Which Allergy Tests Are Right for Your Child?
A frantic trip to the emergency room after your child suddenly breaks out in hives and has difficulty breathing may be your first brush with a severe allergy. For young children, there may be more subtle allergy signs and symptoms, such as eczema, nausea, or fussiness. Whether they’re sudden or chronic, allergy signs and symptoms in children may prompt parents or your family doctor to consider allergy testing for your child.
When to Test for Childhood Allergies
The first and most important step in testing for childhood allergies is for your doctor to make a detailed health history of your child. Your child’s doctor should ask you to describe when the signs and symptoms occur and the circumstances around each event, says Scott H. Sicherer, MD, an Elliot and Roslyn Jaffe professor of pediatrics, allergy and immunology and the chief of the division of allergy and immunology in the department of pediatrics at Mount Sinai Hospital in New York City and author ofFood Allergies: A Complete Guide for Eating When Your Life Depends on It. Common allergy symptoms include itchy skin, eyes, nose, and throat as well as hives, nausea, vomiting, and cramping.
If the signs and symptoms and the timing of exposures to potential allergens suggest allergies, allergy testing may be recommended. Immediate allergy testing may also be recommended if a child experiences a severe allergic reaction, known as anaphylaxis, which can affect many parts of the body at one time and may be life-threatening.
Skin or blood allergy tests may be used to diagnose childhood allergies. Both types of allergy tests measure how the immune system responds to specific allergens. In people with allergies, the immune system overreacts to the offending substance by producing antibodies called immunoglobulin E (IgE) that trigger allergy signs and symptoms. If you’re interested in testing for skin allergies, allergists are more likely to have access to skin testing methods than pediatricians or family doctors are.
Standard Allergy Tests
When you take your child to an allergist to be tested, here are the types of tests that may likely be performed:
Skin prick test.A small amount of an allergen is placed on the skin, and the skin is pricked so that the substance goes under the skin. The health care provider then watches for a reaction, such as swelling or redness, to appear within about 20 minutes.
Intradermal skin test.A small amount of an allergen is injected into the skin, and the health care provider watches for a reaction. This type of test is generally used to look for specific allergens such as insect venom or penicillin. Intradermal skin tests may also be used if the results of a skin prick test are unclear.
Skin patch test.Potential allergens are taped to the skin for about two days and reactions are observed three to four days after exposure.
Blood test.Allergy blood tests require a blood sample to be drawn and sent to a laboratory, where it’s screened for allergen-specific IgE levels. It may take a few days to receive results.
Oral food challenge test.If blood or skin allergy tests are inconclusive, an oral food challenge test may be recommended. In a food challenge test, a small amount of the suspected food allergen is given to the child under close medical supervision to check for a reaction. Oral food challenge tests are most accurate in older children and should be performed only under medical supervision, says Robert A. Wood, MD, a professor of pediatrics and the chief of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, Md.
Elimination diet test.An elimination diet test may be used to evaluate if chronic allergy symptoms go away with the removal of the offending food from the diet. This test should only be done under a doctor’s supervision because it can potentially be very inaccurate or risk nutrient deficiency, Dr. Sicherer says.
Results of Childhood Allergy Tests
“Skin and blood testing are equally accurate, but neither are overly accurate in general,” Dr. Wood says. False positive allergy test results — when the test says a child is allergic to something but he or she really isn't — are common.
A positive blood or skin allergy result means your child’s body is able to recognize the allergen, but it's not necessarily reacting to it or making him or her sick.
A combination of a positive test and a matching history of exposure with signs and symptoms is necessary to confirm a diagnosis of allergy. "If testing comes back positive and confirms the suspicion, it's an allergy,” Sicherer says. “If it's positive without the right story, it's sort of irrelevant."
Unproven Allergy Tests to Avoid
Skin, blood, food challenge, and elimination diet testing are the only allergy tests recommended for food allergies by the National Institute of Allergy and Infectious Diseases. Some doctors may recommend other allergy testing methods, but these haven’t been proven and aren’t recommended for diagnosing food allergies and other childhood allergies. Unproven allergy tests include:
- Applied kinesiology (muscle testing)
- Cytotoxicity testing
- Electrodermal test
- Hair analysis
- Allergen-specific immunoglobulin G or IgG/IgG4 testing
Misdiagnosis is the biggest risk of using these tests, Sicherer says. Your child may be diagnosed with a food allergy that isn’t there or a real allergy may be missed. "You may be avoiding things you don’t need to be, so there can be nutritional and social consequences of an allergy misdiagnosis for your child," he says.
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