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Skin Testing FAQ:

Is Skin testing painful?
Skin tests for food and inhalant environmental allergens are mildly uncomfortable, akin to a quick pinch of the skin.  We do not use needles (intradermal tests) for food or environmental allergen skin testing. 
 
Where on the body do you place skin tests? 
The typical locations for testing are the forearms, but in some cases they will be placed on the back (i.e. usually for very young children).

How long does skin testing take?  
Skin testing to our standard panel of environmental allergens and select food allergens takes approximately 20-30 minutes.

What do you test, and what do the tests show? 
We have a broad array of National and Regional allergens including: trees, weeds, grasses, molds, cat, dog, dust mite, cockroach, horse, and other animals.  We also, have a broad selection of food allergens.  The tests look for an allergy antibody called IgE (i.e. Immunoglobulin E) which is involved in most allergic responses.  Less commonly, drug testing, venom testing and chemical patch testing can be performed through other techniques.

If I (or my child) cannot be skin tested, what alternative testing is there? 
The common reasons one cannot be tested at an initial visit are: recent antihistamine use (i.e. most <4 days), patient cooperation (very young children) limits placement, current illness, skin rashes limiting locations, or select food allergen is unavailable.  The alternative testing is through a blood draw, which gets sent to a lab to detect IgE.  This process is more costly and not immediately available to discuss and direct medication changes or allergy shots if applicable.  These blood tests are not affected by medications.
What ages of patient will you test?  All skin testing is determined on a case-by-case basis as they would relate to an individual’s symptoms and history.  We can test all ages of people, though with the very young we usually recommend more limited environmental testing panels to increase their tolerance and cooperation.  This is at the discretion of the parents and provider.   Food skin tests are commonly done on young children.

What medications should I avoid prior to my appointment for skin testing? 
Generally, most antihistamines should be avoided for 4 days prior to a visit, as they impair one’s skin responsiveness to the allergens.  Not all antihistamines have identical potencies or durations in the blood stream.   Some non-antihistamine medications can have antihistamine effects.  Generally, most medications or treatments will NOT suppress skin tests.  Blood pressure medications, thyroid medications, cholesterol medications, diabetes medications and asthma inhalers do not need to be stopped prior to appointment.  If one takes a medication interfering with testing, we can simply test at a later date.  Please, reference list below and/or call for questions prior to your visit.

Will Herbal Supplements interfere with skin tests? 
Many herbal supplements will not interfere with skin tests.  Licorice, Green Tea, Saw Palmetto, St. John’s Wort, and Feverfew will decrease skin responsiveness and should be avoided for about 4 days prior to testing.

If I am pregnant, can I be tested? 
While allergy testing is generally safe to perform on pregnant women, we usually recommend patients wait until their pregnancy is over.  Blood IgE testing for allergy sensitization can be ordered, but it is more costly, variable in sensitivity, and the results are not immediately available to discuss with patients.  Additionally, allergy shots (if desired) will not be started (new) while pregnant.

If my skin tests are positive, do I have to go on Allergy shots?
No.  The decision to go on allergy shots rests solely with the patient or parent.  We will certainly provide a discussion, recommendation and resources so an ‘educated choice’ can be reached. Allergy shots are the only truly preventive allergic therapy available.  Medications mask symptoms, but ‘shots’ reduce one’s exaggerated allergic immune responses.

If I am pregnant, can I go on allergy shots? 
Allergy shot patients who find out they are pregnant can if desired, remain on allergy shots, however we will not increase their doses from current levels. Pregnant women not already on shots will not be started until after their pregnancies end.
How are allergy shots administered? We inject shots in the upper outer arms just under the skin (subcutaneously).  The shot ‘schedules’ will likely vary from one individual to another, as will the number of injections at each ‘session’ (1 or 2).  We will ‘build up’ the doses of allergens usually over several weeks to reach a set maintenance dose which is then administered about once a month.

Can I give myself (or child) the Allergy shots at home? 
No. For safety reasons, best practices in Allergy discourage allowing patients or parents to administer shots away from a facility capable of promptly recognizing and treating allergic reactions. Safety and Adherence to accepted “evidence-based” medical standards are our priorities while you are under our care.  

How long does one stay on shots?
Current Board-Certified Allergist Practice Parameter guidelines recommend shots to be continued for 3 to 5 years on the maintenance dose.  Some patients will opt to remain on shots longer.  Starting shots does not obligate someone to 3-5 years of treatments, but the longer courses will provide a longer lasting effect in symptom reduction.  Shot schedules will vary somewhat, but generally will be 1-2 times per week for 4-12 weeks of build-up doses, then once every 2-4 weeks thereafter for maintenance doses.

If I go on shots can I stop my allergy medications?
While shots usually help greatly reduce or prevent allergic reactions to allergens, there are no guarantees symptoms will be gone for the rest of one’s life.   Thus, patients may have to use allergy medications, albeit at reduced frequencies/doses, or without resorting to combination therapy.  Most shot patients will notice an improvement in symptom control within 3-9 months.  Pollen allergic patients likely will notice improvement by their next ‘pollen season’.

If I go on shots do I have to carry around an epinephrine ‘pen’? 
The decision to prescribe an epinephrine pen is done on a case-by-case basis.  Allergy guidelines do not currently mandate their prescribing in all cases.

Do I have to make an appointment to get allergy shots? 
For your convenience we are able to accommodate walk-in shot patients.  We do prefer one to make an appointment for their shot(s) to lessen wait time.  Walk-in patients will still need to check-in at the front desk.  Plan for a 20-30 minute observation period after administration of injection(s).  Typically shot patients do not see a provider, unless they book an appointment with the provider, or the nurse requires their assistance.  

How do I pay for ‘shots’? 
Most insurance policies provide allergy benefits, though benefits vary based on each policy.  Please inquire with your insurance if you are considering shots.  If your policy requires a copay or coinsurance, we will collect this prior to therapy.

Do you offer “Allergy drops”? 
Not at this time. Allergy drops or sublingual (“under the tongue”) allergy ‘drops’ are currently under research investigation, and seem to hold ‘promise’ with regard to safety and clinical effectiveness.  However, they require daily or twice dosing, and optimum ‘doses’ are not well known, but are thought to exceed 300-700 times the dose of traditional injections to attain clinical effectiveness.  Additionally, insurers do not currently cover ‘Allergy drops’.  This fact and the number of required doses may preclude patients from seeking this type of therapy due to cost.

What are some resources to review before or after seeing our Allergy provider(s)? 
The AAAAI.org, ACAAI.org and FoodAllergy.org are excellent resources for reviewing information on allergic conditions, medications or ‘shots’ (a.k.a. Immunotherapy).  Weather.com also provides region-specific updates on pollen or mold counts.  Plants.USDA.gov has pictures and shows regional and national plants.