Frequently Asked Questions

FAQ about Skin Prick Test

What is a skin prick test?

A skin prick test is when a small amount of allergen is placed on your skin (usually your forearm or back) and a tiny puncture is made. The allergen you are sensitive to will itch and create a bump similar to a mosquito bite.

Is a skin prick test dangerous?

A skin prick test is a very safe, accurate way to determine what is your offending allergen. In very rare cases if you have a very severe food allergy, you can develop an itch at a remote site such as itchy eyes or nose. It is possible to have a severe allergic reaction, but it has a very low likelihood.

Is a skin prick test painful?

A skin prick test is a number of very small punctures on your skin. These can be uncomfortable but there is minimal pain associated with a skin prick test.

How long does a skin prick test take?

Preparing for a skin prick test- writing on your arm. Takes about 5 minutes. A test is read within 15 minutes. After 15 minutes your arm is wiped clean and an antihistamine cream is applied.

How do I prepare for my skin prick test?

Stop oral antihistamines 4 days before your test and topical cortisones 2 weeks before the test. If your eczema is severe a test might not be possible.

Must I stop any medication for my skin prick test?

Stop oral antihistamnines 4 days before your test and topical cortisones 2 weeks before the test. If your eczema is severe a test might not be possible.

What happens at your first consultation at an allergist?

Your first consultation is a consultation where your history is taken, physical examination done and skin prick test and lung function tests are done if indicated. The more thoroughly your forms are completed, the more streamline the consultation flows. Please bring any additional test results that might be relevant such as CT scans and blood results.

FAQ about Food Challenges

What is a food challenge?

A food challenge is a procedure where you are slowly exposed to a food that you might be allergic to. Your doctor will determine the amount of steps in between exposures. The usual period in between food between doses is 15-20 minutes but it is an individualized process and we will be guided by your reactions on the day.

Is a food challenge dangerous?

A risk stratification is done before your challenge based on previous results as well as previous allergic reactions. Although rare, It is possible to have a severe allergic reaction(anaphylaxis) during a food challenge

How long does a food challenge take?

A food challenge takes anything from 3-4 hours. It is best to make arrangements for your other children to be cared for on the day of you or your child’s food challenge.

A food introduction (lower risk) takes approximately 2 hours i.e. cupcakes.

What must I do to prepare for my food challenge?

You or your child must stop antihistamine 4 days before the food challenge. If you are unable to stop antihistamine please contact the clinic. You and/your child must be well and your asthma must be controlled.

Must I stop my medication for my food challenge?

How much does a food challenge cost?

Food challenge:

Food introduction(Cupcakes, flapjacks and egg/milk ladder)

How do I direct my concerns before the food challenge?

Please find the following document that can possibly help you with some of your concerns.

Please contact the allergy clinic if you have any concerns regarding your food challenge: Reception@allergydoc.co.za or enquiries@allergydoc.co.za

FAQ about Oral Immunotherapy

What is oral immunotherapy?

Oral immunotherapy is the process where you or your child is given the food that causes a severe allergy to induce tolerance to the food to protect you from accidental exposure to the allergen.

Is oral immunotherapy dangerous?

Allergen avoidance carries a risk of accidental exposure to allergens. The highest risk allergen exposure is commercial catering (dining out). Oral immunotherapy increases your tolerance to accidental exposure. Allergen immunotherapy has a risk of anaphylaxis

What is an initial day dose escalation for oral immunotherapy?

Initial dose escalation is the first day of oral immunotherapy(OIT). This process takes 4-5 hours. Small doses are given at 15-30 minutes according to a published protocol. The up dosing is achieved when a desired dose is achieved or after an allergic reaction.

What is an up-dosing visit for oral immunotherapy?

An up-doing visit usually takes one hour, your previous dose is escaletd at 25-100%, the increment is based on you or your child’s individual reaction to the previous dose.

How long does an initial up dosing take with oral immunotherapy take?

An up- doing visit takes approximately one hour.

What must I do to prepare for my oral immunotherapy initial up dosing visit?

You or your child need to be well and not have any oral ulcers/ lesions. You must remain on any allergy medication such as asthma inhalers as well as nose sprays.

Must I stop my medication for my oral immunotherapy up-dosing ?

Do not stop any allergy medication for your oral immunotherapy up-dosing, unless your doctor advises you to change your medication such as ACE inhibitors for blood pressure.

What is the cost of oral immunotherapy?

Initial day escalation:

Up-dosing:

Food challenge:

How do I direct my concerns a week before the food challenge

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FAQ about a Medication Allergy

What is an adverse drug reaction?

An adverse reaction to a drug or medication can be a side effect (a known effect like diarrhoea after antibiotics); Immune reactions can be immediate and severe like an allergic reaction- anaphylaxis. Delayed like a fixed drug reaction that happens weeks after ingesting a drug and a severe delayed reaction that involves skin and mucous membranes such as toxic epidermal necrolysis and Stevens Johnson syndrome.

Can a doctor test for all adverse drug reactions?

Not all adverse drug reactions have skin or blood tests, some drug reactions is made based on history as blood tests might be negative and skin tests are not suitable.

How does a doctor do a skin prick test for a drug allergy?

Drug skin prick test is when a drop of the offending medication is placed on the skin and a small puncture is made. When a bump that is larger than 3 mm occurs, this could indicate and allergy.

How does a doctor do an intra dermal skin prick test for a drug allergy?

Intra dermal tests is when a very small dose of the offending drug is injected into the dermis of the skin. A positive reaction is when the reaction is larger than 3 mm than the bump that is made from injecting the allergen.

What is a drug/medication challenge?

A drug/ medication challenge is when very small amounts of the suspected drug or medication is given to the patient in increasing doses. The interval can be 15-60 minutes, according to published protocols. Close observation will ensure you or your child’s safety.

What is a patch test for medication allergy?

Patch test is when the offending drug or medication is suspended in a petroleum base and applied to the skin for 48-72 hours. After removing the patch, a positive test is when a red, itchy, bump is formed.

Is a skin prick test safe for medication allergy.

A skin prick test is a safe test, but in rare cases a systemic allergic reaction(anaphylaxis) can occur.

Is an intra dermal test safe for a medication allergy?

A skin prick test is a safe test, but in rare cases a systemic allergic reaction(anaphylaxis) can occur.

Is there different types of adverse reactions to medications?

There is different reactions to medication, these can happen within minutes (anaphylaxis to anti-inflammatory and antibiotics) to weeks (fixed drug reaction, DRESS syndrome) after ingesting a medication.

What is a pharmaco- genetic test?

Pharmaco-genetic test is a test that can be done to evaluate your body’s ability to metabolise medication. This test is often done in patients with multiple medication reactions as well as patients with multiple medication reactions and a need for multiple medications like hypertention, and auto-immune disease.

What is a Basophil stimulation test for medication allergy?

Basophil activation test(BAT) is a test that simulates the reaction when your body is exposed to a medication, food or even the environment. It shows the reaction of an allergy cell called a Basophil.

How accurate is a drug allergy skin prick test?

Drug allergy skin prick test is de

How accurate is a Penicillin allergy skin prick test?

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How accurate is a specific IgE allergy test for Penicillin?

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How accurate is a Basophil stimulation test for Penicillin allergy?

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FAQ about Allergic Rhinitis

What is allergic rhinitis?

Allergic rhinitis is when your body recognizes environemental allergens as foreign and responds as if it is fighting a foreign protein. Environmental allergens can be grass, dust, cat, dog. Pollen is a collective term that is often used to describe the presence of grass, tree and weed pollen that can cause seasonal allergies.

What is the different tests for allergic rhinitis?

A skin prick test a blood test (specific IgE/RAST) are the most common allergy tests. Your doctor might do a screening test called a Phadiatop, this test only incicates thye presence or absence of specific antibodies to a group of allergens. A break down test of individual allergens will need to determine to what you might be allergic to.

What is the difference between a skin prick test and a blood test, is the one better than the other?

These tests look at your allergy status in different moments in time. A blood tests counts the specific antibodies (allergens /antigens) that you might be allergic to. The advantage is that you do not need to stop your oral antihistamine.

A skin prick test , indicates your body’s reaction to being exposed to a very small amount of allergen via your skin. You have to be off an oral antihistamine for 4-7 days for the test to be accurate. One of the advantages is that the result is available within 15 minutes.

What is a nasal provocation test?

Nasal provocation test is performed if there is a strong suspicion of an allergy with a negative allergy test (specific IgE or skin prick test). A small amount of allergen is sprayed into your nose to determine if you might be allergic, this is done when there is a strong history of allergic rhinitis. In the case of a positive nasal provocation test you would be classified as local allergic rhinitis.

What are the symptoms of allergic rhinitis?

Allergic rhinitis is often referred to as “sinus”. The symptoms can be nasal congestion, blocked nose, post nasal drip and recurrent infections. When the symptoms of itchy nose, eyes and throat is present it is often referred to as hayfever. You can have one or multiple symptoms.

Can allergic rhinitis lead to sinusitis or middle ear infection?

Uncontrolled allergic rhinitis can lead to recurrent sinus and middle ear infections.

FAQ about Early Introduction of solids

What is the best age to introduce allergenic solids to infants?

The best age to introduce solids in a child, to prevent food allergies is 4-6 months if the child is developmentally ready for solids. Early introduction of allergenic solids (4-11 months), specifically peanut and egg can lead to an 85% relative risk reduction to developing an allergy to egg and milk

Can food allergens be transferred in breastmilk?

Small amounts of food allergen(antigen) is carried into breastmilk.

Can my infant’s eczema be to a food allergy?

Eczema is an inflammatory skin disease, there are many triggers and in young infants and children under 3 eczema can be caused and aggravated by food allergies. Eczema is typically a delayed skin reaction top exposure to certain faoods.

Can my infant’s colicky behaviors be a food allergy?

Non-IgE Cow’s milk protein allergy can can cause symptoms that are similar to reflux and colick, even if an infant is exclusivel;y breastfed.

Why is it important to introduce allergenic food allergens to infants?

Allergen introduction in infants between the ages of 4-11 months can prevnt peany and egg allergy by up to 83%.

What is AERDS Aspirin exacerbated respiratory disease?

Aspirin exacerbated respiratory disease/non-steroidal exacerbated respiratory disease/Samter’s triad is a disease that has 3 components: Aspirin/NSAID allergy; nasal polyps or sinus hypertropy and asthma.

What is N-ERD Non- steroidal exacerbated respiratory disease?

What is a Nasal Polyp?

Nasal polyp is when your mucous membranes produce tear drop like growth, this is usually due to inflammation that is caused by two types of white cells. The eosinophilic polys are associated with AERD/N-ERD and neutrophilic polyps as well as mixed (eosinophils and neutrophils).

What causes Nasal Polyps?

Nasal polyps could be allergic or due to chronic recurrent infections, or when your body lacks a certain enzyme (5-Lipo oxygenase) with a downstream build up of chemical markers that attrack eosinophils and other inflammatory cells as well as cause an allergic reaction f NSAID or Aspirin is taken.

FAQ about Primary immune deficiency

What is a primary immune deficiency/errors of inborn immunity?

Primary immune deficiency is a group of diseases that originate with incorrect signals that lead to too few immune cells manufactured or activated, transported, with a resulting immune system that does not function as well as an individual needs it to function. This results in recurrent infections with a very poor quality of life.

How do I test for a primary immune deficiency (PID)?

Primary immune deficiency is diagnosed when a series of tests are done and indicate too few white calls or too few anytibodies. These tests are performed often over months and might be done to see how an individual responds to certain vaccines. Genetic tests are also valuable tools that can help a doctor to correctly classify your immune deficiency.

What are the symptoms of primary immune deficiency?

Primary immune deficiency is a group of conditions that result in recurrent infections; sinobronchitis, meningitis or middle ear infection.

FAQ about Atopic Dermatitis

What is the cause of atopic dermatitis?

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What is an emollient?

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What is the ingredients of an emollient?

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What is the side effect of topical cortisones?

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What is a biological medication?

Biologic medication is a new generation medication that is specifically manufactured to disrupt, block, or switch off pathological pathways. These are often referred to as monoclonal antibodies. These medications are not first line therapy for most allergic conditions.

Which biologic medication is available in South Africa for allergic disease?

Omaluzimab(Xolair)

was lanched in South Africa in 2016 and since then thousands of patients have been treated for asthma (original indication), eczema, chronic urticaria, mastocytosis (off label indications). Funding remains a challenge and often you will need a motivation for these medications.

Dupilimab(Dupixent)

this exciting medication was launched for the treatment of atopic dermatitis in 2021. It is currently awaiting registration for asthma and nasal polyps in South Africa, but has registration for these conditions in US, UK and Europe.

Rinviq

The latest Biologic drug is a Jak inhibitor that is indicated for moderate to severe atopic dermatitis .

What is Oral Immunotherapy?

Oral immunotherapy is the process where you or your child is given the food that causes a severe allergy to induce tolerance to the food to protect you from accidental exposure to the allergen.

What is Subcutaneous Immunotherapy?

Subcutaneous immunotherapy is a form of therapy where small amounts of allergenic protein(antigen) is injected under the skin. This is slowly released and the exposure through the injection encourage white blood cells to make antibodies that block the allergy antibodies. This then leads to a state of desensitization when you are exposed to the allergenic protein, with minimal reaction. T

How long does Immunotherapy take?

Subcutaneous and sublingual immunotherapy takes 3-5 years. The duration will be determined by your bodies’ response to the injections/drops. The longer the duration the more likely you are to never have symptoms again.

What is Sublingual Immunotherapy?

Sublingaul immunotherapy is when small amounts of allergenic protein(antigen) is administered under the tongue. This trains the immune system to not react to the allergenic protein by producing blocking antibodies and stabilizing allergy cells. The drops are administered daily under the tongue.

Is Sublingual Immunotherapy (desensitization) available for bee venom allergy?

Sublingual immunotherapy is only available for environmental allergens such as cat, dog, grass, tree pollen. Bee and was venom immunotherapy is only available in the subcutaneous form. There is no allergy immunotherapy tablets in South Africa at the time of writing this.

Is Allergen Immunotherapy Safe?

Subcutaneous immunotherapy is associated with more adverse reactions and therefore patients are observed for 30 minutes after the injection.

What is the cost of Subcutaneous Immunotherapy?

Subcutaneous immunotherapy is an imported product currently and prices fluctuate with exchange rates. Cost of injectable immunotherapy also includes the doctor’s fee for injecting the patient. Please contact us for a quote for your allergen immunotherapy. Currently allergy immunotherapy is imported as a Section 21 medication and online SAPHRA approval must first be granted.

Does Medical Insurance pay for Subcutaneous Immunotherapy?

Currently most medical aids does not pay for allergen immunotherapy despite clear cost savings benefit for the patient and the funder.

Does Medical Insurance pay for Oral Immunotherapy?

Currently most medical aids does not pay for allergen immunotherapy despite clear cost savings benefit for the patient and the funder.

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