The exam typically involves several steps:
1.    Detailed Medical History (the most crucial step):
      The allergist will ask extensive questions about your symptoms: 
Nature: What are your symptoms (e.g., sneezing, itching, rash, stomach upset, wheezing)?
Severity: How intense are they?
Frequency: How often do they occur?
Timing: When do they occur (certain seasons, after eating specific foods, after exposure to pets, at night)?
Triggers: What do you suspect makes them worse?
Relief: What makes them better?

 

 

• Environmental Factors: Questions about your home (pets, dust, mold, humidity), work/school environment, hobbies, and travel.

• Dietary Habits: If food allergies are suspected, a detailed dietary history will be taken.

• Family History: Allergies and asthma often run in families, so your family's medical history is important.   

• Medications: A list of all current medications, including over-the-counter drugs and supplements

• Previous Treatments: What treatments you've tried and their effectiveness.

2.    Physical Examination:
      The allergist will perform a general physical exam, focusing on areas commonly affected by allergies: 

• Nose and Throat: Looking for inflammation, polyps, or signs of post-nasal drip.

• Eyes: Checking for redness, swelling, or signs of conjunctivitis.

• Skin: Examining for eczema, hives, or other rashes.

• Lungs: Listening to your breathing for wheezing or other signs of asthma.

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3.    Allergy Testing (if indicated):

• Based on your history, the allergist may recommend specific allergy tests. These tests help confirm the presence of IgE antibodies, which are involved in immediate allergic reactions. 

• Skin Prick Test (SPT): This is the most common and generally preferred method for environmental and some food allergies. 

• Procedure: Small drops of liquid containing different allergens (e.g., pollen, dust mites, pet dander, molds, specific foods) are placed on your forearm or back. The skin beneath each drop is lightly pricked with a tiny, sterile lancet, just breaking the surface.

• Results: Within 15-20 minutes, if you're allergic, a small, itchy, red bump (wheal) with a surrounding flare will appear, similar to a mosquito bite. The size of the wheal helps the allergist interpret the sensitivity.

• Preparation: You'll need to avoid taking antihistamines for several days before the test, as they can suppress the reaction.

• Intradermal Test: Sometimes used when a skin prick test is negative but an allergy is still strongly suspected (e.g., insect venom, some medications). A small amount of allergen extract is injected just under the skin.

• Blood Test (Specific IgE Blood Test or RAST/ImmunoCAP): 

• Procedure: A blood sample is taken and sent to a lab to measure the amount of IgE antibodies to specific allergens in your blood.

• When Used: This test is an alternative if skin testing isn't possible (e.g., severe skin conditions like eczema, inability to stop antihistamines, very young children, high risk of severe reaction to skin testing). It's also used for certain food allergies.

• Limitations: Generally less sensitive than skin prick tests, and results take several days.

• Patch Test: Used to diagnose contact dermatitis (a delayed allergic reaction, not IgE-mediated) caused by substances like nickel, fragrances, or preservatives. Patches containing suspected allergens are applied to the skin for 48 hours and then checked for reactions over several days.

• Oral Food Challenge (OFC): Considered the "gold standard" for diagnosing food allergies, especially when other tests are inconclusive. This is done under strict medical supervision where increasing amounts of the suspected food are consumed, starting with tiny amounts, to see if a reaction occurs. This is a controlled and potentially risky procedure due to the possibility of severe reactions.

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4.    Lung Function Tests (if asthma is suspected):

• Spirometry: A common test to measure how much air you can breathe out and how quickly you can do it. This helps diagnose and monitor asthma.