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Allergy testing
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/003519.htm

Allergy tests are any of several tests used to determine the substances to which a person is allergic.

How the Test is Performed

There are many methods of allergy testing. Among the more common are:

Skin tests
Elimination-type tests
Blood tests (including the radioallergosorbent, or RAST, test)

SKIN TESTS

Skin tests are the most common. Specific methods vary.

One of the most common methods is the prick test. This test involves placing a small amount of suspected allergy-
causing substances on the skin, usually the forearm, upper arm, or the back. Then, the skin is pricked so the
allergen goes under the skin's surface. The health care provider closely watches the skin for signs of a reaction,
usually swelling and redness of the site. Results are usually seen within 15-20 minutes. Several allergens can be
tested at the same time.

A similar method involves injecting a small amount of allergen into the skin and watching for a reaction at the site.
This is called an intradermal skin test. It is more likely to be used when testing is being done to find out if you are
allergy to something specific, such as bee venom or penicillin.

Patch testing is a method to diagnose allergic reactions on the skin. Possible allergens are taped to the skin for 48
hours. The health care provider will look at the area in 24 hours, and then again 48 hours later.

Skin tests are most useful for diagnosing:

Food allergy
Mold, pollen, animal, and other allergies that cause allergic rhinitis and asthma
Penicillin allergy*
Venom allergy
Allergic contact dermatitis

ELIMINATION TESTS

An elimination diet can be used to check for food allergies. An elimination diet is one in which foods that may be
causing symptoms are removed from the diet for several weeks and then slowly re-introduced one at a time while the
person is watched for signs of an allergic reaction.

BLOOD TESTS

Blood tests can be done to measure the amount of immunoglobulin (Ig) E antibodies to a specific allergen in the
blood. This test may be used when skin testing is not helpful or cannot be done

Other blood tests include:

Absolute eosinophil count

Total IgE level

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PROVOCATION

Provocation (challenge) testing involves exposing a person to a suspected allergen under controlled circumstances.
This may be done in the diet or by breathing in the suspected allergen. This type of test may provoke severe allergic
reactions. Challenge testing should only be done by a doctor.

Another method is the double-blind test. This method involves giving foods and harmless substances in a disguised
form. The person being tested and the provider are both unaware of whether the substance tested in that session is
the harmless substance or the suspected food. A third party knows the identity of the substances and identifies
them with some sort of code. This test requires several sessions if more than one substance is under investigation.

While the double-blind strategy is useful and practical for mild allergic reactions, it must be done carefully in
individuals with suspected severe reactions to foods. Blood tests may be a safer first approach.

How to Prepare for the Test

Before any allergy testing, the health care provider will ask for a very detailed medical history. This may include
questions about such things as illnesses, emotional and social conditions, work, entertainment, lifestyle, foods, and
eating habits.

If skin testing will be performed, you should NOT take antihistamines before the test. This may lead to a false-
negative result, falsely reassuring you that a substance is unlikely to cause a severe allergic reaction. Your doctor
will tell you which medicines to avoid and when to stop taking them before the test.

How the Test Will Feel

Skin tests may cause very mild discomfort when the skin is pricked. Itching may occur if you have a positive reaction
to the allergen.

Why the Test is Performed

Allergy tests are done to determine the specific substances that cause an allergic reaction in a person.

Your doctor may order allergy tests if you have:

Allergic rhinitis and asthma symptoms that are not easily controlled with medications
Angioedema and hives
Food allergies
Contact dermatitis
Penicillin allergy*

*NOTE: Allergies to penicillin and closely related medications are the only drug allergies that can be tested using
skin tests. Skin tests for allergies to other drugs can be dangerous.

The prick skin test may also be used to diagnose food allergies. Intradermal tests are not used to test for food
allergies because of high false positive results and the danger of causing a severe allergic reaction.

Normal Results
In a nonallergic person, allergy tests should be negative (no response to the allergen).

What Abnormal Results Mean

A positive result means you reacted to a specific substance. Often, but not always, a positive result means the
symptoms that you are having are due to exposure to the substance in question. In general, a stronger response
means you are more sensitive to the substance.

People can have a positive response with allergy skin testing, but not have any problems with the specific substance

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in every day life.

The skin tests are generally reliable. However, if the dose of allergen is excessive, a positive reaction will occur even
in persons who are not allergic.

Risks
Risks related to skin and food allergy tests may include:

Allergic reaction
Life-threatening anaphylactic reaction

Considerations
The accuracy of allergy testing varies quite a bit. Even the same test performed at different times on a person may
give different results. A person may react to a substance during testing, but never react during normal exposure.
Rarely, a person may also have a negative allergy test and still be allergic to the substance.

Alternative Names
Patch tests - allergy; Scratch tests - allergy; Skin tests - allergy; RAST test

References
Bernstein IL, Li JT, Bernstein DI, Hamilton R, et al. American Academy of Allergy, Asthma and Immunology;
American College of Allergy, Asthma and Immunology. Allergy diagnostic testing: an updated practice parameter.
Ann Allergy Asthma Immunol. 2008 Mar;100(3 Suppl 3):S1-148.

Demoly P, Bousquet J, Romano A. In vivo methods for the study of allergy. In: Adkinson NF Jr, ed. Middleton’s
Allergy: Principles and Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 71.

Gober MD, DeCapite TJ, Gaspari AA. Contact dermatitis. In: Adkinson NF Jr, ed. Middleton’s Allergy: Principles and
Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 63.

Update Date: 6/29/2010

Updated by: Paula J. Busse, MD, Assistant Professor of Medicine, Division of Clinical Immunology, Mount Sinai
School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve,
MD, MHA, Medical Director, A.D.A.M., Inc.

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