Top 7 Questions (and Answers) About Allergy Skin Testing

After antigens are applied to a patient’s back, her skin reacts with bumps and/or wheals — and, possibly, itchiness. After about 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

In our last post, we explained why nearly every doctor should offer allergy skin testing. (If you missed it, click here.) Here are patients’ top seven questions about the test.

1) Should I have an allergy skin test? Allergies cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. If you get any of these symptoms regularly, you should discuss the possibility of allergies with your doctor, who will likely suggest the test and a review of your health history.

2) Can my child have the test? The test is safe for children as well as seniors. In fact, it is appropriate for virtually everyone, with the exception of pregnant women, patients with unexplained episodes of anaphylaxis, patients with active hives or active severe asthma symptoms, and people with significantly suppressed immune systems.

3) What does it test for? AllerVision-affiliated providers test for a wide variety of airborne antigens common to your region of the country — such as pollen from local trees, grasses and molds — as well as molds, dust, animal dander, cockroaches and certain foods. If you suspect allergies to specific foods, your provider may test you separately for those individual items.

4) What happens during the test?  Your provider presses several plastic applicators coated with antigens onto your back. As your skin reacts to certain antigens, you may feel itchiness. After 15 minutes, the provider measures any bumps (or “wheals”) that develop — indicating positive results — and record them. Then he or she cleans your back to relieve any discomfort.

5) Does it hurt? No. You’ll temporarily feel minor pressure from the tines of the testing devices as they’re applied, but they don’t penetrate your skin and they’re specially-designed to prevent pain. Even young children rarely complain. Itching caused by positive results begins to resolve as soon as the antigens are wiped away.

6) Is there anything I need to do to prepare? The most important thing to remember is that you shouldn’t take antihistamines for three days before testing because they can prevent the very reactions your provider needs to see. Also, be sure to inform your provider if you’re pregnant, have asthma, are suffering from severe illness, or have experienced a strong allergic reaction.

7) How long does it take to get results? In just 15 minutes, your doctor will have a clear picture of your allergic reactions so you can plan and begin a treatment program immediately.

 

Exploring the Allergy Roots of Eczema Leads to New Treatment Options

Eczema is a chronic condition that is often associated with allergies. The sharp provider can offer patients several treatment options.

The cold winter months may offer respite for patients with pure pollen allergy, but they are no friend to patients suffering with eczema. Eczema, also known as Atopic Dermatitis, is the classic allergic skin rash. It’s known as “the itch that rashes,” meaning that it is typical for a patient to experience the symptom of itching first and clinical rash next. Atopic dermatitis patients usually have elevated total IgE, which explains why they frequently have comorbid conditions of allergic rhinitis and asthma. The simple treatment for the eczema patient’s symptoms is a prescription for a topical cortisone cream. Cortisone may give the patient temporary relief, but a more comprehensive plan is needed to provide the fundamental disease control that they deserve.

We sometimes forget that the skin is the largest organ in the body.  It covers our entire outer surface. In order to adequately protect that organ, we must provide an emollient that can serve as a barrier to the harsh environment. The good news is these are easy to acquire and they aren’t very expensive. My professor of allergy and dermatology at Columbia Presbyterian Medical Center extolled the benefits of baby oil. Yes, good old fashioned baby oil just after a shower, when the skin pores are wide open, can provide a nice general coating for the skin. In areas of severe dryness or broken skin resulting from the eczema, plain Vaseline or Aquaphor lotion is helpful. Vaseline may be sticky and messy but it’s effective. When we had patients on the dermatology ward with severe rashes, the nurses coated them with Vaseline — it was very soothing and therapeutic.

Cortisone creams are an important element in the treatment regimen, but they should be targeted to the affected areas. It is very important to show the patient how to apply the cream; they must see how to massage it in coin size amounts to the local areas of redness. If they just lightly smear tons of cream over the body, absorption — and therefore effectiveness — is limited. I usually find that a mid-potency steroid cream, such as Mometasone is effective. However, you should use only low potency hydrocortisone (1 or 2.5%) on the face due to the risk of atrophy with the mid-potency preparations. The other important ointment in the treatment spectrum is Muciprin, which contains an antibacterial agent that helps reduce the growth of Staph.aureus on the affected skin areas. Muciprin should be applied to broken skin areas that are oozing with fluid.

The above steps are familiar to most doctors. Now, comes the expert territory. Even dermatologists are a bit lax when pursuing the underlying cause of eczema. Numerous studies show that atopic dermatitis is worse in children with food or environmental allergies — especially to dust mites. It’s important to take a thorough history on these patients and perform an allergy test to see if an allergen exacerbates the condition. Dr. Hugh Sampson, when he was at Johns Hopkins, demonstrated that 50% of children with eczema had food allergies. The studies further showed that eliminating these foods from the children’s diet caused improvement of the eczema. This was ground-breaking information in the late 1990s — now it’s recognized as a standard of care. The AllerVision allergy skin test panel of standard foods is a good place to start your evaluation. AllerVision also offers an additional food panel that allows you to test for 40 individual foods; it’s an excellent way to augment your program.

Exciting new areas of research into eczema treatment indicate that enhancing immunity may provide significant benefit to the patient. The latest studies from Harvard suggest that supplementing with Vitamin D3 can help control patients’ eczema and decrease reliance on topical corticosteroids. As a result, I have recommended supplementation with Vitamin D3 in the ranges of 1,000- 3,000 units daily for all of my eczema patients. I prefer the liquid Vitamin D3 over pills, as the pills can be difficult to swallow. Following your patients’ D3 level along the course of eczema treatment can provide interesting information regarding management.

Finally, it’s worth noting that studies substantiate the value of sublingual allergy immunotherapy (allergy drops) for patients with mild to moderate atopic dermatitis. Specifically data has shown that dust mite allergy, which is associated with aggravating atopic dermatitis, can be treated effectively with sublingual allergy immunotherapy. The same has not been demonstrated with subcutaneous injection immunotherapy.

Once you determine — though medical history and allergy testing — the root of the eczema, you can determine which of these treatments can take the itch out of your patient’s lives.

– Dr. Dean Mitchell