Call: (973) 743-1331

Patient Instructions and Consent Form

The Allergy Matrix Inc.

 

                                                                             ALLERGY SKIN 

                                               PATIENT INSTRUCTIONS AND CONSENT FORM 

Skin tests are a method of testing for allergic reactions to substances or allergens in the environment. A test consists of introducing small amounts of allergens into the skin and noting the development of a positive reaction, which consists of a wheal (swelling) and flare (surrounding redness).

We use the prick method where the outside layer of skin is pricked (scratched) and a drop of allergen is placed.

The entire testing process will take about 30 minutes. We test a variety of important allergens including trees, grasses, weeds, molds, dust mites, and animal dander. After administering the allergens, we wait approximately 15 minutes to review the results. A positive reaction occurs when the skin becomes red, raised, and itchy.

The skin reaction will gradually dissipate within 30-60 minutes. Some people will experience local swelling beginning 4-8 hours after testing. This is not serious and typically no treatment is required. It should disappear in the next few days. Less than 1% of patients may develop a systemic reaction to skin testing, which 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, wheezing, lightheadedness, nausea or vomiting, hives, or anaphylactic shock. This is very rare event that might require further medical evaluation. 

SOME MEDICATIONS INTERFERE WITH TESTING RESULTS: Anti-histamines must be discontinued 5-7 days before skin testing. These are found in many over-the-counter cold medicines, sinus tablets, hay fever medications or pills taken for itchy eyes or skin. Popular drug names include diphenhydramine (Benadryl), chlorpheniramine (Chlor­Trimeton), fexofenadine (Allegra), azelastine (Astelin, Optivar), cetirzine (Zyrtec), promethazine (Phenergan), olopatadine (Patanol, Patanase), ebastine (Evastin, Aleva), and epinastine (Elastat). Claritin, Claritin D, Loratidine, Desloratidine, and Clarinex .  Tricyclic Antidepressants, including amitriptyline (Elavil, Trypitzol, Laroxyl), doxepin (Adapin, Sinequan), imipramine (Tofranil, Janimine, Praminil), nortriptyline (Pamelor,  Aventyl), and propizepine (Depressin, Vagran).

 

 

Pregnant women should not undergo allergy skin testing. A pregnancy test is recommended if you're unsure.

 

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 testing and these questions have been answered.

 

 

 

 

                            

Signature of Patient or Responsible Party                                      Date                                  Print Name of Patient or Responsible Party

 

 

             


Staff Witness                                                                                       Date