BlueCross BlueShield of Tennessee Medical Policy Manual

Allergy Testing - Conjunctival Challenge Test


Conjunctival challenge tests, also known as provocation tests, are proposed as a method to confirm an allergy diagnosis, study the signs and symptoms of the allergic reaction, sample the cells and mediators of the allergic reaction, and evaluate anti-inflammatory therapy.  The test is performed by applying a single drop of allergen solution directly into the conjunctival sac of the eye followed by observation for redness, itchiness, tearing and other similar symptoms.  These tests are often used in research protocols that require an objective standard for evaluating clinical sensitivity to an allergen.




Published peer-reviewed, scientific literature has not established the role of conjunctival challenge/provocation testing in the diagnosis and management of allergies.


Anantasit, N., Vilaiyuk, S., Kamchaisatian, W., Supakomthanasam, W., Sasisakulporn, C., Teawsomboonkit, W., et al. (2013). Comparison of conjunctival and nasal provocation tests in allergic rhinitis children with dermatophagoides pteronyssinus sensitization. Asian Pacific Journal of Allergy and Immunology, 31 (3), 227-232. Abstract retrieved August 28, 2017 from PubMed database.

Annals of Allergy, Asthma, & Immunology. (2008, March). Allergy diagnostic testing: an updated practice parameter. Retrieved July 2, 2014 from,

Fauquert, J.L., Jedrzejczak-Czechowicz, M., Rondon, C., Calder, V., Silva, D., Kvenshagen, B.K. (2017). Conjunctival allergen provocation test: guidelines for daily practice. Allergy, 72 (1), 43-54. Abstract retrieved August 7, 2018 from PubMed database.

Köther, J., Mandl, A., Allekotte, S., Astvatsatourov, A., Chwieralski, J., Liedtke, J.P., et al. (2018). Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy. Clinical and Translational Allergy, 8, 28. (Level 2 evidence)

Kruse, K., Gerwin, E., Eichel, A., Shah-Hosseini, K., & Mäsges, R. (2015). Conjunctival provocation tests: a predictive factor for patients’ seasonal allergic rhinoconjunctivitis symptoms.  The Journal of Allergy and Clinical Immunolgy in Practice, 3 (3), 381-386. Abstract retrieved December 15, 2015 from PubMed database.

Schröder, J., Mösges, R. (2018). Conjunctival provocation tests: prediction of seasonal allergy. Current Opinion in Allergy and Clinical Immunology, doi: 10.1097/ACI.0470 [Epub ahead of print]




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