Allergy testing - skin
Patch tests - allergy; Scratch tests - allergy; Skin tests - allergy; RAST test; Allergic rhinitis - allergy testing; Asthma - allergy testing; Eczema - allergy testing; Hayfever - allergy testing; Dermatitis - allergy testing; Allergy testing; Intradermal allergy testingAllergy skin tests are used to find out which substances cause a person to have an allergic reaction. These substances are called allergens.
Allergic reaction
An allergy is an immune response or reaction to substances that are usually not harmful.
How the Test is Performed
There are three common methods of allergy skin testing.
The skin prick test involves:
- Placing a small amount of substances (allergens) that may be causing your symptoms on the skin, most often on the forearm, upper arm, or back.
- The skin is then pricked so the allergen goes under the skin's surface.
- The health care provider closely watches the skin for swelling and redness or other signs of a reaction. Results are usually seen within 15 to 20 minutes.
Swelling
Swelling is the enlargement of organs, skin, or other body parts. It is caused by a buildup of fluid in the tissues. The extra fluid can lead to a ...
ImageRead Article Now Book Mark Article - Several allergens can be tested at the same time.
Allergens
An allergen is a substance that can cause an allergic reaction. In some people, the immune system recognizes allergens as foreign or dangerous. As ...
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The intradermal skin test involves:
- Injecting a small amount of allergen into the skin.
- The provider then watches for a reaction at the site.
- This test is more likely to be used to find out if you're allergic to bee venom or penicillin. Or it may be used if the skin prick test was negative and the provider still thinks that you're allergic to the allergen.
Patch testing is a method to diagnose the cause of skin reactions that occur after the substance touches the skin:
- Possible allergens are taped to the skin for 48 hours.
- The provider will look at the area in 72 to 96 hours.
How to Prepare for the Test
Before any allergy testing, the provider will ask about:
- Illnesses
- Where you live and work
- Lifestyle
- Foods and eating habits
Allergy medicines can change the results of skin tests. Your provider 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.
You may have symptoms such as itching, a stuffy nose, red watery eyes, or a skin rash if you're allergic to the substance in the test.
In rare cases, people can have a whole-body allergic reaction (called anaphylaxis), which can be life threatening. This usually only occurs with intradermal testing. Your provider will be prepared to treat this serious response.
Anaphylaxis
Anaphylaxis is a life-threatening type of allergic reaction.
Patch tests may be irritating or itchy. These symptoms will go away when the patch tests are removed.
Why the Test is Performed
Allergy tests are done to find out which substances are causing your allergy symptoms.
Your provider may order allergy skin tests if you have:
- Hay fever (allergic rhinitis) and asthma symptoms that are not well controlled with medicine
Allergic rhinitis
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are ...
ImageRead Article Now Book Mark Article - Hives and angioedema
Angioedema
Angioedema is swelling that is similar to hives, but the swelling is under the skin instead of on the surface. Hives are often called welts. They a...
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Food allergies
Food allergies
A food allergy is a type of immune response triggered by eggs, peanuts, milk, shellfish or some other specific food.
ImageRead Article Now Book Mark Article - Skin rashes (dermatitis), in which the skin becomes red, sore, or swollen after contact with the substance
Dermatitis
Contact dermatitis is a condition in which the skin becomes red, sore, or inflamed after direct contact with a substance.
ImageRead Article Now Book Mark Article - Penicillin allergy
- Venom allergy
Allergies to penicillin and related medicines are the only drug allergies that can be tested using skin tests. Skin tests for allergies to other drugs can be dangerous.
The skin prick 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
A negative test result means there were no skin changes in response to the allergen. This negative reaction most often means that you are not allergic to the substance.
In rare cases, a person may have a negative allergy test and still be allergic to the substance.
What Abnormal Results Mean
A positive result means you reacted to a substance. Your provider will see a red, raised area called a wheal.
Often, a positive result means the symptoms you're having are due to exposure to that substance. A stronger response means you are likely more sensitive to the substance.
People can have a positive response to a substance with allergy skin testing, but not have any problems with that substance in everyday life.
Skin tests are usually accurate. But, if the dose of allergen is large, even people who are not allergic will have a positive reaction.
Your provider will consider your symptoms and the results of your skin test to suggest lifestyle changes you can make to avoid substances that may be causing your symptoms.
References
Chiriac AM, Bousquet J, Demoly P. In vivo methods for the study and diagnosis of allergy. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 67.
Homburger HA, Hamilton RG. Allergic diseases. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Philadelphia, PA: Elsevier; 2017:chap 55.
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RAST test - illustration
The RAST (Radioallergosorbent test) is a laboratory test performed on blood. It tests for the amount of specific IgE antibodies in the blood which are present if there is a true allergic reaction.
RAST test
illustration
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Allergy skin prick or scratch test - illustration
One of the most common methods of allergy testing is the scratch test or skin prick test. The test involves placing a small amount of the suspected allergy-causing substance (allergen) on the skin (usually the forearm, upper arm, or the back), and then scratching or pricking the skin so that the allergen is introduced under the skin surface. The skin is observed closely for signs of a reaction, which usually includes swelling and redness of the site. With this test, several suspected allergens can be tested at the same time, and results are usually obtained within about 20 minutes.
Allergy skin prick or scratch test
illustration
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Intradermal allergy test reactions - illustration
Intradermal allergy testing is another method of skin testing to help determine whether an individual is allergic to a specific allergen. The test involves injection of a small amount of the suspected allergen under the surface of the skin. After about 20 minutes the area is examined for a reaction at the site. A typical reaction looks like a small hive with swelling and redness. The intradermal test is more sensitive than the skin prick test and can usually provide more consistent results.
Intradermal allergy test reactions
illustration
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Skin testing - PPD (R arm) and Candida (L) - illustration
The right arm represents a positive reaction to PPD (a skin test for tuberculosis protein). The left arm represents a positive reaction to Candida protein. Candida antigen is tested to determine if the individual's immune system is functioning well; a normal immune system demonstrates a positive reaction.
Skin testing - PPD (R arm) and Candida (L)
illustration
-
RAST test - illustration
The RAST (Radioallergosorbent test) is a laboratory test performed on blood. It tests for the amount of specific IgE antibodies in the blood which are present if there is a true allergic reaction.
RAST test
illustration
-
Allergy skin prick or scratch test - illustration
One of the most common methods of allergy testing is the scratch test or skin prick test. The test involves placing a small amount of the suspected allergy-causing substance (allergen) on the skin (usually the forearm, upper arm, or the back), and then scratching or pricking the skin so that the allergen is introduced under the skin surface. The skin is observed closely for signs of a reaction, which usually includes swelling and redness of the site. With this test, several suspected allergens can be tested at the same time, and results are usually obtained within about 20 minutes.
Allergy skin prick or scratch test
illustration
-
Intradermal allergy test reactions - illustration
Intradermal allergy testing is another method of skin testing to help determine whether an individual is allergic to a specific allergen. The test involves injection of a small amount of the suspected allergen under the surface of the skin. After about 20 minutes the area is examined for a reaction at the site. A typical reaction looks like a small hive with swelling and redness. The intradermal test is more sensitive than the skin prick test and can usually provide more consistent results.
Intradermal allergy test reactions
illustration
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Skin testing - PPD (R arm) and Candida (L) - illustration
The right arm represents a positive reaction to PPD (a skin test for tuberculosis protein). The left arm represents a positive reaction to Candida protein. Candida antigen is tested to determine if the individual's immune system is functioning well; a normal immune system demonstrates a positive reaction.
Skin testing - PPD (R arm) and Candida (L)
illustration
Review Date: 4/17/2022
Reviewed By: Stuart I. Henochowicz, MD, FACP, Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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