Should the skin prick test to horse be included in the standard panel for the diagnosis of respiratory allergy?

Horse allergy has received little attention in the literature, although it affects both pediatric and adult patients, and is considered a risk factor for developing asthma, rhinitis, conjunctivitis, and eczema [1]. The prevalence of horse allergy is extremely variable (from 1% to 10%), depending on geography, climate, and level of exposure [1-3]; however, few studies examine specifi c patient groups. We performed a retrospective study of horse allergy and reported the prevalence of pediatric cases referred to our allergy unit. Over the last 8 years, almost all children (age 2-16 years) attending our unit underwent skin prick testing for the common aeroallergens. Our results revealed a 2.7% prevalence of allergy to horse in a population of 23 460 pediatric patients attended at an allergy unit. Although this prevalence is low, we recommend including horse extract in the routine panel, taking into account the following factors: 1) horse sensitization is often symptomatic and may lead to severe allergic reactions ; 2) horse allergy can develop without previous close contact; and 3) horse allergen can be carried on clothes, and therefore sensitize people who have absolutely no contact with horses. In conclusion, we recommend inclusion of horse allergen in the routine panel, not only to verify a suspected allergy before treating it, but also to inform patients who are unaware of their allergy of the risks connected with exposure to high amounts of the allergen.