Category: Patient Procedures

• ANTIBIOTIC SENSITIVITY TESTING: Penicillin allergy is the most commonly reported antibiotic allergy. In fact, penicillin allergy is reported to affect approximately 10% of the U.S. population. Confirming or ruling out true penicillin allergy is very important for future antibiotic treatment options.

Negating true penicillin allergy may allow for treatment with more cost-effective drugs and help to combat drug resistance in the community. For penicillin testing in particular, we now have the FDA-approved Pre-Pen® test available which is easy, safe, and can be completed in approximately 1 hr. Following this testing, patients with negative skin test results are challenged, in our office, with oral penicillin or amoxicillin and observed for one hour to confirm their ability to tolerate the drug. In addition to penicillin testing, we also have the capability to assess other classes of antibiotics as well.

• ALLERGEN PATCH TESTING: Patch testing is a test for a skin reaction or rash which is also called a hypersensitivity reaction. Patch testing can be done for a number of different substances including metals, fragrances, preservatives and other chemicals.

This reaction is a delayed-type hypersensitivity reaction which will occur on the skin due to contact with the allergen. Patch testing is a reliable and easy test designed to assist in identifying substances found in commonly used products such as makeup, aftershave, shampoo, jewelry, medications, medical appliances, clothing, cleaning supplies, paper/ink, disinfectants, and construction materials. Our standard patch test can identify up to 33 different materials as possible allergens. Some examples of specific allergens that may be identified include Nickel, fragrance, thimersol, formaldehyde, thiuram, and paraben. The test is applied to the skin in the form of a sticker or patch (usually on a patient’s back) and is then read at 48 hrs and at 96 hours to check for reactions. Once an allergen is identified, avoidance of this agent is curative.

• INGESTION CHALLENGE: Often specific foods or prescription drugs are suspected of triggering symptoms which can range from classic hives and facial swelling to vomiting or diarrhea. For the appropriate patient we are able to test or challenge the patient to a specific food or medication in a safe environment by using a graded dosing protocol.

Skin testing initially may be performed, followed by controlled ingestion of increasing amounts of the suspected substance while under careful observation. Ingestion challenges can be performed with one food item at a time– a good example would be almonds. Ingestion challenges may also be done with antibiotics if this is the item in question. These challenges may be very helpful in expanding the diet of someone with multiple food allergies, or expanding the drug options of someone with multiple drug allergies.

• EXERCISE CHALLENGE: This is a test to determine how physical exertion might affect the way you breath.

Exercise-induced asthma (EIA) is a common disease and exercise is a common trigger for patients who have asthma. Exercise-induced asthma occurs as a result of drying or cooling of the airways during exercise. Lung function testing is performed sequentially both before and after a prescribed exercise protocol which is completed on a treadmill. For the majority of asthmatics, exercise can induce some airway constriction and this test will identify changes in lung function that will rule out or confirm EIA. Additionally, if a patient has a firm diagnosis of EIA, this test may also be used to assess the effectiveness of one’s pretreatment medications in preventing their symptoms. Our test is about 2 hours long and is performed in our office.

• METHACHOLINE INHALATION CHALLENGE: This test is one of the most widely utilized bronchial challenges and is performed to determine if a patient will react with asthma symptoms when challenged. The test is painless and consists of a series of breathing treatments and blowing tests.

The patient will inhale small amounts of a medication mist called methacholine. Each inhalation treatment is followed by a brief physical exam (listening to the lungs) and a blowing test (also called spirometry). If asthma symptoms are seen during this challenge, then the diagnosis of asthma is confirmed. If asthma symptoms are seen, these symptoms will be treated and reversed immediately. Although the goal of the test is to demonstrate asthma, the symptoms seen are usually very mild and do not persist and are not dangerous. This test will show airway hyperresponsiveness which is one of the hallmark features of asthma. Methacholine challenge testing may also be an appropriate way to evaluate the possibility of occupational asthma. Finally, the methacholine challenge may be a test that is required of someone wanting to enter a branch of the armed forces but has a history of lower respiratory symptoms such as cough, wheezing, or shortness of breath.

• IMMUNOTHERAPY (Allergy Injections): Individual patients can be immunized or desensitized to most inhaled aeroallergens that trigger allergy and asthma symptoms. Immunotherapy is relatively painless as it involves only a subcutaneous injection (injected into the layer of fat under the skin, not into the muscle).

Initially, allergy skin testing will be performed. The results of this testing will be the basis for deciding which allergens are included in your individualized immunotherapy protocol. Food allergens are NOT included in allergy injections due to the possibility of causing anaphylaxis. Immunotherapy regimens are usually prescribed for three to five years in duration in order to provide maximum improvement with symptoms. If you have more questions, be sure to speak with your doctor or any of our staff members.

• ALLERGY SKIN TESTS: These tests involve very gentle scratching or pricking of the superfical layer of the skin with purified allergenic extracts and then observation for signs of a local reaction on the skin.

A local reaction might consist of a small hive at the site of the scratch. For certain patients we may need to complete a secondary skin test also known as intradermal testing. This testing involves injecting a small amount of purified allergenic extract under the skin with a very small needle. Positive reactions can determine probability of sensitivity to such items as pollen, animal dander, common mold, house dust, latex, or a variety of common foods. This type of skin testing provokes an immediate-type reaction which is mediated by IgE antibodies and helps in the diagnosis of common ailments such as hay fever and food allergies. This type of skin testing is more sensitive and specific than other forms of testing, as well as less expensive and easier to use.