Considering skin testing for your allergies? Learn about the risks, results and what to expect during testing.
During allergy skin tests, your skin is exposed to suspected allergy-causing substances (allergens) and is then observed for signs of an allergic reaction.
Along with your medical history, allergy tests may be able to confirm whether a particular substance you touch, breathe or eat is causing symptoms.
Information from allergy tests may help your doctor develop an allergy treatment plan that includes allergen avoidance, medications or allergy shots (immunotherapy).
Allergy skin tests are widely used to help diagnose allergic conditions, including:
Skin tests are generally safe for adults and children of all ages, including infants. In certain circumstances, though, skin tests aren't recommended. Your doctor may advise against skin testing if you:
Blood tests (in vitro immunoglobulin E antibody tests) can be useful for those who shouldn't or can't undergo skin tests. Blood tests aren't used for penicillin allergy.
In general, allergy skin tests are reliable for diagnosing allergies to airborne substances, such as pollen, pet dander and dust mites. Skin testing may help diagnose food allergies. But because food allergies can be complex, you may need additional tests or procedures.
The most common side effect of skin testing is slightly swollen, red, itchy bumps (wheals). These wheals may be most noticeable during the test. In some people, though, an area of swelling, redness and itching may develop a few hours after the test and remain for a couple of days.
Rarely, allergy skin tests can produce a severe, immediate allergic reaction, so it's important to have skin tests performed at an office where appropriate emergency equipment and medications are available.
Before recommending a skin test, your doctor will ask you detailed questions about your medical history, your signs and symptoms, and your usual way of treating them. Your answers can help your doctor determine if allergies run in your family and if an allergic reaction is most likely causing your symptoms. Your doctor may also perform a physical examination to search for additional clues about the cause of your signs and symptoms.
Before scheduling a skin test, bring your doctor a list of all of your prescription and over-the-counter medications. Some medications can suppress allergic reactions, preventing the skin testing from giving accurate results. Other medications may increase your risk of developing a severe allergic reaction during a test.
Because medications clear out of your system at different rates, your doctor may ask that you stop taking certain medications for up to 10 days. Medications that can interfere with skin tests include:
Skin testing is usually done at a doctor's office. A nurse generally administers the test, and a doctor interprets the results. Typically, this test takes about 20 to 40 minutes. Some tests detect immediate allergic reactions, which develop within minutes of exposure to an allergen. Other tests detect delayed allergic reactions, which develop over a period of several days.
A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites and foods. In adults, the test is usually done on the forearm. Children may be tested on the upper back.
Allergy skin tests aren't painful. This type of testing uses needles (lancets) that barely penetrate the skin's surface. You won't bleed or feel more than mild, momentary discomfort.
After cleaning the test site with alcohol, the nurse draws small marks on your skin and applies a drop of allergen extract next to each mark. He or she then uses a lancet to prick the extracts into the skin's surface. A new lancet is used for each allergen.
To see if your skin is reacting normally, two additional substances are scratched into your skin's surface:
About 15 minutes after the skin pricks, the nurse observes your skin for signs of allergic reactions. If you are allergic to one of the substances tested, you'll develop a raised, red, itchy bump (wheal) that may look like a mosquito bite. The nurse will then measure the bump's size and record the results. Next, he or she will clean your skin with alcohol to remove the marks.
You may need a test that uses a needle to inject a small amount of allergen extract just into the skin on your arm (intradermal test). The injection site is examined after about 15 minutes for signs of an allergic reaction. Your doctor may recommend this test to check for an allergy to insect venom or penicillin.
Patch testing is generally done to see whether a particular substance is causing allergic skin inflammation (contact dermatitis). Patch tests can detect delayed allergic reactions, which can take several days to develop.
Patch tests don't use needles. Instead, allergens are applied to patches, which are then placed on your skin. During a patch test, your skin may be exposed to 20 to 30 extracts of substances that can cause contact dermatitis. These can include latex, medications, fragrances, preservatives, hair dyes, metals and resins.
You wear the patches on your arm or back for 48 hours. During this time, you should avoid bathing and activities that cause heavy sweating. The patches are removed when you return to your doctor's office. Irritated skin at the patch site may indicate an allergy.
A small area of swelling with surrounding redness (arrow) is typical of a positive skin prick test for allergy.
Before you leave your doctor's office, you'll know the results of a skin prick test or an intradermal test. A patch test may take several days or more to produce results.
A positive skin test means that you may be allergic to a particular substance. Bigger wheals usually indicate a greater degree of sensitivity. A negative skin test means that you probably aren't allergic to a particular allergen.
Keep in mind, skin tests aren't always accurate. They sometimes indicate an allergy when there isn't one (false-positive), or skin testing may not trigger a reaction when you're exposed to something that you are allergic to (false-negative). You may react differently to the same test performed on different occasions. Or you may react positively to a substance during a test but not react to it in everyday life.
Your allergy treatment plan may include medications, immunotherapy, changes to your work or home environment, or dietary changes. Ask your doctor to explain anything about your diagnosis or treatment that you don't understand. With test results that identify your allergens and a treatment plan to help you take control, you'll be able to reduce or eliminate allergy signs and symptoms.