Food allergy is a large area of allergy and so has its own FAQ.
Must I stop medications like anti-histamines prior to the allergy testing?
Can babies be tested?
Which allergens can be tested?
I/We are anxious about testing, how can we reduce it?
Do the allergy tests hurt and are they safe?
What emergency and travel plans can we make?
What are food and drug challenges and when, how and where are they performed?
Are there any guidelines regarding schools and allergies?
Is there any followup and support after an appointment?
What is immunotherapy?
I'm pregnant, breastfeeding and concerned about allergy. What can I do?
Where Can I Find More Information About Food Allergy?
Must I Stop Medications like Anti-Histamines Prior to the Allergy Testing?
Yes, if possible, please discontinue anti-histamine medications at least 3 days before your appointment; remember that many children's medicines contain antihistamines, including cough and itch remedies. Antihistamines will only interfere with the results of the Skin Prick Test i.e. not Blood specific-IgE testing. If however, you, or your child is asthmatic, it is important to continue taking the medications. Corticosteroids (inhaled, nasal or oral) will not affect the allergy testing. Antihistamines are common constituents of paediatric medications and contained in many medicines for itch, colic, sleep, car sickness, vomiting, and cough mixtures.
Can babies be treated?
Yes, children of all ages can be tested for allergies (either through a skin test or by specific-IgE blood testing). Whilst negative results in babies less than 3 months old may reflect a lack of prior exposure to the food, positive results suggest that an allergy already exists. This knowledge prevents discovering that your child is allergic only after an allergic reaction. Indeed, the majority of reactions to a food occur when a child is first exposed to it. Positive results may also allow for dietary modification by selecting a hypoallergenic infant formula when breast milk top ups or alternatives are required. Negative results facilitate safe and nutritious dietary expansion. Anxious regarding testing?
I/we are anxious about allergy testing, how can we reduce it?
You may wish to prepare children for the visit by referring to our staff in a personable manner. Dr Du Toit, for example, is often referred to as 'Dr George' or just 'George'. Children like to know that they will first be seen by one of the friendly nurses and then by the Doctor.
After completing the allergy tests, children are rewarded with stickers, and a box of raisin's (if appropriate) - please feel to 'reward' them further! Please feel free to bring along favoured distractions or comforters, for example a teddy bear, toy, DVD or other electronic gizmos.
These tips also apply to adults!
Do the allergy tests hurt and are they safe?
Skin Prick Tests
Skin tests are itchy but - if done correctly - do not hurt. We nearly always perform Skin Prick Testing on the patients arm in order that they can see exactly what is happening to them. It is far more scary if the testing is performed on a child's back. We prepare the test site by drawing on the arm. Depending on the age of the patient, this can result in fun 'works of art' which hopefully resemble the allergen to be tested. Younger children, especially boys, sometimes become frustrated when having their arms held still. During testing, it is essential that the patient is held or seated correctly, this is for everyones comfort and to ensure safe, informative, and extensive testing. Older children sometimes like to help decide which allergens should be tested, they not infrequently seem to ask for 'dog'. Older children sometimes like to 'count down' the tests as they are completed or alternatively make a sound such as 'pop' as each lancet is applied.
Blood IgE Allergy Tests
If blood IgE allergy tests are required, we will nearly always apply a local anaesthetic 'magic cream'. We can do this for both adults and children. This takes about 40 minutes to take effect, so it is best applied early on in the consultation. In younger children, it may be that the application of LA cream is more stressful than having the test done without (especially true if they remember having had the cream applied before).
Reducing Anxiety Associated with Testing
You may wish to prepare children for their testing by referring to staff in a personable manner. Dr Du Toit, for example, is often referred to as 'Dr George' or just 'George'. Children like to know that a friendly nurse will first see them and always like to know the name. We support the #hellomynameis movement. Testing often works better if just a single parents attends, the dynamic with both parents can prove too distracting. After completing allergy tests, children are rewarded with stickers. Bring along favoured distractions or comforters, for example, a teddy bear, toy, DVD or other electronic gizmo, but 'over-distraction' may prove unhelpful. These tips also apply to adults, if you are needle phobic you may lay down during testing to avoid vaso-vagal reactions.
Safety
Both skin and blood testing have excellent safety records. Occasionally, Skin Testing will induce multiple large itchy hives; we will immediately treat this with an antihistamine. Rubbing an allergen into the eye can result in troubling local reactions. Anaphylaxis is described after SPT, but it is extremely rare. Skin testing for medications is more dangerous than testing for foods and aero-allergens. Very occasionally, patients will feel 'faint' due to vasovagal reactions (usually teenage males). Blood testing is also safe, with local mild bleeding and a small haematoma being the only rare complication. Older patients should lay down for the above procedures if they anticipate feeling faint.
What emergency and travel plans can be made?
Dr Du Toit will generate a personalised disease, and age, appropriate emergency plan. While antihistamines are generally sufficient for the treatment of allergic reactions, this may not always be the case. An assessment will therefore be made by Dr Du Toit with regards to the need for an Epipen device in your Emergency Plan.
Dr Du Toit will make use of BSACI approved Emergency Plans.
These popular plans should be copied and issued to carers/teachers... A recent photograph of the patient, and all relevant emergency contact details, should also be entered on the plan. Training in the administration of emergency medication/s will be provided on the day of your appointment. Intramuscular (IM) administration of epinephrine is the primary therapy in the emergency management of more severe reactions (anaphylaxis) that may result from insect bites or stings, foods, drugs, latex, or other allergy triggers. Its efficacy lies in prompt administration after allergen exposure. Self-injectable epinephrine products have been designed for administration within minutes of the onset of symptoms. In children, a parent or other trained personnel may administer these products.
Carry your personalised Emergency Plan with you - this entitles you to fly with medications (may include liquid syrups) and foods, on your person.
Medications must be kept on your person (not in hold).
Consider packing your own food, taking your own liquids.
Carry wet wipes for grubby seats (airline cleaning budgets are now at rock bottom!).
You may wish to seat younger children near the window so that friendly passengers do not touch/feed them as they charge up and down the aisle.
Once boarded, ask head steward to announce that a food/nut allergic passenger is on board and that passengers kindly do not open any nuts during the flight.
Cashew nuts are commonly served as airlines often consider peanut to be the only allergenic nut.
If milk or fish allergic, be cautious of allergen-rich vapours when the hot meals are served.
Be reassured that airlines are generally well stocked wrt to Emergency Medications required for the treatment of Anaphylaxis.
Ascertain the name of a reputable clinic and Allergy Doctor in the city of your destination. Dr Du Toit has good contacts in many European Allergy Centres, as well as Australasia, S. Africa and the USA. Alternatively, obtain the name of an AAAAI allergist practicing in your destination area from the AAAAI Physician Referral System, see - www.aaaai.org/physref
For translation cards for travelling - Food Info Translation
More tips from UK Anaphylaxis Campaign and the AAAAI
Are there any guidelines regarding schools and allergy?
Yes. You can find information from the Anaphylaxis organisation of the UK regarding schools and allergy here.
What is Immunotherapy?
You will find a special section on Sub-Lingual Immunotherapy (SLIT) here.
I'm pregnant, breastfeeding and concerned about allergy. What can I do?
Congratulations on your pregnancy. Genetic makeup is the greatest contributor to allergy or intolerance. However, environmental factors are nonetheless important; this includes both the intrauterine environment and environmental factors affecting the newborn. Dr Du Toit will be happy to discuss with you the latest strategies (dietary, environmental, and medication) for the prevention of food allergies.
In summary, strategies entail a healthy maternal diet rich in antioxidants, low mercury fish oil, and probiotics from the last trimester please. Breast feeding, exclusively for the first 3 months is advised without maternal allergen restriction. Complementary feeding from 3 completed months when baby is hungry and ideally whilst breastfeeding persists. If breastfeeding is not possible, in higher risk scenarios, make use of a recognised hypoallergenic milk please.
You may also wish to refer to Foods Standards Agency advice on Eating during Pregnancy & the NHS guidelines re introducing solids. By contrast, the Australian, Canadian, and USA Pediatric and Allergy Societies all concur that there is no convincing evidence that delaying the introduction of allergenic foods protects babies against food allergies.
With early life allergic symptoms, e.g., troubling reflux, eczema, and food aversion, I would prefer to undertake allergy testing before advising about the introduction of common food allergens, e.g., cow's milk, egg, peanut, tree nuts, kiwi, sesame, soy, and wheat.
Where Can I Find More Information About Food Allergy?
This is a large area of allergy and so has its own FAQ.