About Skin Testing: Skin tests are methods of testing for allergic antibodies. A test consists of introducing small amounts of the suspected substance, or allergen, into the skin and noting the development of a positive reaction (which consists of a wheal, swelling, or flare in the surrounding area of redness). The results are read at 5 to 10 minutes after the application of the allergen. The skin test method we use is called the intradermal method.

About the Intradermal Method: This method consists of injecting small amounts of an allergen into the superficial layers of the skin. Interpreting the clinical significance of skin tests requires skillful correlation of the test results with the patient’s clinical history. Positive tests indicate the presence of allergic antibodies and are not necessarily correlated with clinical symptoms.

You will be tested to important airborne allergens and possibly foods. These include, trees, grasses, weeds, molds, dust mites, and animal danders and, possibly some foods. The skin testing generally takes 3 or more hours, depending on your sensitivity to testing, and may take multiple appointments to complete. Intradermal testing is usually performed on the arm but may be done on the back or leg if required. If you have a specific allergic sensitivity to one of the allergens, a red, raised, itchy bump (caused by histamine release into the skin) will appear on your skin within 5 to 10 minutes. These positive reactions will gradually disappear over a period of 30 to 60 minutes, and, typically, no treatment is necessary for this itchiness. Occasionally local swelling at a test site will begin 4 to 8 hours after the skin tests are applied, particularly at sites of intradermal testing. These reactions are not serious and will disappear over the next week or so. They should be measured and reported to your physician at your next visit. You may be scheduled for skin testing to antibiotics, vaccines, venoms, or other biological agents. The same guidelines apply.

Skin testing will be administered at this medical facility with a medical physician or other health care professional present since occasional reactions may require immediate therapy. These reactions may consist of any or all of the following symptoms: itchy eyes, nose, or throat; nasal congestion; runny nose; tightness in the throat or chest; increased wheezing; lightheadedness; faintness; nausea and vomiting; hives; generalized itching; and shock, the latter under extreme circumstances. Please let the physician and nurse know if you are pregnant or taking betablockers. Allergy skin testing may be postponed until after the pregnancy in the unlikely event of a reactions to the allergy testing and beta-blockers are medications they may make the treatment of the reaction to skin testing more difficult. 

Please note that these reactions rarely occur but in the event a reaction would occur, the staff is fully trained, and emergency equipment is available.

After skin testing, you will consult with your physician or other health care professional who will make further recommendations regarding your treatment. 

Allergy Shots:
Allergen immunotherapy injections or “allergy shots” are prescribed for patients with allergic rhinitis (hay fever), allergic asthma, other allergic problems, or life-threatening reactions to insect stings. Immunotherapy is the only medical treatment that could potentially modify allergic disease. Some studies have shown that it may have a preventive role in allergic children, possibly preventing asthma from developing in some patients with allergic rhinitis. Immunotherapy would be considered for individuals, who have moderate or severe symptoms not adequately controlled by environmental control measures and/or medications.

Effectiveness
Allergen immunotherapy (allergy shots) may “turn down” allergic reactions to common allergens including pollens, molds, animal dander and dust mites. In most cases, the initial 6 to 12 month course of allergy shots is likely to gradually decrease sensitivity to airborne allergens and continuation of injections leads to further improvement. The injections do not cure patients but diminish sensitivities, resulting in fewer symptoms and use of fewer medications. It is important to maintain shots at the proper time interval; missing your shots for a short time may be acceptable but an appropriate adjustment in the dose of vaccine may be necessary for long lapses in injections. Please see us if you miss receiving your injections for longer than what is recommended for your current vial.

How long are shots given?
There are generally two phases to immunotherapy: a build-up phase and a maintenance phase

• Build-up phase: involves receiving injections with increasing amounts of the allergens. The frequency of injections during this phase generally ranges from 1 to 2 times a week, though more rapid build-up schedules are sometimes used. The duration of this phase depends on the frequency of the injections but generally ranges from 3 to 6 months (at a frequency of 2 times and 1 time a week, respectively).
• Maintenance phase: This phase begins when the effective therapeutic dose is reached. The effective therapeutic dose is based on recommendations from a national collaborative committee called the Joint Task Force for Practice Parameters: Allergen Immunotherapy: A Practice Parameter and was determined after review of a number of published studies on immunotherapy. The effective maintenance dose may be individualized for a particular person based on their degree of sensitivity (how ‘allergic they are’ to the allergens in their vaccine) and their response to the immunotherapy build-up phase. Once the target maintenance dose is reached, the intervals between the allergy injections can be increased.
  
  The intervals between maintenance immunotherapy injections generally ranges from every 2 to every 4 weeks but should be individualized to provide the best combination of effectiveness and safety for each person. Shorter intervals between allergy injections may lead to fewer reactions and greater benefit in some people and some individuals may tolerate intervals longer than four weeks between injections.

Reactions to allergy injections
It is possible to have an allergic reaction to the allergy injection itself. Reactions can be local (swelling at the injection site) or systemic (affecting the rest of the body). Systemic reactions include hay fever type symptoms, hives, flushing, lightheadedness, and/or asthma, and rarely, life threatening reactions. Some conditions can make allergic reactions to the injections more likely: heavy natural exposure to pollen during a pollen season and exercise after an injection. Serious systemic reactions can occur in patients with asthma that has worsened and is not well controlled on recommended medications. Therefore, if you have noted worsening of your asthma symptoms, notify your nurse or physician before receiving your scheduled injections! Reactions to injections can occur, however, even in the absence of these conditions.

Please inform the staff if you have been diagnosed with a new medical condition or prescribed any new medications since your last visit. If any symptoms occur immediately or within hours of your injection, please inform the staff before you receive your next injection.  

DO NOT

1. No prescription or over the counter oral antihistamines should be used 4 to 5 days prior to scheduled skin testing. These include cold tablets, sinus tablets, hay fever medications, or oral treatments for itchy skin, over the counter allergy medications, such as Claritin, Zyrtec, Allegra, Actifed, Dimetapp, Benedryl, and many others. Prescription antihistamines such as Clarinex and Xyzol should also be stopped at least 5 days prior to testing. If you have any questions whether or not you are using an antihistamine, please ask the nurse or the doctor. In some instances a longer period of time off these medications may be necessary.
   
   
2. You should discontinue your nasal and eye antihistamine medications, such as Patanase, Pataday, Astepro, Optivar, or Astelin at least 2 days before the testing. In some instances a longer period of time off these medications may be necessary. If you have any questions whether or not you are using an antihistamine, lease please asks the nurse or the doctor. In some instances a longer period of time off these medications may be necessary.
   
   
3. Medications such as over the counter sleeping medications (e.g. Tylenol PM) and other prescribed drugs, such as amytriptyline hydrochloride (Elavil), hydroxyzine (Atarax), doxepin (Sinequan), and imipramine (Tofranil) have antihistaminic activity and should be discontinued at least 2 weeks prior to receiving skin test after consultation with your physician. Please make the doctor or nurse aware of the fact that you are taking these medications so that you may be advised as to how long prior to testing you should stop taking them.

YOU MAY

1. You may continue to use your intranasal allergy sprays such as Flonase Rhinocort, Nasonex, Nasacort. Omnaris, Veramyst and Nasarel.
   
   
2. Asthma inhalers (inhaled steroids and bronchodilators), leukotriene antagonist s (e.g. Singulair, Accolate) and oral theophylline (Theo-Dur, T-Phyl, Uniphyl, Theo-24, etc.) do not interfere with skin testing and should be used as prescribed.
   
   
3. Most drugs do not interfere with skin testing but make certain that your physician and nurse know about every drug you are taking (bring a list if necessary).