What Are Allergies?
An allergy is an abnormal immune system reaction to something that is typically harmless to the average person.
When you have an allergic reaction, your immune system mistakenly believes that substance is harmful to your body. In reaction to the substance, the body produces an antibody called IgE, which in turn causes cells in the body to release a chemical into the bloodstream called histamines. There are several substances that can cause an allergic reaction, but the most common are: certain foods, plant pollen, dust and mold, pet dander, insect bites, and medicines.
An allergy specialist, called an allergist, can run tests by either testing blood samples, or by conducting a skin test. A skin test, or skin prick test, involves pricking the skin (typically on the arms or back) and exposing the skin to small amounts of the proteins found in the potential allergens. If you develop a hive (raised red bump) at the test location you are showing an allergic reaction.
Read more about allergies.
Your family practitioner may recommend you see an allergist if your allergies persist after using over-the-counter anti-histamines, or if they become severe.
What to Expect Before Your Allergist Visit:
Going to an allergist the first time can seem scary. You've heard about the skin prick test, and you've heard they'll be exposing you to known potential allergens. So what exactly does this mean, and how can you prepare for it?
As with most doctor visits, there are a few things you can do to prepare for your appointment. In fact, your allergist may even instruct you to follow a few key steps before your first appointment.
If you are on allergy medication, such as anti-histamines, you may be asked to cease taking the medication for a certain number of days prior to the visit. Typically five days is enough time to clear the drug from your system.
You're asked to do this so that the allergy tests will read your body’s natural reaction to various allergens presented. If there are anti-histamines in your system, the test results may not be as accurate which will skew your treatment options.
If your allergies are severe, this can mean a few days of very unpleasant allergy attacks, so plan accordingly. If you can take time off work, it might be a good time to have a stay-cation and hang around the house away from known allergy triggers. Do everything you can to avoid ingesting, inhaling, or touching known allergens while off your medications.
Keep in mind that while it does suck to be off the medications for a few days, accurate test results will be worth it to get the best treatment for your allergies.
You should wear a short sleeve shirt to your appointment as the allergist will either need access to draw blood, or will perform the skin prick test on your forearms. If the test is to be completed on your back, as with children primarily, you will be provided an open back gown to wear if you are female.
If possible, track your allergies and the severity of the attacks or reactions over a period of time. This will help the allergist determine what potential allergens could be the cause of the reactions. If you have reactions within an hour of eating a meal, document all the foods consumed including ingredients if at all possible.
What to Expect During Your Allergist Visit:
When you first arrive at the allergist office you may need to fill out medical forms, regardless of previous forms submitted by your family practitioner. These forms will ask you questions about your medical history, as well as questions about allergic reactions you believe you've experienced.
If you've been tracking your allergy reactions, provide a copy of those notes for the allergist to review before the tests begin. You will spend the first portion of your visit discussing the information you provided, and laying out a plan of action for the tests to be performed that day.
Be prepared to spend several hours at the allergist's office. Even if they tell you it will be shorter when you make the appointment, it could take longer once they begin seeing how you react to the tests.
The blood test is fairly quick as it simply requires a few vials of blood to be drawn, which are then sent off to a lab for examination. However, the skin prick test can take several hours if several panels of allergens are being tested.
Most skin prick tests for adults are performed on the forearms. You will need to have your forearms exposed, resting on a table, and with your palms facing up. A series of numbers will be drawn on your arms indicating which allergen is being tested at each site. A drop of each allergen will be placed by the number, and then with a sterile thin needle, a tiny prick will be done in the center of each allergy protein drop.
You will sit for a length of time, generally ten to fifteen minutes or so, while the allergist waits to see if you have a reaction. If the skin near a test drop begins to swell and turn red, called a hive, it is a sign of an allergic reaction.
Once the first panel is complete, if your skin is not showing reactions you may be able to undergo a second panel next to the first panel on the arms. The same process is repeated for the second panel.
Skin prick tests for children are often performed on the back, as it provides more space to work with. Your child will squirm, but you should try to distract as much as possible to keep the child still during the test. Try a smart phone or other handheld device to keep the child's attention while he or she undergoes the test. Ideally, you do not want the allergen protein drops running as it can skew the results.
When the skin prick test is complete, an alcohol wipe is used to remove the drops and the numbers from your skin. Some allergist offices also provide lotion to sooth your skin after.
When the tests are complete, you will sit down with the allergist again to review the reactions, the severity, and the treatment plan.
Be prepared to take notes during this part of the visit. Ask any and all questions you have, no matter how silly they may seem at the time.
Ask for pamphlets, or recommended reading materials and websites, to conduct further research on your allergens.
What to Expect After Your Allergist Visit:
Allergy tests can take a long time to complete if you're doing several panels at once. Even with a typical reaction to the tests, it can leave you worn out and tired. It’s more difficult than most people realize to sit perfectly still for hours on end waiting for the tests to present a reaction for the allergist to document.
You may also feel dizzy or woozy from having all the allergen proteins introduced to the body en masse. Be prepared for someone else to drive you home after the appointment, as you might find focusing on the road difficult.
This feeling is similar to when donating blood, or when having several vials of blood drawn. It leaves the body a little stressed, but it should pass within a few hours (on average).
When you leave the allergist’s office, you usually have an idea of what you are allergic to according to the skin prick tests. If conducting a blood based test, you will receive the results within a week or two. Your allergist will help you decide on a game plan to treat the allergies including removing allergies from your diet, for food based allergies, or with medication.
You may be surprised by what you are allergic to. You may find new allergies you didn’t know you had. You might even find out you are allergic to the family pet. Before making any rash decisions, begin researching what steps you can take to prevent allergic reactions to your now known allergens.
You may be given a prescription to carry an epinephrine pen, or epi-pen, if your allergies are severe, or can cause a severe reaction.
Epi-pens generally come in a two pack, and often include a tester pen that doesn't have the needle inside. Read the instructions on how the pen works, and use the practice tester pen before you ever need to use it in a real life situation. Keep the pens in easy to reach locations in areas where you are most likely to come into contact with the allergen.
The key to remember for an epi-pen is that you will remove the cap, then stab it forcefully and HOLD in the thigh for several seconds. This allows the medicine to inject in properly. An epi-pen has only one shot to be used, so once the trigger has been released there is no do-over. The needle is sharp enough to go through most materials such as jeans, so don't bother wasting time with removing clothing.
The epi-pen is used in the thigh, because it’s one of the thickest and fattiest parts of the body. The needle will hurt less in the thigh than other areas of the body, and will allow the epinephrine to reach the blood stream faster.
Complications of an Allergist Appointment:
On rare occasions a skin prick test can result in an extreme allergic reaction. The allergist, and all medical assistants, are equipped and prepared for such a reaction and therefore you have nothing to worry about.
Should you react poorly to an allergen and begin to go into anaphylactic shock, the allergist or medical assistant will immediately inject you with an epi-pen. Again, this is extremely rare but can occur. If you require an epi-pen injection during your test, the allergist then will ride with you via ambulance to the nearest hospital for follow up treatment to ensure the attack does not further develop.
For allergens know for severe reaction, such as wasp or bee stings, the allergy test will be conducted in a hospital with additional staff on site to ensure your safety.
Maintaining Your Allergies Post Visit:
Once you have seen your allergist and you begin treatment, this is not the end. You should see your allergist on a regular basis just as you should with your family practitioner. Your allergies can shift with time, and you can develop new allergies as well.
If your treatment is working, then you should follow the recommended visit plan per your allergist. If you begin to have additional allergic reactions in spite of your treatment, you should schedule a new appointment right away to adjust your treatment.