Adult Allergy Testing
Skin testing of common inhaled allergens (allergic triggers) is often very helpful in the treatment of sinus, nasal, throat or ear symptoms. Tree, grass and weed pollens common to our region are tested in addition to a wide variety of mold spores and household irritants like house dust, dust mites and pet dander. If suspected, food allergies can be evaluated through a separate blood test.
Why Test for Allergies?
Testing allows us to determine how likely inhaled allergens are to play a role in nasal or sinus symptoms. Some conditions like non-allergic rhinitis, food allergy, infection and gastric reflux may produce symptoms identical to allergic rhinitis and can be difficult to distinguish without testing. Another important reason for testing is identification of specific allergic triggers. Identifying your triggers is critical for serious allergy sufferers as one of the keys to effective treatment is AVOIDANCE. Testing is also the first step in formulating an alternative therapy to traditional allergy medications called immunotherapy, which may offer effective long-term suppression of allergic disease.
How to Prepare for Your Allergy Testing Appointment:
Antihistamines that you may be taking for symptoms associated with your nose, sinuses or breathing interfere with allergy skin testing. For this reason, we recommend that you stop taking antihistamines one week before your first appointment. Be particularly careful about over-the-counter (OTC) cold, flu and sinus remedies since most of these have an antihistamine as an active ingredient. Many OTC sleeping pills also contain antihistamines and should be avoided. Certain antidepressants and anti-anxiety medications may interfere with testing and should be held for at least 1 week before testing. Lastly, beta-blockers should be held for 72 hours before testing as these medications interfere with treatment in the event of a serious allergic reaction called anaphylaxis. Please remember we value your health and stopping some medications may result in serious health consequences. Please refer to the list of medications to be withheld below and always check with your nurse or physician if you are uncertain.
Medications to Hold Prior to Testing:
- Prescription Antihistamines (Allegra, Zyrtec, Astelin nasal spray, Clarinex)
- Over the counter (OTC) Antihistamines (Claritin/Loratadine, Chlorpheneramine, Benadryl/Diphenhydramine)
- OTC Cold, flu and sinus medications (these may contain OTC Antihistamines)
- Sleep Aids (Tylenol PM, Unisom, any that contain diphenhydramine)
- Certain Antidepressants (Amitriptyline, Nortriptyline)
- Certain Anti-anxiety Medications (Nefazadone, Clonazepam)
- Beta-Blockers (Toprol/Metoprolol, Inderal/Propranolol, Labetalol, Carvedilol)*
*Check with your prescribing physician before holding your beta-blocker, you may be able to change to a calcium blocker.
How is Skin Testing Performed?
Skin testing is done in two steps and each step uses different techniques. The first step is called the skin prick test and involves the application of several Multi-Test devices to arms. The devices have no needles and do not break the skin. As many as 32 allergens may be placed on the skin as well as a small amount of histamine to make sure your skin is capable of producing a normal, visible skin reaction. Skin reactions are measured after 20 minutes. Itching, redness and wheals (small, itchy lumps) indicate sensitivity to a particular allergen or a normal response to histamine. The second step in skin testing is called the extended skin prick test and involves the application of four Multi-Test devices to the other upper and lower arm. It is basically the same process as the initial screen but just tests for more detailed allergens. A total of 32 allergens are placed on the skin.
The second step in skin testing is called intradermal testing. This allows us to figure out precisely your degree of sensitivity to an allergen that produced a skin reaction on the prick test. It is also a more sensitive test that can tell us if you really are sensitive to an allergen that had little or no reaction on the prick test. Intradermal testing involves injection of a very small volume of each of the allergens into the skin to make a tiny lump (less than ¼ inch). This is similar to the skin test for tuberculosis, also known as a PPD test. We then measure the skin reaction to each of the allergens in 10 minutes.
Are there Any Side Affects to Skin Testing?
Skin testing is not painful and usually well tolerated other than itching and redness. We will provide a soothing cream for your arm after the test. Occasionally large responses may take a few hours to clear. Rarely, they may take a couple of days to clear. Let us know if a delayed reaction occurs (a wheal that develops after 2-3 days where one was not seen before). Wheezing, cough and flaring of allergy symptoms are possible with testing, especially if large skin reactions were seen. People taking beta-blockers and asthmatics are more likely to have these severe reactions.
Who Should Not Have Allergy Skin Testing?
If you are taking beta-blockers (e.g. Toprol, Metoprolol, Inderal, Atenolol) for high blood pressure or heart disease or if you have asthma that is difficult to control (frequent wheezing, shortness of breath or frequent inhaler usage), you should not undergo skin testing because of the increased risk for a severe allergic reaction called anaphylaxis. Blood tests will be done instead. If you are on a beta-blocker, you can not have immunotherapy.
Most allergy symptoms can be controlled by limiting allergen exposure. Allergy medications may be used if you are limiting allergen exposure and still experiencing symptoms. If allergy symptoms persist with medication use, immunotherapy is a viable option that can be discussed.
There are many ways you can help yourself if you have allergies. Besides following your doctor or nurses directions carefully and taking your medication as directed, you can also avoid the things that cause your allergy symptoms. Some common allergens and tips to limit exposure include:
- Found outside especially between 5-11am. Avoid by staying inside when pollen counts are high, keeping windows closed, and avoiding outdoor exercise.
- Use a HEPA filter that cleans the air, and call the National Allergy Bureau (NAB) AT (800)9-POLLEN for reliable weekly pollen and mold spore counts.
- Can be dispersed into the air when you mow the grass or when raking leaves. Avoid by wearing a dust mask.
- Grows in damp, dark, humid areas. Clean the bathroom with mold/mildew remover, use a dehumidifier to keep humidity less than 50% and change the filters on air conditioner and furnaces often.
- Trim back bushes and allow sun to penetrate to kill mold spores.
- 8 legged microscopic arthropods that feed on human and animal skin debris and live in mattresses, pillows, comforters, upholstered furniture, carpets, and curtains.
- Buy impermeable “dust mite” covers for BOTH mattresses and pillows.
- Wash sheets and duvet covers in HOT water at least once each week.
- Open your windows to allow for ventilation.
- Shed small cells called dander from their hair, fur, and feathers. This dander remains in carpets and mattresses. Avoid by keeping pets outdoors and especially out of bedrooms, off furniture, rugs and mattresses. Bathe pets weekly if possible.
Your doctor or provider may prescribe allergy medications that may help prevent or treat your allergy symptoms. These medications include:
- Antihistamines-treat sneezing, itching, runny nose and watery eyes.
- Decongestants-promote easier breathing and decrease nasal swelling.
- Steroid nasal sprays-treat nasal itching and congestion.
- Decongestant nasal sprays-decrease nasal congestion.
- Cromolyn nasal sprays-help prevent and treat allergy symptoms.
Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to substances called allergens. Immunotherapy helps 80-90% of people with allergies. Many patients consider themselves “cured” after completing the 3-5 year course of therapy. Your doctor can help you decide if allergy shots will work for you. Immunotherapy should be used for people who:
- Are allergic to an unavoidable plant or animal.
- Take large amounts of medicine to control symptoms but still have allergy symptoms.
- Have allergies that seriously affect daily life.
- Have lost days of work due to fatigue.
- Are willing to make a commitment to 3-5 years of therapy.
Allergy immunotherapy has many lasting benefits including:
- Having fewer, milder or no allergy symptoms.
- Taking fewer or no allergy medications.
- Visiting your healthcare provider less often for allergy-related problems.
- Reducing medical costs associated with allergies.