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 testing?
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

Source: https://www.springfieldclinic.com/Portals/0/ForPts/services/Allergy/PDFs/9345SKIN_TEST_INFO_AND_CONSENTrevApril_9_2010.pdf