Allergy testing in babies

How to Get Your Baby Tested for Allergies

Testing for baby allergies can be an ordeal, and dealing with the allergy test cost can be difficult if an allergy blood test or skin assay is not covered by insurance. That said allergies are no joke, and food allergies in babies and toddlers can be fatal. So if a kid starts showing symptoms of an allergic reaction, parents should speak to their pediatrician immediately.

“For a baby, the first sign might be eczema,” says Sonal Patel, M.D., double-board certified in allergy and clinical immunology as well as pediatrics, and author of The Mommy MD Guide to Twins, Triplets. and More. “When solids are started, you may notice an immediate reaction with redness, swelling, or difficulty breathing after introducing a new food. Other signs can include asthma or wheezing. Older children may see hay-fever-like symptoms with chronic congestion, rhinorrhea, and sneezing, as well.”

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A severe rash or respiratory distress warrants emergency intervention, but even a mild reaction in infants and toddlers should be reported to the pediatrician – the next reaction may be more severe.

Getting Tested for Baby Allergies

  • Allergy testing – both food and environmental allergies can be tested by skin tests and blood tests. Skin tests require a series of small scratches or pricks to be made in the skin, whereas blood tests require blood to be drawn.
  • Testing shows food allergies, not intolerances – food testing identifies an IgE mediated sensitivity, meaning exposure might send those patients into anaphylaxis. It does not test for food intolerances or sensitivities.
  • Allergy testing cost – allergy testing is usually covered by insurance. Cost may vary depending on where the doctor is and the insurance they accept, as well as on how many allergens are being tested for.

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For previous generations of allergy sufferers, allergy testing involved a skin prick test. Contemporary doctors now prefer ImmunoCAP allergy blood tests over skin prick tests, at least for babies. Not necessarily because the ImmunoCAP is less invasive – blood is still being drawn. The reason is much more practical.

“Babies have a smaller surface area, so you really can’t test for too many allergens,” Dr. Patel explains. “Some babies need a routine blood test for their one-year physical to check for anemia – it may be a good time to add the allergy test, so the baby doesn’t have to be poked an extra time.”

An allergist may still opt for the skin prick test; neither the blood draw nor the skin prick test is as painful as being vaccinated, says Dr. Patel. But they are certainly uncomfortable ordeals in hospitals that can be frightening to a child.

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“Parents should expect that their children will be scared,” cautions Dr. Patel. “Of course, with a blood draw, there is pain associated. The skin testing, in my opinion, is less painful than a blood draw, especially if using the multi-test. But it still is uncomfortable and scary for the patient, so most children do cry.”

Parents shouldn’t be reluctant to have their child tested for allergies – even if an undiagnosed allergic reaction isn’t severe enough to endanger a baby’s life, it sure is enough to make them irritable and fussy. After all, they don’t have many ways to communicate that they don’t feel well. So it may very well be worth trading off an uncomfortable appointment at the allergist for a calmer, happier baby at home.

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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 of Food 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. “Or your child may be in danger, avoiding the wrong allergen and being at risk for coming across the true culprit and having an allergic reaction.”

Allergy Testing in Brisbane — Help for Kids with Suspected Allergies

How to find more information

The Australian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of clinical immunology and allergy in Australia and New Zealand. Its website, allergy.org.au contains a wealth of information on allergies, including anaphylaxis resources, action and treatment plans, specific dietary avoidance information for allergies, and much more. This is an amazing resource and can tell you everything, from what ‘allergy’ is to the National Allergy Strategy. Whether you are just starting out on your allergy journey or you have had allergies for a lifetime, you will find this website useful and informative.

Allergy & Anaphylaxis Australia (AAA) is a charity for allergy support. Their website, allergyfacts.org.au is also another source of excellent, trusted information on everything to do with allergies and anaphylaxis. It is a great place to find information, help and support. There is also a shop where you can buy everything from EpiPens and Medibands to children’s books that can help kids to learn about allergies and living with allergies.

Please remember to seek medical advice if you suspect an allergy in your child, and to call an ambulance in the case of any serious reaction.

About the Author Paula Johnson For over fifteen years Paula has worked as an editor and writer of educational books and support materials, working in England, Hong Kong and Brisbane. Now with two Brisbane Kids of her own, she enjoys spending time with her children, discovering new places together, making things and getting grubby … and sharing it all with our readers! She loves the fun and creativity of writing for Brisbane Kids and how it allows her to combine her two greatest passions — writing and mummying! Tell All Your Friends About This! Tweet

1-in-3 children have an allergy, however, many parents do not know it. Allergy testing is safe for children of all ages, but testing can make children anxious. Early allergy intervention has shown it can prevent children who have allergic rhinitis from getting asthma. Allergies can also lead to poor school attendance and even affect the quality of children’s play.

Some parents remember a severe version of an allergy test from their childhood, however, testing has evolved and is not painful. While the cause of allergies is not exactly known, allergies often run in families. This leads some parents to decide to get their child tested because they had allergies as a child.

A Pediatrician may also recommend the test if they see telltale signs of allergies. These signs include nasal congestion, runny nose, watery eyes, sneezing, allergic “shiners” and itching of the nose, eyes or skin with no fever present. Many of our doctors are trained to treat children, as they are board certified in pediatrics as well as allergy/immunology.

Testing

Our allergists diagnose allergies with the combination of an allergy skin test and patient medical history. Allergy skin testing is a simple series of tiny scratches on the back using a small instrument similar to a small plastic toothpick. Each toothpick contains trace amounts of an allergen. After a nurse administers the test, reactions may take 15-20 minutes to appear. Typical reactions are mild and will cause a small, itchy bump like a mosquito bite.

An allergist reviews the reactions and determines if additional testing is needed. In these cases, intradermal testing may need to be done on the forearm to provide more detailed results. During these tests, a small amount of the allergen is injected under the skin of the arm to see if it causes a reaction.

Another option is a blood test. This requires a simple blood draw that is sent off to the lab to determine if IgE levels suggest an allergy. A blood test can be used if a patient is already on antihistamines but is less accurate than skin test when diagnosing allergies.

Tips to Prepare:

Stop Antihistamines

We require patients to stop certain medications 3-5 days before the test. If your child is already on antihistamines, other allergy medication, or is taking over-the-counter cold medicines, they should be stopped, as they may interfere with the test results. Please see a complete list here.

Bring a Distraction

We recommend bringing a comfort toy, book, or an electronic tablet to distract your child. While it is not painful after the skin test, patients may get itchy and uncomfortable from the reactions. A toy can help pass time and distract them during the long initial appointment.

Talking to Your Child About the Allergy Test

Tests and going to the doctor can sound scary to a child. Reassure them that the test will not be painful, and explain to them it is necessary to learn what they are allergic to and will help them feel better.

The Results

Another benefit of skin testing is that you will leave the appointment knowing what allergens are bothersome to your child. Our allergists will work with you to develop an action plan, whether it’s a combination of avoidance and medication or allergy shots to desensitize them to their allergens. If diagnosed with a food allergy, our allergists prescribe an epinephrine auto-injector and give our patients a plan to help avoid the allergen.

If you have additional questions about how to prepare for your visit, contact our offices at 800.999.1249.

Guest Post By Meenal Lele, Mom and Founder of Lil-Mixins

I remember when our pediatrician first suspected our son of having a food allergy. He was having eczema that wouldn’t resolve, so I started doing some research on food allergy testing.

I was beyond dismayed to learn that in food allergy testing, the false positive rate is over 50%. That means 50-60% of positive results are not real!

What’s the point of a test that is wrong at least half of the time?

And yet, when a food allergy is suspected, the first step is often an allergy test, specifically what is known as a skin-prick test or sometimes, IgE blood testing.

So, should you drag your child to the allergist to undergo an uncomfortable skin prick session, or not? Here’s a quick introduction to food allergy testing.

Things to Remember About Food Allergies

An important thing to remember is that as a general rule, food allergies are not sneaky. If symptoms show up after eating a food, then you might have an allergy.

Conversely, if you can sometimes eat the food, or if your child can eat a food without hives/anaphylaxis vomiting or other highly noticeable symptoms, there’s probably no allergy, and maybe no intolerance either.

In the end, eating a food and seeing a reaction is the only true way to confirm a food allergy.

But there are a few good reasons to go ahead with the skin prick testing or IgE blood testing:

  1. Both can, with high certainty, rule out an allergy. If it’s negative, there’s almost definitely no allergy.

  2. Both can help differentiate a food intolerance, which is non-immunologic, and therefore not IgE mediated, from a food allergy.

  3. If there is a suspected allergy based on past history, then the tests can help confirm that.

As a parent, there’s a strong urge to “just test them for everything.” But a lot of doctors recommend against that because of the high rates of false signals (also called false positives). An IgE sensitization is not the same as having an allergy. You may end up taking a bunch of foods out of your child’s diet for no reason.

What to Expect with IgE Testing

In skin prick testing, the doctor will place a drop of liquid containing the allergenic protein on the skin and then push down to prick through the top layer of skin. If your body already has the specific IgE antibody for that particular allergen, you’ll see a red puffy welt start to appear around that prick within fifteen minutes. After looking for welts and measuring the size, the doctor will wipe the area clean and apply a cortisone cream to stop any itching.

Our son’s first skin prick test at the doctor’s office

For IgE specific blood testing, a tube of blood is taken. The blood is sent to a lab where allergenic proteins are introduced to the blood, and the levels of specific IgE antibodies that show up are measured.

You’ll get a result for each allergen tested that from 0-100 kg/ IL. Higher scores in general mean more immune reaction, so a high score would likely indicate an allergy.

However you should not interpret the results without consulting a doctor. Different levels actually mean different things for each allergen, and it is quite common to see mildly elevated results all around in children who have other conditions such as eczema, asthma, or seasonal allergies.

We saw this with our son when he was first diagnosed and his eczema was not controlled. When the test was repeated a year later, all the values went down significantly across the board.

The printout showing our son’s IgE blood test results

Oral Food Challenges

A doctor supervised oral food challenge is the one definitive test of a food allergy. This test is commonly used when it seems like someone may have outgrown a food allergy, based on IgE testing. Generally speaking, you will go to the doctor’s office and eat increasingly large amounts of the suspected allergen. This process takes four hours, so come prepared!

Our son doing his oral food challenge with syrup covered french toast

Once you have eaten a certain amount of the protein, you are considered to tolerate that allergen and therefore do not have an allergy. Why is it important to do this at a doctor’s office? Because a reaction can come on fast and you want to be right there with help if needed.

What About Home Food Allergy Test Kits?

These days, because my search history is all about food allergies, I see a lot of advertisements online for home-based food allergy or food intolerance screening tests.

I’ve done a bunch of research, and as far as I’ve been able to find, none of these diagnostic tests have been cleared by the FDA. That means that they have never created and presented data showing that their tests work.

Also, acupuncture, hair/urine testing, and any other such testing you may have heard of is also not proven.

When it comes to food allergies, it’s important to focus on science-based testing and interpretation of results.

Conclusion

Hopefully this introduction to food allergy testing will be useful to you. If you have any further questions, definitely reach out to your child’s pediatrician to get specific answers by a trained medical professional.

Remember that food allergy testing doesn’t have to be stressful, and with proper care and management, you will pull through this uncertain period, just like we did.

Lil Mixins is the #1 selling Infant Peanut Powder and Infant Egg Powder, helping moms around the country start early introduction of peanuts and other allergens to their infants and babies.

Learn more about food allergies and your child on our About Page, in our Parent Resource Center, and our FAQ.

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Allergy and allergy tests

What types of things can cause allergic reactions?

Common things that people are allergic to include food (e.g. milk, eggs, wheat, soy, peanuts and tree nuts, fish and shellfish), pollens, grasses, house dust mites, moulds, animals (usually furry or hairy such as cats, dogs, horses, guinea pigs, and rabbits), medicines and insect stings.

What types of allergic reactions can you get?

Allergic rhinitis

Allergic rhinitis is an allergic reaction in the nose when you breathe in something you are allergic to. Allergy to pollens, house dust mites and animal dander usually causes symptoms of allergic rhinitis (runny nose, blocked nose, itchy eyes). They are usually around all year long (e.g. dust mite, animal dander).

Dust mites and animal dander may also cause symptoms (wheeze and cough) in people with asthma.

When allergic rhinitis is caused by seasonal pollens, it is called hay fever.

Eczema

Eczema is an allergic reaction where your skin becomes red, itchy or inflamed. In some people with eczema, their eczema may get worse if they eat a food they are allergic to. This is a delayed type reaction and can’t be tested for with skin or blood tests.

Food allergy

Food allergy occurs in around 1 in 20 children and in about 2 in 100 adults. The most common triggers are egg, cow’s milk, peanut, tree nuts, seafood, sesame, soy, fish and wheat. The majority of food allergies in children are not severe, and may be ‘outgrown’ with time.

However, peanut, tree nut, seed and seafood allergies are less likely to be outgrown and tend to be lifelong allergies. Some food allergies can be severe, causing life-threatening reactions known as anaphylaxis. Anaphylaxis is treated with intramuscular injection of adrenaline (epinephrine) e.g. Epipen / Epipen Jr.

Mild to moderate symptoms of food allergy include:

  • Swelling of face, lips and/or eyes
  • Hives or welts on the skin
  • Abdominal pain, vomiting

Signs of a severe allergic reaction (anaphylaxis) to foods include:

  • Difficult/noisy breathing
  • Swelling of tongue
  • Swelling/tightness in throat
  • Difficulty talking and/or hoarse voice
  • Wheeze or persistent cough
  • Persistent dizziness and/or collapse
  • Pale and floppy (in young children)

Not all adverse reactions to foods are due to allergy?

Adverse reactions to foods that are not allergy include food intolerances, toxic reactions, food poisoning, enzyme deficiencies, food aversion or irritation from skin contact with certain foods. These adverse reactions are often mistaken for food allergy.

Allergy testing

Allergy testing using skin prick tests or blood tests for allergen specific IgE helps your doctor to confirm what substances you are allergic to, so that appropriate advice can be given.

Allergy testing is usually performed on people with suspected allergic rhinitis (hay fever), asthma or allergic reactions to insects or foods. In people with allergic rhinitis or asthma, allergy testing usually includes house dust mite, cat and dog dander (or other animals if contact occurs), mould spores, pollen from relevant grasses, weeds or trees and in some cases, occupational allergens. Testing can also be used to confirm suspected allergies to foods, stinging insects and some medicines.

Allergy test results cannot be used on their own and must be considered together with your clinical history.

What is a skin prick test?

There are different types of skin tests. The most common type of skin test to identify allergies is a skin prick test.

In a skin prick test, a small drop of a protein extract (allergen) is placed on the skin (usually the forearm) and a small prick is made in the skin through the drop. The size of the swelling (wheal) is measured after 10- 15 minutes.

Skin prick tests are slightly uncomfortable (itchy) but are usually well tolerated, even by small children. Local itch and swelling normally subside within 1-2 hours. More prolonged or severe swelling may be treated with a non-sedating antihistamine, a painkiller tablet and/or a cool compress. Occasionally people will feel dizzy or light-headed and need to lie down. Severe allergic reactions from allergy testing for asthma or allergic rhinitis (hay fever) are very rare.

Antihistamine tablets, syrups or medications with antihistamine-like actions (such as some cold remedies and antidepressants) should not be taken for 3-7 days before testing as these will interfere with the results of testing. You may also be advised to avoid creams and moisturisers on your forearms on the day of the test to reduce the likelihood that allergen extracts will run into each other.

What is an allergy blood test?

Immunoglobulin E (IgE) antibodies directed against specific allergens can be measured with a blood test, formerly referred to as RAST tests (RAST was the abbreviation for the original name of the technology – RadioAllergoSorbent Test). These tests are often performed when skin testing is not easily available, when skin conditions such as severe eczema preclude skin prick testing, or when a person is taking medications (such as antihistamines) that interfere with accurate skin prick testing.

Other skin testing methods?

Scratch testing was used in the past but it is less reliable than skin prick testing, and causes much greater discomfort. Intradermal skin testing may be used to test for allergies to antibiotic drugs or stinging insect venom, when greater sensitivity is needed. Intradermal testing should not be used to test for allergy to inhalants or foods.

My child’s skin test was positive, what does that mean?

Skin prick testing should only be performed by a health professional who has been trained in the procedure. A doctor should be present to select the allergens, interpret the results and deal with any generalised allergic reaction that might very rarely occur.

As well as helping to diagnose an allergy if they are positive, skin tests are very useful if they are negative. If a skin test is negative, it is extremely unlikely that your child has an immediate allergy to that food.

Why is it so important to find out for sure whether my child is really allergic? Can I just assume my child will have a reaction to the foods that are positive on their skin tests?

  • Allergies, especially food allergies are not just annoying; they do have a large impact on many aspects of life.
  • There are a few very important reasons to find out whether your child is allergic:
    • If your child is really allergic, you need to know whether the allergy is potentially life threatening, so that precautions can be taken.
    • Your child may not be allergic! It is a great pity to think you are allergic to a food that actually causes no problems. This may lead to anxiety and restrictions in where your child can eat. In some cases children have been placed on such restrictive diets that they become malnourished.
    • There is some evidence that avoiding foods that your child is not allergic to, may increase their allergies.
    • The diagnosis of allergy also has money and lifestyle affects.

Remember:

  • Most allergy is caused by a reaction between IgE and another substance.
  • Allergies may cause hay fever, asthma or skin reactions such as hives.
  • The most severe type of allergy is called anaphylaxis.
  • A positive skin or blood test for foods does not always mean that your child will have an allergic reaction if they eat the food. Sometimes a challenge is needed to diagnose the allergy.

Further information is available on the ASCIA website www.allergy.org.au

Skin prick test is one of the most common allergy tests.

Some alternative practitioners offer allergy tests and treatments. These tests are often expensive and may be of little or no use in correctly detecting allergies.

Types of allergy tests

The most common forms of allergy tests are the skin prick test and the blood test.

If you have skin prick testing, you would be pricked on the arm or back a number of times, with a tiny amount of allergen dropped onto the pinprick. If you are allergic, where you were pricked will become swollen and itchy. This generally subsides within two hours. Although skin prick testing can be uncomfortable, most people find it tolerable. The results are available within 20 minutes.

Blood tests can be also used to test for allergies.

Other, less common allergy tests include:

  • intradermal skin testing
  • patch testing
  • and oral allergen testing

How much does allergy testing cost?

In Australia, Medicare covers part of the cost of skin prick tests and blood tests used to detect allergies, if the tests have been ordered by a doctor. You can expect to pay about $120 for each test once Medicare has covered some of the costs. Concession card holders might be charged less.

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