Allergic Procedures

What type of allergy & immunology testing can be completed?

We offer a full suite of allergy & immunology testing that is tailored to your particular concerns:

• Skin Testing
• Patch Testing
• Spirometry
• Exhaled Nitric Oxide Evaluation
• Bronchoprovocation Challenge
• Rhinolaryngoscopy
• Drug Challenge
• Food Challenge

Allergy Skin Test

Allergy skin testing is performed to assess for allergenic sensitivities to:

• environmental allergens (pollen, animal proteins, dust mite, mold, cockroach)
• food allergens
• insect venoms (honeybee, yellow jacket, yellow hornet, white faced hornet, paper wasp, fire ant)
• medicationssuch as penicillin

In prick allergy skin testing, a sharp plastic lancet is passed through the allergenic extract or control solution, the skin on the back or forearm is lifted and a small break in the epidermis is created through which the extract or solution penetrates. If an allergenic sensitivity is present, a hive/welt like reaction develops in the area of prick.

Intradermal allergy skin testing is most commonly completed adjunctively to negative prick testing in evaluation of venom and drug allergy, and is infrequently completed in the evaluation of environmental allergy. In intradermal skin testing, a small needle is used to inject the allergenic extract or control solution into a deeper layer of skin, called the dermis, on the arm. If an allergenic sensitivity is present, a hive/welt like reaction develops in the area of intradermal application.

Allergy skin testing is considered superior and less expensive than specific IgE blood tests in the diagnosis of allergy.

Patch Test

Patch testing is primarily performed to assess for contact allergic dermatitis, a type of inflammatory skin reaction that can be secondary to cosmetics, jewelry, fragrances, soap, household and industrial chemicals, and even rubber. 

More recently, food patch testing is also being performed to assess for food triggers of eosinophilic esophagitis.

In patch testing, patches of suspect chemicals or foods are placed on the back for a minimum of 48 hours and subsequently removed with evaluation of the skin for reactions consisting of redness, swelling, and tiny blisters. Because such reactions are immunologically considered a delayed type of hypersensitivity reaction, skin reactions in the areas of patch placement may not occur until 4-5 days after placement. Accordingly, a third visit maybe necessary to further examine the skin.

Spirometry

Spirometry is a breathing test that measures how much air you are able to inhale, and how much and how fast you are able to exhale air.

It is an important test in the evaluation of asthma and/or recurrent symptoms of cough, shortness of breath, wheeze, and chest tightness.

This test is performed by forcibly inhaling and exhaling air through a tube connected to a computer.

Exhaled Nitric Oxide

Exhaled nitric oxide (eNO) is a type of breathing test used to assess airway inflammation which can be seen in asthma.

The American Thoracic Society states that eNO measurements can be helpful in:

• diagnosing eosinophilic airway inflammation
• determining steroid responsiveness of chronic respiratory symptoms such as cough
• supporting the diagnosis of asthma when objective evidence is needed

This test is performed by exhaling into a machine.

Bronchoprovocation Challenge

Bronchoprovocation challenge is a breathing test that is typically completed when asthma is suspected, and spirometry is normal or near-normal.

Challenge agents include:

• methacholine
• histamine
• mannitol
• cold air
• exercise

After exposure to the challenge agent, serial spirometry is completed to assess for declines in expiratory air flow that can be associated with airway hyperresponsiveness.

Rhinolaryngoscopy

Rhinolaryngoscopy is the use of a fiberoptic scope to evaluate the nose and throat. Allergists perform rhinolaryngoscopy to evaluate for nasal polyps, sinusitis and vocal cord dysfunction.

In this procedure, a topical nasal decongestant and anesthetic are applied, and a spaghetti-sized rhinoscope is passed through different levels of the nose and to the throat evaluating for pathology.

Drug Challenge

Drug challenges are considered the gold standard test to assess for drug allergy.

In this procedure, patients are administered medication and are monitored for the development of reaction.

Drug challenges are typically performed in settings where allergy skin testing to drug is negative or in settings where no standardized skin test is available and no contraindications to challenge exist.

Food Challenge

Food challenges are considered the gold standard test to assess for food allergy.

In this procedure, patients are administered the suspect food in sequentially increasing doses monitoring for the development of reaction.

Food challenges are typically performed in settings where allergy skin and/or specific IgE blood testing prognosticate possible food tolerance.

In preparation for allergy skin tests what medications should be held?

Please review for a detailed list of medications which may interfere with completion of allergy skin tests.

What are allergy shots (immunotherapy)?

Allergy immunotherapy, also called “allergy shots,” is prescribed to modify the immune system’s response to allergens with the goal of minimizing and/or preventing an allergen initiated inflammatory response.

This therapy is approved for the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma, stinging insect hypersensitivity and atopic dermatitis (Allergen immunotherapy: A practice parameter third update 2010).

Should your history and test results suggest that you may benefit from allergen immunotherapy, your provider will prescribe immunotherapy that is individualized to your particular allergenic sensitivities as revealed by allergy testing.

With immunotherapy, you will receive subcutaneous injections in the arm during the build-up (more frequent injections) and the maintenance (less frequent injections) phases. Typically, courses of immunotherapy range 3-5 years.

In patients with allergic rhinitis, allergen immunotherapy may reduce the development of asthma, the development of new allergenic sensitivities and lead to persistent benefit even after discontinuation of immunotherapy.

Further particulars about allergen immunotherapy will be discussed with you if you are a candidate for this therapy.

Please note that Board Certified Allergists & Immunologists are considered the experts in allergen immunotherapy.

For more information, please visit the AAAAI section on allergy immunotherapy.

We are a HIPAA compliant practice and fully respect our patients’ privacy.

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