Microsoft word - 9345skin_test_info_and_consentrevapril_9_2010.doc
Dr. D. Siri, FAAAAI, FACAAI Dr. R. Govindaiah Dr. E. Pratt
Allergy Skin Test Info
rmation and Instructions
What is skin testing?
If you suspect that a particular allergen (for
Skin testing is a rapid way to detect if you are
allergic to an inhalant or food. It is more sensitive
provoking your symptoms, please inform the
and economical than allergy blood tests.
Specifically, it tests for the presence of allergic
If indicated, you may be scheduled to return for
further testing for specific allergens (for example,
What are some of the indications for skin
extended inhalants, antibiotics, anesthetics, insect
What are the risks?
You may experience anxiety, skin irritation with
local itching and swelling, and minor bleeding.
Local irritation of the skin usually subsides after 1-2
hours. Excessive itching may be treated with oral
anti-histamines or a topical spray or cream.
Occasionally, a delayed local reaction may occur at
the site of skin testing. This usually occurs several
How is it performed? No Scratches!
hours after testing and may last for days to a week.
Disposable one-time use plastic devices will be
These reactions are usually not serious and will
used to introduce small amounts of potential
disappear radually over the next week. Excessive
allergens into your skin (PRICK TEST) to detect if
warmth or lack of improvement may indicate a mild
you might be allergic to that particular allergen. We
skin infection. The reaction should be measured
may perform the skin test on the backs and arms.
A similar plastic testing device with multiple prongs
On rare occasions, very sensitive (allergic) persons
may be used on small children to make the testing
may experience a severe systemic reaction called
anaphylaxis. Symptoms may include increased
itching of eyes, nose, face, or body, increased
Prick testing may be followed by SELECTED
sneezing or runny nose, congestion, throat or chest
INTRADERMAL TESTING, which involves injection
tightness, wheezing, lightheadedness, nausea and
of potential allergens into the skin with very small
vomiting, hives, profound anxiety, and shock.
syringes. This testing is more sensitive than the
Anaphylaxis may be life threatening if not treated
Prick Test. Allergy to a particular allergen usually
cannot be excluded unless intra-dermal testing is
Our physicians and staff are fully trained in the
treatment of mild to severe reactions including,
How long will the skin testing take?
anaphylaxis, and we take the utmost care in
Skin testing and the follow-up visit with the doctor
ensuring your safety. For this reason, if you are
having a worsening of your asthma, fever, or an
active infection, we may defer your skin testing
What allergens might be tested?
procedure to a later date. Please call if you think
How will I know if I am allergic to something
Please STOP these medicines FOURTEEN DAYS
PRIOR to your skin test day. Please consult with
The skin will swell up and itch, like a hive. Positive
and negative controls are used in the skin testing
panel in which to compare the tested allergens. We
note the size and grade of your reactions to
determine what allergies might exist. Based on
your history, symptoms, exam, and skin test results,
Dr. Siri, Dr. Pratt or Dr. Govindaiah, who are
specialty trained in allergy and immunology, will
assist you in determining what you might be allergic
Let the staff know if you have taken any anti-
histamines prior to your skin test. It may still be
possible to skin test your even if you have taken
What should I do to prepare for the skin test?
Antihistamine and other medicines may block the
histamine response, making skin test results
Please inform the nurse if you:
Are or think you might be PREGNANT.
Are taking a medication or an eye drop
that is in the BETA-BLOCKER class.
These medicines are usually used to
treat high blood pressure or glaucoma.
(Examples, carvedilol, propanolol,
atenolol, timolol eye drops, etc.)
Are taking an MAO INHIBITOR.
Please DO CONTINUE
taking inhaler medicines for
asthma, oral steroids, steroid nasal sprays and
other medicines that are not anti-histamines.
PHENYLEPHRINE, are fine to take for temporary
relief while you are off anti-histamines. If you have
asthma, a breathing test or peak flow measurement
Please STOP these medicines SEVEN to TEN
may be taken before proceeding with the test.
Your arms and back should be clean and free of
lotions or cosmetics. Please do not wear
perfumes or fragrances on the day of testing.
After the skin test.
immediately. You may take Benadryl or another
antihistamine to relieve discomfort if needed.
Topical steroids may also be used to relieve
discomfort. Please wash and cleanse your skin as
usual. Please abstain from any vigorous activity for
All over-the-counter medicines for cough,
cold, and allergy. These drugs often contain antihistamines, such as: ACTIFED, ALLEREST, BROPHENIRAMINE, CLORPHENIRAMINE, CHLORTRIMETON, CONTAC, DIMETAPP, DRISTAN, DRIXORAL, DURAHIST, D’ALLERGY, ROBITUSSIN, RYNATAN, NYTOL, NYQUIL, TYLENOL PM, TAVIST, TRIAMINIC, TYLENOL SINUS, EQUATE allergy, WAL-ITIN, etc.
Dr. D. Siri, FAAAAI, FACAAI Dr. R. Govindaiah Dr. E. Pratt
Please detach this form to give to the Allergy Office.
CONSENT FOR SKIN TESTING
I have read the information sheet on allergy testing and understand it.
I have been provided the opportunity to ask questions regarding the testing, indications, risks and these
questions have been answered to my satisfaction.
I understand that every precaution consistent with best medical practice will be carried out to protect me
against such reactions.
I consent to the skin testing procedure.
Patient (or PARENT if patient is a minor)
_________________________________________________ ________________________ Witness
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