Patient instruction/consent sheet for allergy skin testing

PATIENT INSTRUCTION/CONSENT SHEET FOR ALLERGY SKIN TESTING

Skin Test: Skin tests are a method of testing for allergic antibodies. A test consists of introducing small
amounts of the suspected substance, or allergen, into the skin and noting the development of a positive reaction
(which consists of a wheal, or swelling, or flare in the surrounding area of redness). The results are read 15 to 20
minutes after application of the allergen. The skin test methods used are:
Prick Method: The skin is scratched or pricked where a drop of allergen has already been placed.
Intradermal Method: This method consists of injecting small amounts of an allergen into the superficial layers
of the skin.
Interpreting the clinical significance of skin tests requires skillful correlation of the test results with the patient's
clinical history. Positive tests indicate the presence of allergenic antibodies and are not necessarily correlated
with clinical symptoms.
You will be skin tested to important midwestern airborne allergens and possibly some foods. These include
trees, grasses, weeds, molds, dust mites, and danders and, if needed, foods. The skin testing generally takes 2
hours. Prick tests will be performed on your back and intradermal tests on your arms. If you have a specific
allergic sensitivity to one of the allergens, a red, raised itchy hive (caused by histamine release into the skin) will
appear on your skin within 15-20 minutes. These positive reactions will gradually disappear over a period of 30-
60 minutes, and, typically, no treatment is necessary for this itchiness. Occasionally local swelling at a test site
will begin 4 to 8 hours after the skin tests are applied, particularly at sites of intradermal testing. These reactions
are not serious and will disappear over the next week or so. They should be measured and reported to your
physician at your next visit. You may be scheduled for skin testing to antibiotics, caines, venoms, or other
biological agents. The same guidelines apply.
DO NOT.
1. No prescription or over-the-counter antihistamines should be used at least 3 days prior to the scheduled skin
testing. These include cold tablets, sinus tablets, hay fever medications, over-the-counter sleeping medicines (e.g., Nytol) or oral treatments for itchy skin. Some of the names of these drugs include Actifed, Drixoral, Dimetapp, Dristan, Ornade, Benadryl, Rondec, Trinalin, Zyrtec, Claritin, Allegra, and many others. If you have any questions whether or not you are using an antihistamine, please ask the nurse or the doctor. Patients on Hismanal should not take this antihistamine for 6 weeks prior to skin tests.
2. Do not stop taking your asthma medication prior to testing.
YOU MAY.
1. You may continue on your intranasal allergy sprays such as Nasacort, Rhinocort, Vancenase, or Nasalide.
2. Asthma inhalers (Intal, beclomethasone [Beclovent, Vanceril], Aerobid, Atrovent, Azmacort, Alupent,
Brethaire, Albuterol [Proventil, Ventolin]) and oral theophylline (Theo-Dur, T-Phyl, Uniphyl, Theo-24, etc.) do not interfere with skin testing and should be used as prescribed. 3. Most drugs do not interfere with skin testing but make certain that your physician and nurse know about Please let the physician and nurse know:
1. If you are taking any beta-blockers or antidepressants.
2. If you are pregnant.
3. If you have a fever or wheezing.
4. Any medications you are taking (bring a list if necessary).
Skin testing will be administered at this medical facility with a medical physician present since occasional
reactions may require immediate therapy. These reactions may consist of any or all of the following symptoms:
itchy eyes, nose, or throat; nasal congestion; runny nose; tightness in the throat or chest; increased wheezing;
lightheadedness; faintness; nausea and vomiting; hives; generalized itching; and shock, the latter under extreme
circumstances. PLEASE NOTE THAT THESE REACTIONS RARELY OCCUR BUT IN THE EVENT A
REACTION WOULD OCCUR, THE STAFF IS FULLY TRAINED AND EMERGENCY EQUIPMENT IS
AVAILABLE.

The time set aside for your skin test is exclusively yours for which special antigens are prepared. If for
any reason you need to change your skin test appointment, please give us at least 24 hours notice.

__________________________________________________________________________________
I have read the patient information sheet on allergy skin testing and understand it. The opportunity has been
provided for me to ask questions regarding the potential side effects of allergy skin testing and these questions
have been answered to my satisfaction. I understand that every precaution consistent with the best medical
practice will be carried out to protect me against such reactions.
PATIENT NAME (Print)__________________________________________
PATIENT SIGNATURE___________________________________________ DATE SIGNED______________
(Or parent if patient is a minor)
WITNESS_______________________________________________________ DATE SIGNED______________

Source: http://www.foxcitiesallergists.com/files/patientinstructions-skintest.pdf