Allergy Skin Testing

If you have allergies it means that you are reacting to specific substances, usually proteins, called allergens. To determine which allergens are causing your symptoms a test will be done called allergy skin testing. This is the first step in determining what type of treatment would be most effective.

Allergy testing is done for one of several patterns of symptoms:

RESPIRATORY: Asthma, cough, hay fever (rhinitis), post-nasal drip, nasal congestion, itchy nose, swelling and dark circles under the eyes, etc.) This allergy could be due to substances in the air such as pollen, mold, animal dander, dust mites, etc. SKIN, INTESTINAL: Hives, itching, swelling, abdominal pain. This may be due to foods or a medication. DRUG REACTIONS: Symptoms of drug allergies can be similar to symptoms from many of the other allergic reactions and may produce hives, swelling, itching or anaphylaxis. Testing may be done for many medications such as antibiotics or local anesthetics. Some medicines cannot be tested this way such as narcotic pain medicines, aspirin and some high blood pressure medications. Drug reactions causing non-allergic side effects such as stomach upset, insomnia or toxic effects to the liver or kidneys also cannot be determined by skin testing. SKIN CONTACT ALLERGIES: This refers to rashes suspected to be caused by allergens that come in contact with the skin. Many chemicals can cause this including preservatives in cosmetics, topical medications as well as fragrances and latex materials. In some people, metal objects (jewelry, clothing snaps) may cause rashes in this fashion if they contain nickel and come in direct contact with the skin. ANAPHYLAXIS This is a severe, life threatening reaction which can be caused by many different things including foods, medications, latex (natural rubber) or insect stings (bee, wasp, fire ant, yellow jacket). There are some conditions in which an allergy may not even be the cause of the symptoms.

How skin tests are done

There are three types of skin testing: prick, intra-dermal and patch testing. Prick testing: This is generally done first and is done with a small plastic device by applying small pricks on either the back or the forearm. After testing it takes about 15-

20 minutes to get the results. There may be slight discomfort but it is generally not painful. After testing a small, red itchy bump may appear for a short while, usually less than an hour. This is called a wheal. There may also be some surrounding redness, called flare. The allergist will measure the bumps and compare them to controls (tests expected to produce positive or negative results). Intradermal testing: This is done by injecting a small amount of diluted allergen in to the skin as a means of fine tuning the results. It may be done for airborne allergens, certain medications, and insects but is not used for food allergy testing. Patch testing: This is done by applying a tape patch on the skin, usually on the upper back. This tape contains a standard panel of 24 allergens (sometimes more) known to cause this type of allergy. This test must be left in place for 48 hours before it is read. No needles or pricks on the skin are involved with this testing. Some itching may occur that can persist for several days.

What causes the itchy bump

When someone has an allergy there are white blood cells, called lymphocytes that produce an antibody called IgE. This IgE is uniquely specific for a particular protein such as oak pollen, cat dander, penicillin, etc... The IgE then attaches to a cell in the skin called a mast cell. This cell contains a chemical called histamine which, when released produces the symptoms we recognize as allergy symptoms. When the allergen comes in contact with the IgE attached to the mast cell the histamine is released into the tissues or bloodstream thereby causing the allergy symptoms. The skin test exposes the skin cells to the suspected allergens thereby producing this reaction at the allergist can observe and measure. The results are measurable in 15-20 minutes. We will then discuss the reactions the test found and the treatment options.

Reasons Allergy Testing Cannot Be Done

Interference from other medications:
ANTIHISTAMINES - These are the medications generally taken to treat allergy symptoms and will suppress the allergy test result. They will need to be discontinued for 2 weeks. Many of these medicines are non-prescription so you should notify the doctor of any medications you are taking including non-prescription allergy medications, nasal sprays and eye drops. Beta Blockers - These are medications generally prescribed to treat high blood pressure, migraine headaches and certain irregular heartbeats. There are also eye drops used to treat glaucoma that are in this family that will need to be temporarily discontinued. These medicines could pose a danger in a patient undergoing allergy testing. They need to be discontinued temporarily. You should ask the physician who prescribed the medication if stopping the medication temporarily is safe Anti-depressants Certain anti-depressants and tranquilizers can suppress the allergy test response. These medications need to be temporarily discontinued. If it may be unsafe to do so, you should ask the physician who prescribed the medication if stopping it is safe.

Sleep Medicines/sedatives Also called hypnotics, or sleep aids these medicines may be prescription or over-the-counter. The name often ends with PM meaning that they will probably make you drowsy and are intended to be taken at bedtime. Examples: Sominex, Tylenol PM. Miscellaneous drugs Dopamine and clonidine can both suppress allergy test response and need to be temporarily stopped once the prescribing physician has indicated it is safe to do so.

Other illnesses/conditions affecting allergy testing:

ASTHMA Unstable asthma increases risk of a reaction to allergy testing. PREGNANCY Allergy testing itself is safe during pregnancy but is considered a risk since a reaction may result in the need for medications which could be hazardous. You should tell the nurse or doctor if you may be pregnant.

Risks Involved with Allergy Testing

Numerous studies by several allergy organizations have concluded that allergy testing should be done by an experienced allergist. Reactions other than an itchy bump on the skin are rare but have been known to occur. Such reactions may involve itching and hives, wheezing, and rarely, shock or throat swelling. It is for that reason that allergy testing should be done in a safe medical setting with a doctor present who is prepared to treat any unexpected side effects.

What is done with the results

The test results are generally graded on a scale from 1-4 depending on the severity of the reaction. The allergist will discuss these results with you and determine if these allergies are the primary cause of your symptoms. If it does not appear that they are then other types of testing may also need to be done such as blood tests, sinus x-rays, or maybe getting an opinion from another medical specialist such as a dermatologist or an ear, nose and throat specialist. The exposure to some allergens can be significantly reduced in the home or work environment and measures to accomplish this will be discussed. This would include dust mites, cat or dog dander, mold spores, feathers, cockroach droppings or housedust. Exposure to other allergens may be predominantly outdoor and therefore it may not be able to reduce ones exposure to allergens such as pollen and certain mold spores. Usually, reducing ones exposure to allergens is combined with medications. For adequate reduction of symptoms, both the above measures plus allergy shots (called immunotherapy) may be needed. We can discuss these measures and there are additional handouts that cover topics such as dust mite reduction measures, allergy

shots, and animal allergies. You can ask or look in the holders in the exam rooms or download them from our office website at www.jacksonvilleallergycenter.com.

Alternatives to Allergy Skin Testing

You may have heard of a blood test for allergies. It is called a RAST test and is also called in vitro testing. This testing is less accurate than skin testing, is much more expensive and the results may not be available for several weeks. The accuracy may also vary from one laboratory to another. Blood allergy testing may be used as a substitute when a skin condition such as eczema or psoriasis prohibits the ability to do accurate skin testing. In general, however, this type of testing is an insufficient method upon which to base a definitive allergy treatment plan. An internet search will quickly show numerous commercially available (and expensive) blood tests touted to be accurate in self-diagnosis of allergies. Many of these tests test for IgG which is the wrong antibody and is not even associated with allergies. This test, therefore, has no scientific basis and is considered inappropriate for the diagnosis of allergies. Other tests proven to be an invalid include a test called Rinkel test or a sublingual test. Sublingual administration of allergy extracts as an alternative to allergy injections is currently under study and may eventually prove satisfactory once safety, dosing and effectiveness have been established.

Revised 10/4/2012