) is $99 per provider per month after a 14-day free trial.
Related guides
Sources
Last reviewed October 21, 2026. Summaries paraphrase the cited documents; read the originals before making clinical decisions. This page is for clinicians and practice teams, not patient instruction.
- Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1–S148. www.aaaai.org
- Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: a 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333–1393. doi.org
- NIAID-Sponsored Expert Panel (Boyce JA, et al.). Guidelines for the diagnosis and management of food allergy in the United States. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–S58. pmc.ncbi.nlm.nih.gov