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Know Before You Go: The Allergist

Know Before You Go: The Allergist

It's your first appointment. What should you walk away with?

You've noticed, lately, every time you go to your uncle's house, you have problems breathing. Your chest becomes tighter, and you begin coughing or wheezing. Last time, you had a full-on asthma attack. You're convinced you have an allergy, but aren't sure exactly what's triggering your issues. You know, though, you're finally ready to get help.

It's estimated at least 50 million Americans have allergies, or immune reactions to substances like pollen, dust, pets and food. They can start at any age and may change over time, and physical reactions vary from person to person. For you, cats may trigger allergic asthma attacks; someone else may get hives.

If your symptoms are severe or frequent, interfere with daily activities or make other problems like asthma hard to control, an allergist can devise a treatment plan to help you function from day to day. These special doctors are frequently covered by health insurance, and often, they will be referred by your primary care physician.

What to expect from the first appointment
For your first visit with an allergist, bring any applicable medical documentation. Let your doctor know if you're taking prescriptions or over-the-counter drugs, and how much they've helped. Notes about symptoms and triggers can also be helpful.

During your appointment, your allergist will first take your personal medical history, a crucial part of diagnosis. They may ask some general health questions, and will focus on the details of your allergy attacks. You should discuss:

  • Your symptoms, their duration and how severe they were
  • Any triggers you may have observed
  • Reactions that involved emergency care
  • Your family's history of allergies
  • Known allergies or past treatment for allergies

Then, the doctor will conduct a physical exam, checking areas of your body where allergies often manifest. These include your ears, nose, throat, eyes, lungs/chest and skin. If you've had breathing problems, you may receive a pulmonary function test or lung x-ray, as well.

Once your allergist is finished, they'll determine whether or not you should be tested for allergies. This can happen at the first appointment, or in subsequent appointments.

Kinds of allergy tests
Your diagnosis will depend on two things: A) your personal medical history, and B) your allergy test. Allergy tests can help tell what you're allergic to, though perhaps not how badly allergic you are.

The two most common types of allergy tests are skin tests and blood tests. Skin tests are generally used first, as they're considered to be more sensitive and accurate. There are two kinds of skin tests.

  • During a skin prick test, your doctor will prick a tiny amount of potential allergen (pet dander, mold, etc.) into the surface of your skin, usually on your arm or your back. If you're allergic, your skin may turn red and swell, or a hive-like bump may form.
  • An intradermal test is much like a skin prick test, except allergens are injected deeper under the skin. It may be used when results from the skin prick test are uncertain.

If a skin test isn't feasible—say, you're taking certain medication or you have a skin condition—you may receive a blood test. Your doctor will take a blood sample and send it to a lab for analysis.

Based on your history and the results of your allergy test, your allergist will prescribe a course of treatment. It will likely begin with strategies to avoid allergens, like cleaning your home of pet dander or mold, and may also involve medication. Immunotherapy (allergy shots) isn't usually prescribed during the first visit, though it may eventually be, depending on your allergy.

Questions to ask and what to leave with
Before ending your first visit with an allergist, make sure you have answers to the following:

  • What am I allergic to?
  • What can I do myself to prevent allergic reactions?
  • Do I need medication? How much, and what are its side effects?
  • When should I see you again, how often should I visit and what is your availability?
  • What should I do during an emergency allergic reaction?
  • What can I expect from my allergy moving forward?

Your doctor may give you reading material or suggest websites for more information about your allergy. Make sure you read them, and reach out with questions—perhaps at your follow-up appointment.

Medically reviewed in January 2018.

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