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Epicutaneous Test (The Prick or Puncture Test Method)

Infants and young children have this performed on their back or forearm. For older children and adults it is usually done on the forearms. First the skin is examined and cleaned with alcohol, and then numbers or dots are written with a pen to identify each allergen (any substance that causes an allergy) that is to be tested. A small disposable plastic pricking device is used to apply a small drop of each allergen just in the outer surface layer of the skin (epidermis). This is not a shot, and does not cause bleeding. In addition, this procedure is not painful, but has been described as feeling like getting a mosquito bite. The applications of the tests are usually performed in a matter of seconds, and complete results are available during your visit. Many medicines, especially antihistamines, can block the results from skin testing, and must be stopped for a certain period of time before attempting this test. Please check with Asthma, Allergy & Sinus Center or your doctor before stopping any medications.

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Intradermal Test

After examining and cleaning the skin with alcohol, a small amount of each allergen is injected into the second layer of skin, or dermis, similar to a tuberculosis test (but smaller). This test is often done and is considered the gold standard for diagnostic allergy testing when the highest sensitivity is needed. It is mainly used to test for specific allergies when epicutaneous testing fails to reveal a highly suspected allergy. The same medications that can affect scratch testing may also affect this test. The allergy testing requires that you be off antihistamines for 5 days to be accurate, please call us for details or if you do not think you can hold antihistamine therapy for that timeframe. Avoid sedating sleep medications the night before your allergy test is scheduled. 

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Patch Testing

This test is performed by examining and cleaning the skin on the patient’s back, and applying patches that contain small amounts of various substances that are known to cause contact dermatitis (a rash or inflammation of the skin caused by contact with various substances). The patches are typically worn for two days, and cannot get wet. After two days the patches are removed and the underlying skin is examined. A follow up skin exam is usually performed two more days after that. Patches are applied on Monday, removed on Wednesday and follow up skin exam on Thursday or Friday.  If you are allergic to any of these substances, your skin will become irritated and may itch. This test is frequently performed in the diagnosis of allergic contact dermatitis, and sometimes during the work-up of eosinophillic esophagitis. It is not routinely done for evaluation of allergic rhinitis or asthma.

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Spirometry

Spirometry is a breathing test that gives the physician a good idea of the patient’s lung function. It is not a complete lung function test, but is good for screening for suspected asthma, COPD (chronic obstructive pulmonary disease like emphysema or chronic bronchitis), interstitial lung disease and laryngeal disorders of air movement. We often perform this test on the initial visit for diagnosing lung disease, so you may be asked to refrain from using your rescue inhaler/neb (Albuterol) medication and Symbicort, Advair or Dulera inhaler the morning of the test (if you use these medications and feel it is safe to do so). Do not stop your inhalers if you feel you need them, the test can be done at another time after we have made an initial evaluation. For follow up visits where this test will be performed, it is permissible to use your medications as usual.

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Immunotherapy

Immunotherapy treatment (allergy shots) is based on the concept that the immune system can be desensitized to specific allergens that trigger the allergy symptoms caused by allergic respiratory conditions, such as allergic rhinitis and asthma.

 

While common allergy medications often control symptoms, if you stop taking the medication(s), your allergy symptoms return shortly afterward. Allergy shots (immunotherapy) may lead to lasting remission of allergy symptoms, and they can play an important role in preventing the development of asthma and new allergies.

 

The decision to begin immunotherapy will be based on several factors:

• Length of allergy season and severity of symptoms

• How well medications and avoidance of allergens control the allergy symptoms

• Desire to avoid long-term medication use

• Time – immunotherapy will require a significant time commitment during the build-up phase with a less-frequent commitment during the maintenance phase

• Cost – cost may vary depending on insurance coverage. Allergy shots can be a cost-effective approach to managing symptoms.

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 The Process

 

A unique mixture is prepared, based on test results, to include the important allergies for your condition. Treatment involves injecting the allergen mixture, starting with very tiny doses, and increasing slowly with an injection every week to build-up to the full maintenance dose. Because the target (maintenance) dose varies from person to person, the "build-up” phase could last 4–6 months. Once the maintenance dose is reached, it is repeated every two to four weeks, and is continued for 3–5 years to help make the immunity more long-lasting. Most people have lasting improvement of their allergy symptoms, but some may have increased symptoms after stopping the shots, and some may go back on immunotherapy. So the duration of allergen immunotherapy varies from person to person.

 

The only risk involved with immunotherapy is of allergic reactions to the injections. This can cause local swelling at the injection site in the arm, and sometimes the dose must be adjusted to avoid very large swelling. Serious life-threatening anaphylactic reactions are rare, but immunotherapy should be given only under the supervision of a medical professional in a facility equipped with proper staff and equipment to identify and treat adverse reactions.

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