Allergy testing identifies the specific substances, or allergens, that trigger an immune system response. When the immune system overreacts to a typically harmless substance, it produces symptoms ranging from mild to severe. Pinpointing the exact cause is the first step toward effective management. This guide clarifies the roles of different doctors and describes the testing methods used to determine your particular allergic triggers.
Starting Point: Primary Care Physicians and Pediatricians
Primary Care Physicians (PCPs) and pediatricians often serve as the initial point of contact for patients experiencing allergy symptoms. These general practitioners are trained to address a broad spectrum of common medical issues, including the initial assessment and basic management of allergies. They can typically manage mild to moderate seasonal allergic rhinitis, or hay fever, using over-the-counter or basic prescription medications.
The PCP conducts an initial evaluation, takes a detailed medical history, and rules out other potential causes for the symptoms, like a cold or a sinus infection. They can prescribe initial treatments, such as antihistamines or nasal steroid sprays, for immediate symptom relief. If symptoms are persistent, severe, or do not respond to these standard treatments, the PCP provides a necessary referral to a specialist.
The Allergy Testing Specialist: Allergists and Immunologists
The definitive specialist for allergy testing is an allergist/immunologist. These physicians possess highly specialized training focused exclusively on the diagnosis, treatment, and management of allergic diseases, asthma, and immune system disorders. Their comprehensive scope allows them to handle complex cases that extend beyond the general practitioner’s typical practice.
To become an allergist/immunologist, a physician completes a three-year residency program in internal medicine or pediatrics after medical school. Following this residency, they complete an additional two to three years of intensive fellowship training specifically in allergy and immunology. This extensive post-residency education ensures they are experts in the body’s immune response to allergens and in administering specialized treatments like immunotherapy.
Their expertise includes managing difficult-to-control allergic asthma, treating various skin conditions like chronic hives and eczema, and diagnosing primary immunodeficiency disorders. The allergist is uniquely qualified to perform and interpret the complex testing procedures required to identify specific triggers and to create a long-term treatment plan. They are the only specialists who can safely administer and supervise procedures like oral food challenges, which are sometimes necessary for definitive food allergy diagnosis.
Understanding Allergy Testing Procedures
Specialists primarily use two main categories of tests to identify specific allergens: skin tests and blood tests. Skin tests are typically the preferred method because they are quick, inexpensive, and provide immediate results within about 15 to 20 minutes.
The most common form is the skin prick test, where a small drop of a purified allergen extract is placed on the skin, usually on the forearm or back, and the surface is lightly pricked. If a patient is allergic, a localized reaction, known as a wheal, will appear at the test site, resembling a small mosquito bite.
An intradermal test may be performed if the skin prick test is negative but an allergy is still suspected. This involves injecting a small amount of diluted allergen just under the skin’s surface. Both skin tests measure an immediate, IgE-mediated immune response to the substance.
Blood tests, specifically the Specific IgE blood test, measure the amount of Immunoglobulin E antibodies in the blood directed against a particular allergen. This test is often reserved for patients who cannot undergo skin testing, such as those taking interfering medications or those with widespread severe skin conditions. While blood tests are safer in cases of suspected severe allergy, they are generally more expensive and results can take several days or weeks to return.
Knowing When to Seek a Specialist
A patient should seek an appointment with an allergist/immunologist when mild symptoms escalate or fail to respond to initial treatment. If allergy symptoms, such as nasal congestion or a persistent cough, last for several months of the year, a specialist consultation is warranted. This includes symptoms that disrupt sleep, daily activities, or school/work performance.
You should also see a specialist if you meet any of the following criteria:
- You have a history of severe symptoms, such as recurrent sinus or ear infections, or asthma that is difficult to control.
- There is any suspicion of a food allergy or drug allergy.
- You have a history of anaphylaxis, which is a severe, potentially life-threatening allergic reaction.
- You are interested in long-term treatment options like immunotherapy (allergy shots or sublingual tablets).