Allergy Testing & treatment

Allergies Explained

Allergies can occur to anyone, anytime. Allergies can affect our daily activities and reduce our quality of lives. Allergy is more common in people with atopy (genetically more prone towards allergy), positive family and personal history of allergic rhinitis, eczema and asthma.

Allergies occur when the body’s immune system reacts to a usual harmless substance (known as an allergen). Allergen normally do not cause any issues in most people, however, in allergic individuals, the body’s immune system identifies the allergen as a threat and mount an inappropriate response to it. This is known as an allergic reaction.

Allergic reaction is triggered when a person is in contact with an allergen, the body recognizes the allergens and triggers a defense response. This leads to the release of a substance known as histamine. Histamine can induce inflammation, swelling, and itching making one feel uncomfortable.

Allergy response involves various organs of the body. In the respiratory tract, one can present with sneezing, runny nose, coughing, wheezing, breathlessness. There is a strong association of allergy with allergic rhinitis and asthma. In the gastrointestinal system, an allergic response can trigger nausea, vomiting, abdominal pain and cramps, or diarrhea.

What are the Common Types of Allergies?

Allergies can occur in numerous types, affecting various parts of the body.

Types of allergies include skin allergy, food allergy, hay fever, allergic rhinitis, eye allergy, insect stings allergies, latex allergy, pet allergies and drug allergies.

Common allergens include protein produced by house dust mites, pollen, molds, pets, medicine, insects such as bees and wasps, as well as food such as peanut, milk and eggs.

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Skin Allergy
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Food Allergy

Are allergies genetic?

You may notice someone in your family having allergies too. Allergies can be hereditary. Allergies are more common in people with a atopy background, with a positive family and personal history of allergic rhinitis, eczema, and or asthma.

Though allergies are more common in children, it can happen at any age. Allergies can resolve over time, and recur many years later.

How do you know You have allergies? What are the Symptoms?

Allergies affect various organs of our body.

In the skin, one commonly presents with itchy, red swelling particularly over the gravity dependent region such as the mouth, lips, eyes, and may have rashes that appear nettled-like (hives) or eczema.

In the respiratory tract, one can develop sneezing, itchy runny nose, cough, wheezing or even breathlessness.

In the gastrointestinal tract, one can develop symptoms such as nausea, vomiting, abdominal pain, cramps or diarrhea.

In severe conditions, one may develop a full-blown allergic reaction that potentially be dangerous. One may present with acute difficulty in breathing, wheezing, throat swelling, lip and mouth swelling, eyes swelling, rashes and a drop in your blood pressure. 

This tends to occur within minutes to hours after exposure to allergen. This condition is known as anaphylaxis. 

You should seek medical assistance immediately in such dire situation, and it is advisable to carry emergency adrenalin pen for standby use.

Allergy sign and symptom

Allergy Testing: Types of allergy Test Available

Allergy testing is offered to detect specific allergens. By identifying the culprit allergens, they can be avoided to preventing future allergic reactions or undergo Immunotherapy as part of the treatment. Allergy testing can be performed via blood tests or skin prick test.

Allergy to specific allergens can be detected via blood tests or skin prick test. Your doctor will discuss with you on the pros and cons of each tests and which option is suitable to individual concerns and condition.

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skin-allergy-test

RAST Blood test is a blood-taking procedure performed via your trained doctor or phlebotomist. The allergy blood test is  used to detect specific IgE antibodies produced against certain allergens. Currently, there are a wide range of allergen panels that can be tested through IgE antibodies blood tests.

This is an alternative to skin-prick test, to measure the amount of allergic antibodies present in a person’s blood.

Skin prick test is a procedure performed over the inner forearm or upper back of a patient. This test allows a possible allergen to come into contact with the cells of your immune system through the skin. It involves introduction of allergens into the skin via small sterile needles that penetrates the skin surface.

This is performed by a drop of a standardized extract of the food on the forearm. The tested area of the skin will be marked and the skin will be pricked with small drops of different allergens. The test is nearly painless, with most patients tolerate the test well with minimal discomfort. Your doctor will review the tested area of the skin, monitor for any evidence of redness, bumpy swelling, and measure the size of swelling (if any). Any itching, redness and swelling may indicate a positive reaction. If you are sensitive towards a particular allergen, you may experience mild redness and itchiness over the tested area.

There is a small theoretical risk of anaphylaxis in skin-prick test. Your doctor will weigh out the risks and benefits of the procedure before offering to you. The test is usually performed in a controlled setting such as an allergy clinic, GP clinic or hospital.

There is a small theoretical risk of anaphylaxis in skin-prick test. Your doctor will weigh out the risks and benefits of the procedure before offering to you. The test is usually performed with close monitoring from your health care providers, in a controlled setting such as an allergy clinic, GP clinic or hospital. Severe reaction to skin prick test is uncommon.

Skin prick test is not suitable for

  • Those with history of anaphylaxis to that particular allergens
  • People with severe skin inflammatory conditions that affect most areas of their skin such as eczema or psoriasis
  • One that is on oral antihistamine and is not able to stop prior skin prick test

Allergy Test Singapore FAQ

Speak to your doctor on your individual concerns and allergy conditions. Your doctor will discuss in detail with you on the pros and cons of each tests before advise further.

This is a relatively simple, and accurate way of detecting an allergy. Skin Prick Test is a procedure performed over the arm of a person. It involves marking of the tested skin area, following the introduction of allergens into the skin. The test is later interpreted by your doctor for any evidence of allergic reaction.

Severe reaction to skin prick test is uncommon. The test is offered in clinic setting with close monitoring from your health care providers. Most people tolerated the procedure well with minimal pain and without any bleeding, though some may experience mild itch and redness over tested skin area.

It varies individually, depending on new onset of allergy symptoms and possible associated new allergen triggers.

It is best that you check with your insurance company about this.

Long term medications such as antidepressants may interfere the results as well.

Please inform your doctor on all the medications that you are consuming.

 

When skin prick test is performed correctly, it is relatively reliable. However, you may have a negative skin prick test, yet develop allergy later on in life. This is known as false negative. This might happen due to:

  • Your body may develop new allergy over time due to repetitive exposure to the allergens.
  • You may be consuming certain medications that lead to a false negative result.
  • Physician variability – Skin prick test is performed by doctors with invariably slight deviation in their methods and skills.

The allergy blood test has the edge of having a test result that is not interfered by medicine that the person is taking. However, there is a chance of false positive and this may cause unnecessary confusion and anxiety to patients.

Yes, you may have a negative skin prick test, yet develop allergy later on in life. This is known as false negative. This might happen due to:

  • Your body may develop new allergy over time due to repetitive exposure to the allergens.
  • You may be consuming certain medications that lead to a false negative result.
  • Physician variability – Skin prick test is performed by doctors with invariably slight deviation in their methods and skills.

 

Allergy blood test takes approximately 1-2 weeks for the results to be ready after laboratory processing.

Skin prick test procedure takes approximately 20-30 minutes and you will be able to obtain a copy of the results on the same day.

Schedule An Appointment For Allergy Testing Today

Food Allergy

Food Allergy occurs when one’s immune system react unusually to a particular food. 

The body defense mechanism mistaken certain protein in certain food as a threat, hence producing an abnormal immune response towards the food. This can affect both adults and children. The incidence of food allergies has increased tremendously over the past few decades.
The actual reason remains elucidated, but it is postulated that there are evolutionary changes in a typical child’s diet over the past 30-40 years. Another belief involves the ‘hygiene hypothesis’.  In our new generation children are increasingly growing up in a ‘germ-free’ environment.
This leads to the body immune system not developing well, as it is not exposed to germs in their early stages of life. When the person is introduced to a certain food in their later life, allergy occurs.

What are the Types of Food Allergies?

The most common type. A specific food triggers the body’s immune system to produce an antibody known as immunoglobulin E (IgE). A patient can develop allergic symptoms a few seconds or minutes after consuming the food. There is a greater risk of anaphylaxis in this type of food allergy.

This is less common. This type of food allergy is not caused by immunoglobulin E, but other cells of the immune system.  The allergy reaction takes longer (up to hours and days) to develop after eating the culprit food.

This occurs in people developing allergy reaction such as itch, swelling over their mouth and throat, directly after eating fresh vegetables and fruits. The body’s immune system produces allergy antibodies against certain proteins in fresh fruits, vegetable, and mistaken them for pollen. Anaphylaxis can occur. The symptoms of oral allergy syndrome can resolve by cooking the fruits and vegetables.

Interestingly, food allergy can be triggered in certain people after eating a particular food and then exercising. In severe cases, anaphylaxis can occur, and this is termed food-dependent exercise-induced anaphylaxis. Avoiding certain food or avoid eating few hours before exercising can prevent this type of allergy.

What are the Symptoms of Food Allergy?

Often food allergic reactions are mild, though they can present with life-threatening symptoms that one should be aware of.

IgE-mediated food allergy causes symptoms within few seconds to minutes after eating certain food. Common symptoms include:

  • Itchiness and flushing over the mouth, throat, or ears
  • Itchy raised red bumpy rashes over body
  • Swelling affecting the face, eyes, lips, tongue
  • Abdominal cramps
  • Diarrhea
  • Nausea or Vomiting
  • Hay fever-like symptoms such as itchy eyes, sneezing

Anaphylaxis. This is a serious allergy condition, that any delay in treatment can result in fatality. Having said that, it is completely reversible if managed promptly. Call 995, if you think yourself or anyone has symptoms of anaphylaxis such as:

  • Breathing difficulty
  • Wheezing
  • Tongue swelling
  • Swallowing or speaking difficulty
  • Feeling lightheaded or dizzy
  • Collapse

None-IgE-mediated food allergy causes allergic reaction much slower after ingesting the food. This can sometimes take up to hours or even days after ingesting the food. Symptoms include:

  • Itchy red bumpy rashes
  • Dry itchy cracked eczematous skin
  • Nausea or vomiting
  • Abdominal cramps
  • Diarrhea
  • Constipation

What are the food that commonly causes Food Allergies?

Almost any food can cause allergic reaction, however common food that can cause allergic reaction include:

  • Egg
  • Peanut
  • Tree nut
  • Shellfish
  • Wheat
  • Fruit & vegetable
  • Milk
  • Soybean
  • Fish

Food intolerance is NOT the same as food allergy.

Food intolerance happens due to difficulty of body to digest certain food such as lactose, gluten, food additives or other food components.

A person with food intolerance presents with symptoms such as abdominal cramps, bloating, and diarrhea. The symptoms of food intolerance usually occur few hours after ingesting the food.

A person with food intolerance usually need to eat a huge amount of that particular food to trigger response, whereas in food allergy, a person only need a small amount of the culprit food for allergic reaction.

Food Allergy Testing & Diagnosis

Your doctor will enquiry further on your symptoms of allergy and history of exposure of the food. Your doctor may offer you skin-prick testing, blood test, or even place you on a food elimination diet.

Food Elimination Diet

Your doctor will advise you to avoid consuming the possible food that causes allergy for 2-6 weeks. The food is later then reintroduced. 

A positive test suggesting food allergy or intolerance is when the symptoms resolved with food avoidance and recur with food re-introduction. 

Depending on individual cases, your doctor may refer you to an Allergist for further evaluation.

Schedule Appointment For Food Allergy Test Today

Food Allergy Treatment Options

The key is to identify the food allergy and avoid the culprit food all together. You may be asked to work together with your doctor for a food diary and management plan:

  • Identify the possible triggering food
  • Avoid the possible triggering food
  • Aware and able to manage the early stages of allergic reaction with antihistamine
  • To be aware of the symptoms of severe allergic reaction and reach out for help
  • Alternative diet replacement to ensure sufficient nutritious diet
  • Injectable Epinephrine
food-allergy-management

In cases of anaphylaxis, your doctor will prescribe you an epinephrine pen (Epi-pen).

Your doctor will teach you how to self-administer the medication in the event of anaphylaxis allergic reaction.

This is a life-saving medication that acts quickly to improve breathing, and swelling over face and lips within seconds. You can repeat inject the medication every 5-15 minutes as needed. You must then go immediately to the Emergency Department for further acute care.

Can Food Allergies Be Cured?

While food allergy has no cure, here are some measures to deal and live with food allergy:

  • Know your food allergens, avoid them.
  • Be watchful for food ingredients labelling. If food labelling is not available, ask before consuming.
  • Carry standby emergency epinephrine pen.
  • Avoid restricting diet during pregnancy or breastfeeding.
  • Take care, eat well.

Schedule An Appointment For Food Allergy Treatment

Skin Allergy

In the skin allergy, one commonly presents with eczema, swelling in particularly over the gravity dependent areas such as the eyes, lips, mouth (angioedema) and develop nettle-like rashes (hives).

Severe Skin Allergic Reaction

Sometimes, the allergic reactions can be very serious and even be life-threatening. This a condition known as anaphylaxis. This usually occurs within minutes to hours where one is exposed to allergen, and presents with acute breathlessness, wheezing, throat swelling, lip and mouth swelling, puffy eyes, rashes, and drop in blood pressure.

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Lip & mouth swelling
eye-eczema
Ecezma around the eyes
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Hives

Those who has a history of anaphylaxis should always carry an emergency adrenaline pen injection known as Epipen. It is a complete reversible condition, yet one can succumb to the condition if delay seeking treatment.

What can You do if You have Skin Allergy?

  • Write a diary on where and when a reaction occurs
  • Reduce the risk of an allergic reaction by avoiding the allergen wherever possible
  • Speak to your doctor, to understand the treatment options available

Skin Allergy Treatment Options

  • Avoidance of the culprit allergens
  • Adequate moisturizer. Consider soothing calming moisturizing cream
  • Antihistamine to ease the irritation, itch, inflammation and swelling
  • Steroid to reduce hypersensitivity, inflammation and swelling
  • Introducing Immunotherapy. This works by desensitizing and down-regulating the body immune system against specific allergen. It is feasible by repeated regular small exposure to specific allergen. Immunotherapy can be administered by sprays underneath the tongue (Sublingual sprays)

Allergy Immunotherapy

Allergy Immunotherapy modifies a person’s body immune response towards allergens, hence easing allergy symptoms. Allergy immunotherapy is performed by repeatedly delivering allergens to an allergic person in hope to change the body’s immune response and de-sensitized the body’s system towards the allergen. Allergy immunotherapy is effective against IgE-mediated allergy, and benefits in particular individuals with a limited type (1 or 2) of allergies.    

How is Allergy Immunotherapy delivered

Allergy Immunotherapy Shots: Immunotherapy shots are delivered via injections in high dosed standardized vaccines containing the allergen every month. Over time, the dose is gradually increased for the body’s immune system to adapt. As there is a risk of unforeseen severe allergic reactions such as anaphylaxis, immunotherapy shots should only be given by trained doctor or immunologist in a controlled setting clinic with standby resuscitation facilities available. The duration of Immunotherapy shots is usually 3-5 years.

Sublingual Immunotherapy (SLIT): Sublingual Immunotherapy is emerging as an an effective and safe alternative form of allergy therapy. SLIT targets a particular allergen, modifying the body’s immune system, allowing it to adapt and de-sensitized against the allergen.  It is useful in allergic respiratory diseases such as allergic rhinitis and asthma.

Furthermore, SLIT has the advantage of self-administration of medication by the patient himself at home.  As the name suggest, sprays or tablets containing allergens are administered under the tongue daily.

The choice of whether considering immunotherapy shots vs sublingual immunotherapy can be determined by patient’s preference with prudent guidance from the trained physician.

Allergy Immunotherapy FAQ

You can consider Allergy Immunotherapy if you are:

  • Your allergy is related to a condition known as IgE-mediated allergy, with positive skin prick test or RAST blood test
  • Inevitably exposed to the allergen
  • You have tried conventional medical treatment without success
  • You have a limited spectrum of allergies
  • You are committed to try immunotherapy for years
  • You are aware of the risks and limitations of immunotherapy

Who are the contraindicated for Allergy Immunotherapy?

  • You should avoid Allergy Immunotherapy if
  • You have an asthma which is poorly controlled
  • You are taking beta-blockers for your heart condition or blood pressure control
  • You have other immune system disease
  • You are less than 5-year old
  • You are pregnant

Medical reviews have shown significant improvement in allergy symptoms with immunotherapy, with reduction in requiring rescue medication, and general improvement of quality of life. Also, immunotherapy has shown long term benefits by modifying the underlying cause of allergy condition. There are several research studies that showed continue long-term benefit of reduction of allergy up to 7-8 years following discontinuation of immunotherapy.

Allergy Immunotherapy is a proven effective treatment for allergic conditions such as allergic rhinitis, asthma, insect sting allergy, and certain individuals with eczema in particularly allergic to airborne allergens such as house dust mite, and animal dander.

The limitation of immunotherapy shots lies on the risk of possible systemic allergic reactions, such as anaphylaxis that can be fatal. Risks factors for systemic reactions include a history of previous systemic reactions, presence of asthma, a history of high sensitivity allergen exposure.

SLIT is a safer option. SLIT is associated with localized symptoms such as itching and tingling of the tongue or mouth, tongue and lip swelling in 50% of patients. The symptoms usually resolve within 1-2 weeks after commencement of treatment.

 

Sublingual Immunotherapy (SLIT) FAQ

  • It is relatively safe and effective in reducing or even treating allergy.
  • It reduces long term allergy medication burden.
  • It is easy to use, can be self-administered at home.
  • It reduces the risk of acquiring asthma.

You do not usually need to stop your other medications for allergy treatment. However, over time, you may need less of your medications as the sublingual immunotherapy has effectively reduce your allergy symptoms.

If you are concerned of any medications interacting with sublingual immunotherapy, you can speak to your doctor.

This is a type of sublingual Immunotherapy that can be administered via a spray underneath the tongue. It comes in a vial with a spray nozzle containing extracts from particular allergens.

Directions for using the SLIT Spray:

  1. Hold the spray with your dominant hand.
  2. Raise your tongue and direct the nozzle spray underneath your tongue.
  3. Repeat the procedure daily.

The effectiveness of the treatment correlates with the length of treatment. A good medication compliance promises a better long-run sustaining effect of reduced allergy symptoms or even an allergy cure.

Effectiveness of SLIT Spray. You are expected to see some functional results within the first year of treatment. You should experience lesser allergy symptoms.

The recommended duration of treatment is 3-5 years. In the event of you stopping the treatment before 3 years, the effectivity of allergy improvement may not sustain over time.

You may experience temporary side effects such as mild itching or swelling over the administered site. However, as the spray covers a wide surface area of the mouth, the side effects might be lesser in comparison to tablets.

Where should I store my SLIT Spray?

You are advised to keep the spray in the refrigerator at a temperature of 2-8C. Having said that, the spay is safe and stable at a temperature below 25C.

Any Travelling Tips?

It is relatively hassle-free. Check with your airlines, as passengers are usually allowed to hand carry when travel by air, and stored it in a small bag with an ice pack.

Is there are other options of Sublingual Immunotherapy?

Yes, speak to your doctor for other options.

 

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