What are Ocular Allergies?
Many people suffer from ocular allergies which can manifest themselves as itching, burning, tearing, and irritation of the eyes, which may be accompanied by a runny nose and scratchy throat. A rash involving the eyelids is also common. Ocular allergies are common in people who suffered from allergies earlier in life, but may occur at any time. Ocular allergies may co-exist with dry eye syndrome, blepharitis, and other conditions that cause similar symptoms.
What is Allergy Skin Testing?
Allergy skin testing is a method of testing patients for allergic antibodies that indicate allergies to specific substances called allergens. Skin testing consists of scratching the superficial layer of skin and introducing a drop of allergen into the skin and noting the development of a positive reaction which may consist of localized swelling (a wheal), redness, and itching, 15-20 minutes later. Skin testing will usually be performed on your arms, and sometimes on your back, with multiple scratch tests being performed simultaneously. You will be tested to important environmental airborne allergens which include trees, grasses, weeds, molds, dust mites, and animal dander that are specifically associated with ocular allergies. Interpreting the clinical significance of skin tests requires skillful correlation of the test results with the patient’s clinical history. A positive skin test indicates the presence of allergic antibodies to an allergen, and is often correlated with the clinical symptoms outlined above. The red, raised, itchy bump associated with a positive skin test usually requires no treatment. Your doctor may apply some anti-itch medication to the test sites on the skin to alleviate any discomfort. These bumps should gradually disappear over 30-60 minutes. Occasionally, localized swelling at a test site may begin 4-8 hours after the skin test was applied, and although these reactions are not serious, they should be reported to your doctor.
Why get Allergy Skin Testing?
Allergy skin testing will help to confirm whether or not you suffer from environmental allergies, which will assist your doctor in devising an effective treatment plan for you, which may include eye drops, ointments, pills and avoidance therapy. The symptoms of ocular allergies can mimic other diseases that would require different treatment plans.
What are the risks of Allergy Skin Testing?
Skin testing will be administered at this facility under the supervision of your physician or other health care professional since occasional reactions may occur and require immediate treatment. Allergy skin testing will not affect your vision, will not affect underlying conditions like glaucoma or macular degeneration, and will not make your allergies worse. Adverse reactions to allergy skin testing may include: itchy eyes, nose or throat; nasal congestion; runny nose; tightness in the throat or chest; increased wheezing or exacerbation of asthma; lightheadedness; faintness; nausea and vomiting; hives; generalized itching; anaphylaxis; and very rarely, shock. Please note that these adverse reactions rarely occur, but in the event that they would occur, the physician and staff are fully trained and emergency equipment and medication are available. Please notify your physician if you are pregnant, as this skin testing should be delayed until after the pregnancy, in the unlikely event of an adverse reaction. Please notify your physician if you are taking a beta blocker as this may influence the treatment of an adverse reaction.
Alternatives to Allergy Skin Testing
One can be referred to an allergist/immunologist or ear, nose, and throat specialist for skin testing if they so desire. The risks of allergy skin testing with these other type physicians remains the same. One can refuse the allergy skin testing and have their physician use their best clinical judgment as to whether or not you have ocular allergies.
Treatment Options for Ocular Allergies
In the event you have positive skin test results for airborne allergies, there are several treatment options. Avoidance of the specific allergens is one effective treatment modality. Topical anti-allergy eye drops are often effective. Topical steroid eye drops are another effective form of treatment, but there are risks of elevated intraocular pressure, cataract formation, and worsening of some ocular infections. Sublingual immunotherapy is a relatively new treatment modality that avoids the need for injections, and consists of placing medication under the tongue to combat the allergic symptoms. The risks of sublingual immunotherapy include itching or swelling of the lips, mouth, or ears; hives; angioedema; and anaphylaxis.
General Medications to discontinue before Allergy Skin Testing (See Meds to Avoid List)
No oral anti-histamines (both over the counter and prescription forms) should be used for 5 days prior to the scheduled allergy skin testing. These oral anti-histamines include cold tablets, sinus tablets, hay fever medication, oral treatments for itchy skin, and allergy medications.
-Over the counter products to stop include the following medications: Claritin, Zyrtec, Allegra, Actifed, Dimetapp, Benadryl, Tylenol PM, and many others.
-Prescription anti-histamines to stop include: Clarinex and Xyzol.
-If you have any questions about whether or not to discontinue a medication, please ask the doctor.
No nasal or ocular anti-histamine medications should be used for 5 days prior to scheduled allergy skin testing.
The preparations to stop include: Patanase, Pataday, Patanol, Zaditor, Astepro, Optivar, and Astelin.
Medications to continue before Allergy Skin Testing
Steroid nasal allergy sprays may be continued prior to testing
These steroid nasal sprays include: Flonase, Rhinocort, Nasonex, Nasacort, Omnaris, Veramyst, and Nasarel.
Asthma inhalers should be continued prior to testing
Includes Albuterol and VoSpire ER
Oral leukotriene antagonists should be continued prior to testing
Includes Singulair and Accolate
Oral theophylline should be continued prior to testing
Includes Theo-Dur, T-Phyl, Uniphyl, Theo-24, etc.