How do you reconcile differences between SPT and serum IgE testing for aeroallergens when preparing AIT?

The 2008 Allergy Diagnostic Testing Practice Parameters would note as follows:

"The precise sensitivity of these immunoassays (serum IgE testing) compared with prick/puncture skin tests has been reported to range from less than 50% to greater than 90%, with the average being approximately 70% to 75% ...

I base my decision on which allergens to include based on the clinical history of symptoms and cross-reactivity relationships to reconcile any differences. Skin testing has a higher sensitivity, but I’ve had patients test negative on skin tests only to test positive on serum IgE testing. If symptoms...