Procedures

Providing the most up-to-date diagnostic testing procedures and maximizing treatment options is essential for patient-centered care. Diagnostic testing is typically rapid and is often almost painless. By identifying and understanding the underlying triggers leading to symptoms, specific avoidance recommendations and measures to decrease exposure can be offered to optimize medical treatment regimens.


Allergy skin testing

Skin prick testing is performed in evaluation of environmental allergy and food allergy.

A small amount of the suspected allergy trigger (allergen) is placed on the skin, often on the forearm or upper back. The skin is gently pricked to introduce the allergen under the skin, and the skin is observed for any reaction. Results are usually obtained within 15 minutes.

Serum specific IgE testing

This blood testing is sensitive for identifying allergens causing allergic disorders. The advantage of this testing is that medications do not need to be stopped.

Allergy Component Testing

This is the most advanced and cutting edge allergy testing available, and is not performed by all allergists. It is a blood test that is used in combination with skin testing that allows for more specific diagnosis of food allergies. In combination with skin testing, allergy component testing allows for improved determination of specific type of food allergy present, and can offer more options for treatment.

Patch testing

This is a convenient and simple test to help diagnose allergic contact dermatitis by identifying the causative agent(s). Sticky patches are applied to the skin on the upper back and contain various common chemicals found in household and work environments. A positive test reaction will look like a red patch and is sometimes itchy. Patch testing requires 3 office visits in one week. Test allergens will be applied to the upper back on the day of the 1st visit, and removed after 48 hours (2nd visit). A delayed reading is typically done 48 hours thereafter (3rd visit). Patients are often tested with a standard set of allergens, that account for over 70% of contact allergens. Patients are also encouraged to bring in their own products used at home, which can also be tested for concurrently.

To prevent excessive sweating please refrain from exercising, performing hard work, taking a shower or hot bath. The patch test area must remain dry.

Do not take oral steroid medications within 2 weeks prior to testing.

Spirometry (Lung function testing)

This test records detailed measurements of a patient’s lung function and is used in assessing asthma and emphysema/COPD. Often, a medication such as albuterol is given to assess for improvement after the medication is given.

Allergen Immunotherapy (allergy shots)

This treatment involves administering increasing doses of allergens to which a patient is allergic. This therapy causes the immune system to become less sensitive to the allergens over time. When exposed to the allergens in the future, the patient’s allergy symptoms are often significantly less. Trees, weeds, grasses, furry animals (cat, dog), dust mite, mold, and insect venom allergens can be used in immunotherapy.

Penicillin allergy testing and drug challenges

Penicillin allergies are often overdiagnosed and many patients report a penicillin allergy that has never been confirmed.  A misdiagnosed penicillin allergy may result in the use of less appropriate or more expensive antibiotics of broader spectrum, leading to more potential side effects and increased resistance.  Most patients with a history of possible reactions to penicillin can safely take them because they were either not truly allergic in the first place or they have grown out of the allergy with age.  Penicillin testing and drug challenges are excellent ways to know for certain, and allows for treatment with the most appropriate antibiotic choices when needed.

The testing procedure is a three phase test, that begins with skin prick testing. A small amount of the components of Penicillin being tested are placed on the skin, often on the forearm or upper back. The skin is gently pricked to introduce the allergen under the skin, and the skin is observed for any reaction. Results are usually obtained within 15 minutes. As long as the initial skin prick test is negative, the second phase of testing is an intradermal test, which is more sensitive and helps to rule out false negative results from the initial skin test. Intradermal testing involves an injection of a small amount of medication into the layer of skin called the dermis, and the skin is observed for any reaction. Results are usually obtained within 20 minutes. The final phase of testing, which rules out Penicillin allergy is an ingestion challenge with Amoxicillin. Patients are observed for a period of time after ingestion, usually 30 to 60 minutes depending on the severity of initial reaction. After completion of the ingestion challenge, the test is complete.

Open food challenge

An open food challenge is a highly accurate diagnostic test for food allergy, and is performed by an experienced allergist.  Food challenges are very safe when performed in the right setting; however, emergency medications are always available in the rare case of an allergic reaction.  During the food challenge, the suspect food is ingested in gradually increasing increments with interval periods of observation, and if there are no symptoms, gradually increasingly larger doses are ingested.  With any sign of a reaction, the food challenge is stopped.  When reactions occur, they are mostly mild, such as flushing or hives, and severe reactions are very uncommon.

Biologic medication administration

Multiple biologic medications used for the treatment of asthma, chronic urticaria (hives), and moderate to severe atopic dermatitis are administered in our office including Xolair (omalizumab), Nucala (mepolizumab), Fasenra (benralizumab), and Dupixent (dupilumab).