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Testing Standards

Board-certified allergists are specialists trained to help you take control of your allergies and asthma, so you can live the life you want. They understand the ins and outs of allergy testing and oversee what happens during and after test sample analysis. These skills are important because there are many variables that affect allergy test results. If these nuances are missed or wrongly interpreted by physicians who do not specialize in allergies and asthma, you may not get the best treatment to relieve your symptoms.

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Skin tests for allergic disorders have been used successfully for more than 100 years. Today, prick or puncture tests are commonly used by allergists as diagnostic aids. These tests are not very invasive and, for most allergens, they tend to produce quick results. If the results of prick or puncture tests are negative, they may be followed by intradermal tests, which give allergists more details about what’s causing the underlying symptoms.

Here is how both types of tests are given:

  • Prick/puncture: A diluted allergen is applied using a small, disposable plastic device to prick the surface of your skin.
  • Intradermal: Using a small and very thin needle, a diluted allergen is injected just below the skin surface.

After either type of test, the area of the skin is observed for about 15 minutes to see if a reaction develops. The “wheal”—a raised, red, itchy bump and surrounding “flare”—indicates the presence of the allergy antibody. The larger the wheal and flare, the greater the sensitivity.

Although skin testing may seem simple, it must be carried out by trained practitioners with an understanding of the variables and risks of the testing procedure.

Steps should include:

  • After reviewing the patient’s medical history and performing a physical exam, the allergist determines that allergy skin testing is both appropriate and safe to perform on you that day.
  • A trained staff member performs the skin testing under the supervision of the allergist.
  • The skin test is read and graded for the level of response.

These factors include:

  • Proper evaluation and selection of which patient may benefit from skin testing
  • Condition and reactivity of the skin
  • Proper selection of where the skin tests are placed
  • Type of skin test placed
  • Device used for skin testing
  • Proper technique in applying the tests
  • Quality and selection of the allergen extracts used
  • Medications that could alter the validity of the results

Potential risks of non-specialist care include:

  • Misinterpretation of test results
  • Overdiagnosis
  • Mismanagement
  • Overprescription of medications and treatments
  • Costly and unnecessary allergen avoidance

FAQs

Source: www.aafa.org, Asthma and Allergy Foundation of America (AAFA)

Allergy skin testing is done to find out exactly what things a person may be allergic to.

With my mom’s help, I kept a record of my allergy symptoms for 2 weeks. I wrote down when I had my symptoms, how long they lasted, where I was, what I was doing and medicines I took for them. My doctor reviewed the record but still couldn’t figure out what I was allergic to. So he referred me to an allergist for skin testing, which showed I was allergic to mold. The next step was to get rid of the mold in our home.

Jamie, age 17

How are skin tests done?

Skin tests are done in an allergist’s office.

There are two types of skin tests:

  • Prick or scratch test: In this test, a tiny drop of a possible allergen—something you are allergic to— is pricked or scratched into the skin. (This is also called a percutaneous test.) It is the most common type of skin test.
  • Intradermal test: This test shows whether someone is allergic to things such as insect stings and penicillin. A small amount of the possible allergen is injected under the skin through a thin needle.

What is an allergy?

An allergy occurs when you react to things like pollen or cats that don’t affect most people. If you come into contact with something you are allergic to (called an allergen), you may have symptoms such as itching or sneezing. This is called an allergic reaction.

What can I expect during a skin test?

A number of different allergens will be tested. It takes about 5 to 10 minutes to place the allergens on your skin. They are usually put on the forearm in adults and on the back in children. Then you will wait about 15 minutes to see if a small red lump appears where any of the allergens were placed.

The prick or scratch test and intradermal test may hurt slightly. If you are sensitive to any of the allergens, your skin may itch where the allergen was placed.

How should I prepare for the test?

  • Tell your allergist about all medicines you’re taking, including over-the-counter medicines.
  • Don't take antihistamines for 3 to 7 days before the test. Ask your allergist when to stop taking them. (It’s okay to use nose [nasal] steroid sprays and asthma medicines. They will not interfere with skin tests. Talk to your allergist’s staff before the testing to find out which medications you can continue using.)

Is the test safe?

Very small amounts of allergens are tested on your skin, so skin testing is safe. During the test, the allergist will watch for a possible severe allergic reaction, but it rarely happens.

What do the skin test results mean?

If you’re sensitive to an allergen:

  • With the prick or scratch test and intradermal test, a small red bump appears on the skin where that allergen was placed, and this area may itch. The larger the bump, the more sensitive you may be to it.

These results are called positive skin tests and mean that you may be allergic to the allergen tested.

Even if a skin test shows that you’re allergic to something, you may not react to it when you’re exposed to it later. Your allergist will review your medical history and skin test results to help find out what you’re allergic to.

What happens if the skin test shows I have allergies?

Your allergist will create a plan for controlling your allergies. This means preventing and treating symptoms. Take these steps:

  • Avoid or limit contact with your allergens. For example, if you’re allergic to dust mites, reduce the clutter in your house, which collects dust.
  • Take medicine to relieve your symptoms. Your allergist may prescribe medicines such as antihistamines, decongestants, nose (nasal) sprays, or eye drops.
  • Get allergy shots if the allergist says you should. Some people need them when they can’t avoid an allergen. The shots contain a tiny but increasing amount of the allergen you’re sensitive to. Whether given in shot form or under the tongue, immunotherapy involves giving gradually increasing doses of the substance to which you are allergic (also known as your allergen). The small increases over time in the amount of your allergen – things like dust, pollen, mold and pet dander – cause the immune system to become less sensitive to it. That reduces your allergy symptoms when you come across the allergen in the future. Immunotherapy also reduces the inflammation that comes with hay fever and asthma.

Who does skin testing to diagnose allergies?

Allergists are experts who test for, diagnose and treat allergies.

Does health insurance cover skin testing for allergies?

Most health insurance plans cover allergy testing and treatment. Ask your insurance carrier:

  • Do I need a referral from my doctor to see an allergist?
  • Does my insurance cover patient education or special services for my allergies?
  • What allergy testing and medicines does my plan cover?

 

This page was reviewed and updated 4/16/2018.