TESTING & TREATMENT
Skin testing represents the primary diagnostic tool in the field of allergy. Skin tests are used to demonstrate an allergic reaction on the skin. When performed properly under the supervision of a trained allergy specialist, skin tests provide very useful confirmatory evidence for the diagnosis of a specific allergy. Skin testing is the most accurate test available for testing allergies.
Skin Puncture Test Method
Using up-to-date, easily placed applicators, we can test for a variety of allergens. Allergens available for testing include pollens, molds, dust mites,animal dander and various foods. With the skin test puncture method, disposable devices called Multi-test Applicators are used to place multiple drops (8 per applicator) of antigen on cleansed skin (usually on the back). With this device, the skin is then superficially punctured with a rocking motion allowing a small amount of the allergen to enter the very top cell layer of skin. If you have an allergy, the specific allergens that you are allergic to will cause a chain reaction to begin in the superficial skin layer only. After 10-15 minutes, the test area is observed and size of the reactions is measured and recorded for interpretation.
Results are interpreted by comparison to a [positive] histamine control and a [negative] normal saline control. The allergen extracts or vaccines used in allergy tests are made commercially and are standardized according to U.S. Food and Drug Administration (FDA) requirements.
Adults and children of any age can be tested for allergies. Because different allergens bother different people, we will take your medical history to determine which test is the best for you. Some medications can interfere with skin testing. Antihistamines, in particular, can inhibit some of the skin test reactions. Use of any antihistamines should be stopped 5 days prior to skin testing (including eye drops or nasal sprays that contain antihistamines).
Test results are available within 15 minutes of testing, so you don't have to wait long to find out what is triggering your allergies. And you won't have any other symptoms besides the slightly swollen, small hives where the test was done; this goes away within 30 minutes.
Allergy tests provide concrete, specific information about what you are and are not allergic to. Once we have identified the specific allergen(s) causing your symptoms, we can develop a treatment plan aimed at controlling or eliminating your allergy symptoms.
Blood testing (RAST) is used when skin testing is prohibited (i.e. certain skin conditions, dermatographism and those on prohibitive medications that cannot be discontinued). It is considered less specific and more expensive than skin testing. We continue to strive for the best of testing methods that deliver reproducible, clinically significant results with excellent patient tolerance.
Intradermal Test Method
Some adult patients may require additional limited tests by the intradermal test method. Intradermal tests are more sensitive. A small volume of allergen is injected into the outer layer of the skin with a small syringe.
SPIROMETRY (PULMONARY FUNCTION TESTS)
For patients being evaluated for asthma, we perform Pulmonary Function Tests in our office. Pulmonary Function Tests (or spirometry) are a group of tests that measure how well the lungs take in and release air. This group of tests is performed with breathing into a single sterile mouth piece. With these tests, a patient breathes normally and quietly, then is asked to take a forced inhalation and exhalation after taking a deep breath.
Pulmonary Function Tests are used to diagnose asthma (or other lung disease), to assess the effect of medicines in treating asthma and to measure the progress in asthma treatment. Pulmonary Function Tests can usually be accomplished in all adults and children over 6 years of age, and are essential in guiding asthma therapy.
RADIOGRAPHIC STUDIES (CHEST X-RAY/SINUS CT)
In some instances we may order radiographic tests to evaluate your chest or sinuses. This includes a chest X-ray in patients with asthma (or other lung diseases). Often, a CT scan of the sinuses is ordered to serve as an image of the sinuses to allow for proper treatment. A sinus CT scan shows a great amount of detail, and is extremely helpful in localizing sinus disease. Sinus CT scans provide much more information than routine standard sinus X-rays.
In some situations we will send you to a lab for blood tests. In certain instances these tests can be useful in diagnosing allergies (in addition to skin tests). Some types of white blood cells, called eosinophils, can be measured as they can serve as an important diagnostic feature in some allergies, and also in some patients with asthma. Lab studies for patients with recurrent infections are often ordered to measure a patient’s immune status. Some patients with recurrent hives undergo in-depth laboratory tests, including measuring for immunological illnesses.
Some patients have recurrent infections that need to be treated with antibiotics. Some patients have too many infections. Some patients have infections that last longer or are more severe than the typical population. A board certified allergist is certified in both allergies and immunology, with expertise in diagnosing and treating immune system problems (called an immunodeficiency). There are many forms of immunodeficiency and while some are severe and life-threatening, many are milder but still important enough to cause recurrent or unusual infections.
The most common forms of immunodeficiency are caused by defects in the patient’s ability to produce antibodies. Antibodies are proteins that attach to germs and help the body eliminate these germs.
An allergist can determine if a patient is experiencing too many infections. When performing an immune evaluation, blood tests are needed. This blood test includes measuring specific antibody responses (including to the diphtheria, tetanus and the pneumonia vaccine). Very often this evaluation gives reassuring results. If treatment is warranted, early treatment can prevent complicating infections.
ALLERGY SHOTS (ALLERGEN IMMUNOTHERAPY)
Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to substances called allergens. These allergens are identified by allergy testing, and are the substances that trigger your allergy symptoms when you are exposed to them. Allergen immunotherapy is a therapeutic intervention in which the patient is administered increasing doses of an extract consisting of the specific allergens to which the patient has been demonstrated to be allergic.
Immunotherapy has been shown to prevent the development of new allergies and, in children, it can prevent the progression of the allergic disease from allergic rhinitis to asthma. Allergen immunotherapy can lead to the long-lasting relief of allergy symptoms after treatment is stopped.
Immunotherapy is only recommended for allergic asthma, allergic rhinitis and conjunctivitis, and stinging insect allergy. Five is the youngest recommended age to start immunotherapy in the United States. Recent studies have suggested immunotherapy may prevent the development of new allergies in children and also may prevent the development of asthma in children who have rhinitis. There is no upper age limit for receiving immunotherapy.
Allergen immunotherapy works like a vaccine. Your body responds to the injected amounts of a particular allergen, given in gradually increasing doses, by developing an immunity or tolerance to the allergen(s). As a result of these immune changes, immunotherapy can lead to decreased, minimal or no allergy symptoms when you are exposed to the allergen(s) included in the allergy vaccine.
If immunotherapy is successful, maintenance treatment is generally continued for 3 to 5 years. The decision to stop immunotherapy should be discussed with your allergist/immunologist after 3 to 5 years of treatment. Some individuals may experience lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy. Therefore, the decision to stop immunotherapy must be individualized.
There are two types of adverse reactions that occur with immunotherapy: local and/or systemic reactions.
Local reactions are fairly common and present as redness and swelling at the injection site. This can happen immediately, or several hours after the treatment.
Systemic reactions are much less common than local reactions. Systemic reactions are usually mild and respond rapidly to medications. Systemic reactions require immediate treatment. Most serious systemic reactions develop within 20 minutes of receiving an allergy injection and this is why it is recommended you wait in the office for 20 minutes after your allergy injections. We are trained to monitor for such reactions and to identify and treat systemic reactions.
The positive side of immunotherapy greatly outweighs the time and effort involved. Immunotherapy may provide relief and way of life that would never have been previously possible.
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