A diagnostic procedure to identify the allergen in children with recurrent sneezing, wheezing, eczema or food reactions, performed with skin prick testing and, when necessary, blood tests.
Indication
- Suspected allergic rhinitis (recurrent sneezing, runny nose and nasal congestion)
- Lower respiratory complaints such as asthma, wheezing breathing and chronic cough
- History of reactions to foods such as milk, egg, peanut, hazelnut or fish
- Atopic dermatitis (childhood eczema) and recurrent urticaria
- Suspected allergic reaction due to bee sting or medication
- At-risk children with a family history of asthma, allergic rhinitis or food allergy
Preparation
- Antihistamine medications must be discontinued 5-7 days before the test (under physician supervision)
- If topical cortisone cream or high-dose oral cortisone is being used, the timing is planned with the physician
- The test may be postponed if there is active eczema, widespread skin rash or acute viral infection
- Suspected allergens and reaction history are reported in detail to the physician
- Skin prick testing is generally applied safely in children aged 3 and older; in younger children, blood testing may be preferred
How it's performed
- The inner forearm or back skin of the child is cleaned and the test areas are marked
- Standard allergen drops (pollen, house dust mite, fungi, animal hair, foods, etc.) are dropped onto the skin
- A very superficial prick is made at the drop site with a sterile lancet; the child usually feels only mild itching rather than pain
- After waiting 15-20 minutes, the diameter of the wheal (papule) and redness is measured
- When necessary, specific IgE levels are requested from blood; this method is used in children whose skin is unsuitable or who are very young
- The results are evaluated together with the child's clinical history; a positive test alone does not establish an allergy diagnosis
Post-procedure
- After the test, the wheal at the area generally regresses within 1-2 hours
- Avoidance of the identified allergen, in-home measures and environmental adjustments are explained to the family
- In respiratory allergy, a treatment plan (nasal sprays, antihistamine and immunotherapy if needed) is arranged
- In food allergy, referral to a pediatric dietitian for a diet plan may be made
- Children at risk of severe reactions are trained on the use of an adrenaline auto-injector
Risks
- Temporary itching, redness and slight wheal at the test area (expected response)
- Very rarely a generalized allergic reaction (anaphylaxis); the test is always performed in an appropriate setting where intervention equipment is available
- False positive or false negative results may occur; results must always be interpreted together with the clinical picture
- If antihistamines are not discontinued before the test, the results may be inadequate
FAQ
From what age can the allergy test be performed?
Skin prick testing is generally performed in children aged 3 and older; however, when needed, it can also be performed at younger ages. In infants, specific IgE tests measured from blood are often preferred.
Is the test painful?
The lancet makes a very superficial prick; most children describe only mild itching. Because there is no needle insertion, it is generally more comfortable than a blood draw.
Does a positive test mean a definite allergy?
No. A positive result indicates sensitization; if not assessed together with clinical complaints, it may lead to excessive dietary restrictions. It must be interpreted by a pediatric allergy specialist.
Why is it necessary to discontinue antihistamines?
These medications can suppress the allergic response and cause a false negative test. They must usually be discontinued 5-7 days in advance; how to discontinue them is determined by the physician.
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