Procedure in the allergy office: how and when to perform them
Skin testing : Skin testing may require prolonged contact with
the patients, and there is a risk of fluid body contamination,
especially in children that may cry or cough while doing the procedure.
In the red zone, such a procedure can be delayed as often information is
not essential for the immediate treatment of the patient.
Skin tests can be resumed in yellow/orange zone (Phase 2/3) if
appropriate PPE is available for health care providers like a mask, eye
protection, gowns, and gloves.6,7
Food challenges : food challenges represent the gold standard
for the diagnosis of food allergy, as in vitro and in vivo testing have
not enough specificity and sensitivity to predict tolerance of food in
patients with IgE and not IgE mediated food allergies. For not IgE
mediated food allergies like food protein-induced enterocolitis (FPIES),
no other tests exist besides food challenge.
Introduction of peanuts in patients sensitized to peanuts may prevent
the development of food allergies (LEAP), food challenges or office
maybe be required to introduce peanuts in patients at high risk of
developing peanut allergies who have a positive IgE for peanuts.
Diagnostic food challenges maybe food challenges, can largely be delayed
except for peanut challenge in an infant for peanut introduction due to
LEAP protocol or for introducing a food critical for appropriate
nutrition to avoid intervention like G tube or NG tube
placement.6,7
In the yellow/orange phase, food challenge may be resumed starting for
those patients who are avoiding foods like milk, egg, wheat, or who have
multiple food restrictions to avoid malnutrition and expand diet to
essential foods. As during food challenges prolonged contacted potential
life resuscitation may be required PPE should be worn, and some hospital
may require a negative swab from patients within 72 hours similar to
those patients requiring procedures.