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Stinging Insect Allergy

Tips to Remember: Stinging Insect Allergy

Each year, many Americans are stung by insects. For most, these stings mean pain and discomfort generally lasting only a few hours. Symptoms may include redness, swelling and itching at the site of the sting.

However, some people are allergic to insect stings. This means that their immune systems overreact to the venom injected by a stinging insect. After the first sting, the allergic person's body produces an allergic substance called Immunoglobulin E (IgE) antibody, which reacts with the insect venom. If he or she is stung again by an insect of the same or similar species, the insect venom interacts with the IgE antibody produced in response to the earlier sting. This triggers the release of histamine and other chemicals that cause allergic symptoms.

Symptoms of severe reactions

For a small number of people with severe venom allergy, stings may be life-threatening. Severe allergic reactions to insect stings can involve many body organs and may develop rapidly. This reaction is called anaphylaxis. Symptoms of anaphylaxis may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness. Anaphylaxis is a medical emergency, and may be fatal. If you or anyone else experiences any of these symptoms after an insect sting, obtain emergency medical treatment immediately. After your symptoms are treated in the emergency room, you should also obtain referral to an allergist/immunologist to learn about treatment options.

Identifying stinging insects

To avoid stinging insects, it is important to learn what they look like and where they live. Most sting reactions are caused by five types of insects: yellow jackets, honeybees, paper wasps, hornets and fire ants.

Yellow jackets are black with yellow markings, and are found in various climates. Their nests, which are made of a papier-mach� material, are usually located underground, but can sometimes be found in the walls of frame buildings, cracks in masonry or woodpiles.

Honeybees have a rounded, "fuzzy" body with dark brown coloring and yellow markings. Upon stinging, the honeybee usually leaves its barbed stinger in its victim; the bee dies as a result. Honeybees are nonaggressive and will only sting when provoked. However, Africanized honeybees, or so-called "killer bees" found in the southwestern United States and South and Central America, are more aggressive and may sting in swarms. Domesticated honeybees live in man-made hives, while wild honeybees live in colonies or "honeycombs" in hollow trees or cavities of buildings. Africanized honeybees may nest in holes in house frames, between fence posts, in old tires or holes in the ground, or other partially protected sites.

Paper wasps' slender, elongated bodies are black, brown, or red with yellow markings. Their nests are also made of a paper-like material that forms a circular comb of cells which opens downward. The nests are often located under eaves, behind shutters, or in shrubs or woodpiles.

Hornets are black or brown with white, orange or yellow markings and are usually larger than yellow jackets. Their nests are gray or brown, football-shaped, and made of a paper material similar to that of yellow jackets' nests. Hornets' nests are usually found high above ground on branches of trees, in shrubbery, on gables or in tree hollows.

Fire ants are reddish brown to black stinging insects related to bees and wasps. They build nests of dirt in the ground that may be quite tall (18 inches) in the right kinds of soil. Fire ants may attack with little warning: after firmly grasping the victim's skin with its jaws, the fire ant arches its back as it inserts its rear stinger into the skin. It then pivots at the head and may inflict multiple stings in a circular pattern. Fire ant venom often causes an immediate burning sensation.

Preventing stings

Stay out of the "territory" of the stinging insects' nests. These insects are most likely to sting if their homes are disturbed, so it is important to have hives and nests around your home destroyed. Since this activity can be dangerous, a trained exterminator should be hired.

If you encounter any flying stinging insects, remain calm and quiet, and move slowly away from them. Many stinging insects are foraging for food, so don't look or smell like a flower - avoid brightly colored clothing and perfume when outdoors. Because the smell of food attracts insects, be careful when cooking, eating, or drinking sweet drinks like soda or juice outdoors. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot. Also, avoid loose-fitting garments that can trap insects between material and skin.

Treating stings

If you are stung by a honeybee that has left its stinger (and attached venom sac) in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of a fingernail removes the stinger and sac. Avoid squeezing the sac - this forces more venom through the stinger and into the skin. Hornets, wasps, and yellow jackets do not usually leave their stingers. Try to remain calm, and brush these insects from the skin promptly with deliberate movements to prevent additional stings. Then, quietly and immediately leave the area.

If you are stung by fire ants, carefully brush them off to prevent repeated stings, and leave the area. Fire ant stings usually result in the development of a blister about 24 hours after the sting. The material in this will become cloudy and appear to be pustular. IT IS NOT! Fire ant venom kills bacteria, this is just dead tissue and should be left alone. It will dry and heal within the next 7 - 10 days. If the blister is opened it must be monitored for secondary bacterial infection. Diabetics and others with circulatory disorders, including varicose veins and phlebitis, can be particularly at risk for complications, and should see a physician to monitor their condition after being stung. Up to 50% of patients develop large local reactions at the site of fire ant stings - swelling may last for several days and may be accompanied by itching, redness and pain.

Taking the following steps can help in treating local reactions to insect stings

  • Elevate the affected arm or leg and apply ice or a cold compress to reduce swelling and pain.
  • Gently clean blisters with soap and water to prevent secondary infections; do not break blisters.
  • Use topical steroid ointments or oral antihistamines to relieve itching.
  • See your doctor if swelling progresses or if the sting site seems infected.

If you are severely insect-allergic and have had prior reactions, try to avoid being outdoors in case you require prompt emergency treatment. Carry an auto-injectable epinephrine (adrenalin) device, a short-term treatment for severe allergic reactions. Learn how to self-administer the epinephrine according to your allergist/immunologist's instructions, and replace the device before the labeled expiration date.

Remember that injectable epinephrine is rescue medication only, and you must still have someone take you to an emergency room immediately if you are stung. Additional medical treatment may be necessary. Those with severe allergies may want to consider wearing a special bracelet or necklace that identifies the wearer as having severe allergies and supplies other important medical information.

Consulting your allergist

Anyone who has had a serious adverse reaction to an insect sting should be evaluated by an allergist/immunologist, who will take a thorough history, perform an examination and recommend testing to determine whether you have an allergy, and which type of stinging insect caused the reaction. Skin or blood (RAST) testing for insect allergy is used to detect the presence of significant amounts of IgE antibody.

Your allergist/immunologist will help you determine the best form of treatment. People who have severe allergies to insect venom should consider receiving insect venom immunotherapy, a highly effective vaccination program that actually prevents future allergic sting reactions in 97% of treated patients. During immunotherapy, the allergist/immunologist administers gradually stronger doses of venom extract initially every week, but as maintenance doses are reached the interval may sometimes be expanded to one month or more.

If you have questions about venom immunotherapy or other treatments for stinging insect allergy, be sure to ask your allergist/immunologist. Patients who receive appropriate treatment such as immunotherapy and who practice careful avoidance measures can participate in regular outdoor activities.

Your allergist/immunologist can provide you with more information on stinging insect allergy.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.

Latex Allergy

Tips to Remember: Latex Allergy

Allergy to proteins in natural rubber latex became a significant concern by the late 1980s. Fortunately however, the epidemic of new cases of latex allergy appears to have crested in the 1990s. Latex allergy appears to have originated from an increased use of latex gloves over the past decade due to infection precaution policies that have been instituted at health care facilities, and changes in processes used to manufacture latex products.

What is latex?

Latex is a milky fluid produced by rubber trees (Hevea brasiliensis). Using different methods, latex can be processed into a variety of products, such as gloves and balloons. During manufacturing, chemicals are added to increase the speed of curing (vulcanization) and to protect the rubber from oxygen in the air.

Products made from blends of natural rubber latex and other compounds are very common. In those with latex allergy, allergic reactions are most often triggered by dipped latex products. Products that commonly cause reactions can include gloves, balloons and condoms.


In rare instances, people who are allergic to latex may also react to rubber bands, erasers, rubber parts of toys, various rubber components in medical devices, rubber elastic in clothes, or feeding nipples and pacifiers. Products molded from hard, crepe rubber, such as soles of shoes, are unlikely to cause reactions. Almost all latex paints are not a problem since they do not contain natural rubber latex.

Types of allergic reactions

There are two types of allergic reactions to latex. The first is delayed-type contact dermatitis, a poison ivy-like rash that appears 12-36 hours after contact with a latex product. This most commonly appears on the hands of people who wear latex gloves, but it may occur on other parts of the body following contact with rubber products. The prevalence of this form of latex allergy does not seem to be increasing. Contact dermatitis is usually the result of sensitization to chemicals that are added during rubber processing. While very irritating, this form of allergy is not life-threatening.

Immediate, or IgE antibody-mediated allergic reactions, are potentially the most serious form of allergic reactions to latex. Like other common forms of allergy, these reactions occur in people who have previously been exposed to latex and have become sensitized (latex-specific IgE antibody positive). With re-exposure, symptoms such as itching, redness, swelling, sneezing, and wheezing may occur. Rarely, a person will experience life-threatening symptoms. This severe allergic reaction is called anaphylaxis, and is characterized by symptoms such as shock, severe trouble breathing or loss of blood pressure. If not immediately treated, it can be fatal.

The severity of the immediate reaction depends upon the person's degree of sensitivity and the amount of latex allergen to which the person is exposed. The greatest danger of severe reactions occurs when latex comes into contact with moist areas of the body or internal surfaces during surgery, because more of the allergen can rapidly be absorbed into the body.

Latex can also become airborne and cause respiratory symptoms. For example, latex proteins can adhere to the cornstarch powder used in latex gloves. As powdered latex gloves are used, the starch particles and latex allergens become airborne, where they can be inhaled or come into contact with the nose or eyes and cause symptoms. High concentrations of this allergenic powder have been measured in intensive care units and operating rooms. The use of non-powdered latex gloves, or synthetic (vinyl, nitrile) gloves reduces the risk of these reactions. The capacity of latex products-especially gloves-to cause allergic reactions varies enormously by brand and by production lot.


Certain groups of individuals who are frequently exposed to latex are at high risk for developing immediate allergic reactions. Individuals with spina bifida (a congenital problem in the development of the back) and those with congenital urinary tract problems who need multiple surgeries seem to have a risk of nearly 50%. Health care workers and others whose jobs require wearing latex gloves or working around them have a risk of about 10%. Others who may be at increased risk are those who have had many medical or surgical procedures, resulting in repeated exposure to latex gloves. Rubber industry workers also are at increased risk. Even in normal adults, the risk of sensitization to latex may be as high as 6%.

People with latex allergy may also experience an allergic reaction to some foods that contain some of the same allergenic proteins as those in latex. This reaction, called cross-reactivity, can be triggered by bananas, avocados, kiwi fruit, and European chestnuts.

Evaluation and treatment

The first step in treating latex allergy is awareness of the problem. Visit your allergist/immunologist if you think you may have symptoms of latex allergy. After taking a detailed history and examining you, your doctor will decide whether additional diagnostic tests for latex allergy are needed. If you are allergic to latex, you should avoid contact with natural rubber latex products as much as possible. Inform your family, health care professionals, employer and school personnel about your allergy. Discuss with your physician whether you should wear a special bracelet or necklace that notifies others of your allergy. Your doctor will also determine whether you should carry injectable adrenalin (epinephrine) to provide immediate, emergency treatment in case you experience a severe allergic reaction.

If you have reactions to latex, see an allergist/immunologist. The 1990 Americans with Disabilities Act (ADA) covers people with severe allergies to substances such as latex. If you are otherwise qualified but can no longer work with latex in a job setting because of your allergy, work with your employer to determine other options and make reasonable accommodations. If you are allergic and need to wear gloves, or are in contact with persons wearing gloves, there are several options.

You may try substituting synthetic (vinyl or nitrile) gloves for latex gloves, although they may not work as well in some situations. These work in nearly all situations where latex gloves work, including surgery, but in some cases, they are more expensive. For individuals with contact dermatitis reactions to latex, latex gloves made without additional chemicals may work.

If you have significant latex allergy respiratory symptoms from inhaling latex particles, you need to avoid areas where powdered gloves are used frequently. Ideally, all high glove use areas should use powder-free gloves to avoid allergic reactions. Using latex condoms can be a severe problem for some latex-allergic people. One option is natural skin condoms. These do not contain latex and can prevent pregnancy, but they do not protect against viruses like HIV, which cause AIDS, or some other sexually-transmitted diseases (STDs). Synthetic rubber condoms, created to prevent both pregnancy and STDs, are now available.

Manufacturers are currently working to produce latex products that contain less latex allergen. As these products become more available, the risk of reactions in people sensitive to latex, as well as the risk of more people developing latex allergy, should decrease.

Your allergist/immunologist can provide you with more information on latex allergy.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.

Allergic Reaction

Tips to Remember: Allergic Reaction

Approximately 50 million Americans suffer from some form of allergic disease, and the incidence is increasing. When most of us think of allergies, we think of sneezing, a runny nose or watery eyes. While those are symptoms of some types of allergic disease, an allergic reaction is actually a product of several events occurring within your immune system.

The immune system


The immune system serves as the body's defense mechanism against the countless different substances present in the air we breathe, the foods we eat, and the things we touch. Within this immense group of materials, the term "allergen" refers to any substance that can trigger an allergic response. Common allergens include pollen, mold, animal dander, and cockroach and house dust mite droppings.

Antibodies circulate in the bloodstream and are present in almost all bodily fluids. They help to capture unwanted invaders. People who have allergies have an antibody called Immunoglobulin E, or IgE. When allergens first enter the body of a person predisposed to allergies, a series of reactions occurs and allergen-specific IgE antibodies are produced. Following IgE production, these antibodies travel to cells called mast cells, which are particularly plentiful in the nose, eyes, lungs and gastrointestinal tract. The IgE antibodies attach themselves to the surface of the mast cells and wait for their particular allergen.

Each type of IgE has specific "radar" for one type of allergen only. That's why some people are only allergic to cat dander (they only have the IgE antibodies specific to cat dander) and others seem to be allergic to everything (they have many more types of IgE antibodies.)

The next time an allergic individual comes into contact with the allergens to which he or she is sensitive, the allergens will be captured by the IgE. This initiates the release of chemical "mediators" such as histamine and other chemicals from the mast cells. These mediators produce the symptoms of an allergic reaction, such as swelling of tissues, sneezing, wheezing, coughing and other reactions.

The allergic reaction typically continues: these newly released mediators recruit other inflammatory cells to that site, resulting in additional inflammation. Many symptoms of chronic allergic disease - such as swelling, excessive mucus and hyperresponsiveness to irritating stimuli-are the result of tissue inflammation due to ongoing exposure to allergens.

It is not yet fully understood why some substances trigger allergies and others do not, nor why every person does not develop an allergic reaction after exposure to allergens. A family history of allergies is the single most important factor that predisposes a person to develop allergic disease. If one parent has allergic disease, the estimated risk of the child to develop allergies is 48%; the child's risk grows to 70% if both parents have allergies.

Types of allergic disease

The existence of IgE antibodies is common to all forms of allergic disease. But the physical symptoms differ depending on the type of mediator released and where they act. When a person with allergies begins to experience symptoms, key questions are: What allergens am I reacting to? When, and how much, am I exposed to these substances?

Major allergic diseases include:

  • Allergic rhinitis, or "hay fever;"
  • Allergic conjunctivitis (an eye reaction);
  • Asthma;
  • Atopic dermatitis, or allergic skin reactions;
  • Urticaria, also known as hives;
  • Severe allergic reactions to substances such as food, latex, medications, and insect stings;
  • And problems commonly resulting from allergic rhinitis-sinusitis and otitis media (ear infections).

Symptoms of allergic rhinitis, commonly referred to as "hay fever," occur when allergens touch the lining of the nose - called the mucus membranes - of a person who is sensitive to that particular allergen. Allergic rhinitis is characterized by congestion, itching and dripping of the nose and itchy, watery eyes. If the person continues to have daily, ongoing exposure to the responsible allergen(s), the symptoms will continue. Similar to allergic rhinitis, allergic conjunctivitis occurs when the eyes react to allergens with symptoms of reddening, itching and swelling.

Symptoms of atopic dermatitis, also called eczema, often result from allergen exposure to the skin. Dermatitis symptoms include itching, reddening, and flaking or peeling of the skin. Symptoms begin in childhood for 80% of those with atopic dermatitis. Dermatitis often precedes other allergic disorders; over 50% of those with atopic dermatitis also develop asthma.

Urticaria, or hives, another allergic skin reaction, is characterized by itchy red bumps that can occur in clumps and be either large or small. Hives are often triggered by infection, certain foods or medications. Foods commonly associated with hives include nuts, tomatoes, shellfish and berries. Medications include penicillin, sulfa, anti-seizure medications, phenobarbital and aspirin.

Asthma is a chronic lung disease that affects more than 17 million Americans and is characterized by coughing, chest tightness, shortness of breath and wheezing. Allergic rhinitis is considered a risk factor in developing asthma: up to 78% of those with asthma also have allergic rhinitis.

When an individual experiences asthma symptoms, the inflamed airways become constricted so it becomes more difficult to breathe through the narrowed air passages. For those with allergies, inhaling allergens may produce increased inflammation of the airway lining and further narrowing of the air passages. Asthma may also occur as a result of other stimuli, such as respiratory tract infections or exposure to irritants.

Individuals who have allergies to specific foods may have severe and possibly life-threatening reactions if they eat them. The most common food allergy triggers are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. Food allergy occurs more frequently in children than adults. Many of these children may lose their sensitivity to particular foods over time.

Foods and other allergens, including penicillin, insect stings and latex, can trigger a severe, systemic allergic reaction called anaphylaxis. Anaphylaxis is caused by swelling throughout the body, and can involve several organ systems. Symptoms of anaphylaxis include a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. Other symptoms may include feelings of light-headedness, shortness of breath, severe sneezing, anxiety, stomach or uterine cramps, and/or vomiting and diarrhea. In severe cases, patients may experience a drop in blood pressure that results in a loss of consciousness and shock. Without immediate treatment with an injection of epinephrine (adrenalin), anaphylaxis may be fatal.

Sinusitis and otitis media are other common allergic diseases that often are triggered by allergic rhinitis. Sinusitis is an acute or chronic inflammation of the nasal sinuses, which are hollow cavities within the cheek bones found around the eyes and behind the nose. This condition affects over 15% of the U.S. population. Otitis media - or ear infections - is the most common childhood disease requiring physician care. If not properly treated, it can affect a child's speech and language development. You can learn more about various allergic diseases by reading the appropriate Tips brochures in this series.

Diagnosing and treating allergic reactions

An allergist/immunologist is best qualified to treat allergic diseases. To determine if you have an allergy, your allergist/immunologist will take a thorough medical history and perform an exam. If indicated, he or she will then perform allergy skin testing, or sometimes blood testing, to determine precisely which substance is causing your allergy. Once your allergy triggers are identified, your physician can help you establish a treatment program. The first step is to minimize your exposure to your particular allergens to whatever extent possible. Your physician may also prescribe medications to reduce allergic symptoms as well as inflammation.

Immunotherapy, also known as allergy shots or vaccinations, may also be recommended to modify your immune response. For many patients, immunotherapy can help diminish their reactions to allergens. Please see the Tip brochure in this series for more information on allergy shots.

In summary, an allergic reaction is a complex chain of events that involves many cells, chemicals and tissues throughout the body. While there is not yet a cure for allergic disease, there are many treatments available to lessen symptoms. See your allergist/immunologist to determine the best course of treatment.

Your allergist/immunologist can provide you with more information on allergic reactions.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.

Allergy Testing

Tips to Remember: Allergy Testing

If you are allergic, you are reacting to a particular substance. Any substance that can trigger an allergic reaction is called an allergen. To determine which specific substances are triggering your allergies, your allergist/immunologist will safely and effectively test your skin, or sometimes your blood, using tiny amounts of commonly troublesome allergens.

Allergy tests are designed to gather the most specific information possible so your doctor can determine what you are allergic to and provide the best treatment.

Who should be tested for allergies?


Adults and children of any age who have symptoms that suggest they have an allergic disease. Allergy symptoms can include:

  • Respiratory symptoms: itchy eyes, nose, or throat; nasal congestion, runny nose, watery eyes, chest congestion or wheezing
  • Skin symptoms: hives, generalized itchiness or atopic dermatitis
  • Other symptoms: anaphylaxis (severe life-threatening allergic reactions), abdominal symptoms (cramping, diarrhea) consistently following particular foods, stinging insect reactions other than large local swelling at the sting site.

Generally, inhaled allergens such as dust mites, tree, grass or weed pollens will produce respiratory symptoms and ingested (food) allergies will produce skin and/or gastrointestinal symptoms or anaphylaxis but both types of allergens (ingested and inhaled) can produce the spectrum of allergy symptoms.

What are the reasons for undergoing allergy skin testing?

To help you manage your allergy symptoms most effectively, your allergist/immunoloigst must first determine what is causing your allergy. For instance, you don't have to get rid of your cat if you are allergic to dust mites but not cats.

Allergy tests provide concrete specific information about what you are and are not allergic to. Once you have identified the specific allergen(s) causing your symptoms, you and your physician can develop a treatment plan aimed at controlling or eliminating your allergy symptoms. With your allergy symptoms under control you should see a considerable improvement in the quality of your life. Improved sleep quality because of less congestion, days without constant sneezing and blowing your nose, improved ability to exercise, and better control of your atopic dermatitis (eczema) are some of improvements you may gain from your allergy treatment plans.

Which allergens will I be tested for?

Because your physician has made a diagnosis of allergies, you know that one or more allergens is causing your allergic reaction - itching, swelling, sneezing, wheezing, and other symptoms. Your symptoms are probably caused by one of these common allergens:

  • Products from dust mites (tiny bugs you can't see) that live in your home;
  • Proteins from furry pets, which are found in their skin secretions (dander), saliva and urine (it's actually not their hair);
  • Molds in your home or in the air outside;
  • Tree, grass and weed pollen; and/or cockroach droppings.

More serious allergic reactions can be caused by:

  • Venoms from the stings of bees, wasps, yellow jackets, fire ants and other stinging insects;Foods;
  • Natural rubber latex, such as gloves or balloons; or
  • Drugs, such as penicillin.

Types of Allergy Tests

Prick Technique: The prick technique involves introducing a small amount of allergen into the skin by making a small puncture through a drop of the allergen extract. If you have an allergy, the specific allergens that you are allergic to will cause a chain reaction to begin in your body.

People with allergies have an allergic antibody called IgE (immunoglobulin E) in their body. This chemical, which is only found in people with allergies, activates special cells called mast cells. These mast cells release chemicals called mediators, such as histamine, the chemical that causes redness and swelling. With testing, this swelling occurs only in the spots where the tiny amount of allergen to which you are allergic has been introduced. So, if you are allergic to ragweed pollen but not to cats, the spot where the ragweed allergen touched your skin will swell and itch a bit, forming a small dime-sized hive. The spot where the cat allergen scratched your skin will remain normal. This reaction happens quickly within your body.

Test results are available within 15 minutes of testing, so you don't have to wait long to find out what is triggering your allergies. And you won't have any other symptoms besides the slightly swollen, small hives where the test was done; this goes away within 30 minutes.

Intradermal: involves injecting a small amount of allergen under the skin with a syringe. This form of testing is more sensitive than the prick skin test method. This form of allergy testing may be used if the prick skin tests are negative.

Other Allergy Testing Techniques

Scratch tests: The term scratch test refers to a technique not commonly used at the present, which involves abrading the skin and then dropping the allergen on the abraded site.

Challenge testing: Involves introducing small amounts of the suspected allergen by oral, inhaled or other routes. With the exception of food and medication, challenges are rarely performed. When they are performed, they must be closely supervised by an allergist/immunologist.

Blood (RAST) test-Sometimes your allergist/immunologist will do a blood test, called a RAST (radioallergosorbent) test. Since this test involves drawing blood, it costs more, and the results are not available as rapidly as skin tests. RAST tests are generally used only in cases in which skin tests cannot be performed, such as on patients taking certain medications, or those with skin conditions that may interfere with skin testing.

Other types of allergy testing methods the American Academy of Allergy, Asthma and Immunology considers to be unacceptable are: applied kinesiology (allergy testing through muscle relaxation), cytotoxicity testing, urine autoinjection, skin titration (Rinkel method), provocative and neutralization (subcutaneous) testing or sublingual provocation. If your physician plans to conduct any of these tests on you, please see an AAAAI member allergist/immunologist for appropriate allergy testing.

Who can be tested for allergies?

Adults and children of any age can be tested for allergies. Because different allergens bother different people, your allergist/immunologist will take your medical history to determine which test is the best for you. Some medications can interfere with skin testing. Antihistamines, in particular, can inhibit some of the skin test reactions. Use of antihistamines should be stopped one to several days prior to skin testing.

Your allergist/immunologist can provide you with more information on allergy testing.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.

Dust Mite Control

Tips to Remember: Dust Mite Control

All mattresses and box springs in the room should have special dust proof covers, which encase the mattress on the top and bottom and the four sides. The correct type of cover is the kind that you slip the mattress into and close with a zipper. These covers are generally made of plastic or a special impervious material, and they are available from department and medical supply stores. Since dust mites or their particles could escape through the zipper seam, you should seal it shut with wide plastic tape. When you change the bed, check for leaks or cracks and seal them with tape. For comfort, you may put a washable quilted top mattress cover on top of the plastic one. If you always wanted a waterbed (and your house can support the weight), note that dust mites do not collect in a waterbed mattress.

Get washable, polyester pillows, and take the patient�s pillow along when traveling. Avoid feather and foam rubber pillows, as they will not be the same after they are washed. Wash the pillow in very hot water every two or three week to kill the dust mites. Warm or cold water does not kill the dust mites. Be sure to dry the pillows completely, or they might grow mildew. If this is not possible for you, you must encase your pillows with special dust proof covers. This should be done for all the pillows present on patient�s bed.

Wash all bedding in hot water every 2-3 weeks. Do not use bed linens, mattress covers, blankets, and spreads that are not washable.

Dust mites can also live in carpets. Benzyl Benzoate kills dust mite and Tannic Acid inactivates the dust mite proteins. Carpets must be treated with above chemicals once every two months. When carpet wears out, it is preferable to replace wall to wall carpeting with tile or linoleum, or to refinish your hardwood floors. Use small washable area rugs where needed.

Remove as many other sources of dust from the bedroom as possible. This includes bookshelves and books. As many things as possible in the room should be washable. Upholstered furniture is not a good idea. Washable curtains are better than dry-cleanable heavy drapes. Blinds are hard to keep dusted. Ceiling fans should be cleaned monthly.

Washable stuffed toys should be used, since dust mites would collect in a favorite teddy bear. Alternatively, remove the stuffing from an older toy, and replace it with washable stuffing. Collections of stuffed toys should be relocated from the bedroom to another room or to the closet.

The door to the bedroom and the closet door should be kept closed as much as possible. The bedroom closet should be used only for clothing in current use.

The central return filter of the heating and air conditioning unit should be changed or cleaned at least monthly. The circulating fan of the unit can be left on to optimize filtering capacity. Heating and air conditioning vents for the room should be covered with cheesecloth, glass wool, or nylon, and this should be changed monthly. Holes or other openings around pipes, and in the floor and walls should be sealed permanently.

Clean the room thoroughly with a cloth or a mop dampened with water. Dry dusting will only scatter dust particles around. Repeat this weekly to keep dust under control. The patient should be out of the room while this is done, and for two hours afterward, since any cleaning stirs up some dust mite particles. An allergic person doing the cleaning should wear a disposable mask that covers the nose and mouth.

Even if the patient is not presently allergic to animal dander, pets should not be permitted in the bedroom. Under no circumstances should a pet be allowed to sleep on the bed of an allergic patient. Remember that people are not born with allergies, but develop them after exposure.

Other ways of taking care of dust mites have been proposed. A variety of home air filtration devices are available. Since dust mite particles are relatively heavy, they quickly settle out of the air, so these filtration devices are not particularly useful. Beware of exaggerated claims for appliances that are sold for air purification. Even ordinary vacuum cleaners have been promoted for preventing or treating respiratory ailments. Although some air cleaners are capable of removing dust form the air, much of the dust they remove is inert, and no air purifier can truthfully be promoted for treating viral or bacterial illness such as colds, influenza, pneumonia, or tuberculosis.

Allergy Shots

Tips to Remember: Allergy Shots

This brochure is designed to answer the basic who, what, when, where, how and why questions you may have regarding allergen immunotherapy, also known as "allergy shots."

What is immunotherapy?

Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to substances called allergens. These allergens are identified by allergy testing, and are the substances that trigger your allergy symptoms when you are exposed to them. Allergen immunotherapy involves injecting increasing amounts of an allergen to a patient over several months. Immunotherapy has been shown to prevent the development of new allergies and, in children, it can prevent the progression of the allergic disease from allergic rhinitis to asthma. Allergen immunotherapy can lead to the long-lasting relief of allergy symptoms after treatment is stopped.

Who should be treated with immunotherapy?

Immunotherapy is only recommended for allergic asthma, allergic rhinitis and conjunctivitis, and stinging insect allergy. Immunotherapy for food allergies is not recommended. The best option for people with food allergies is to strictly avoid that food. The decision to begin immunotherapy will be based on several factors including:

  • Length of allergy season and severity of symptoms.
  • How well medications and/or environmental controls control allergy symptoms.
  • Desire to avoid long-term medication use.
  • Time: immunotherapy will require a significant time commitment.
  • Cost: may vary depending on region and insurance coverage.

Can children receive immunotherapy?

Five is the youngest recommended age to start immunotherapy in the United States for several reasons, including the difficulties younger children may have in cooperating with the immunotherapy program. Recent studies have suggested immunotherapy may prevent the development of new allergies in children and also may prevent the development of asthma in children who have rhinitis.

There is no upper age limit for receiving immunotherapy. In considering immunotherapy in older persons, consideration must be given to the other medical conditions (such as cardiac disease) that are more frequent in older individuals, which could potentially make immunotherapy more risky.

Where should immunotherapy be given?

Immunotherapy should be given under the supervision of a physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in the prescribing allergist/immunologist's office but if this is not possible, your allergist/immunologist should provide the supervising physician with comprehensive instructions about your immunotherapy treatment.

How does immunotherapy work?

If you are allergic to a substance such as ragweed, you will not overcome your allergy by repeatedly inhaling ragweed into your nose or lungs. So, how can a series of injections that include the substances that trigger your allergies, relieve your allergy symptoms?

Allergen immunotherapy works like a vaccine. Your body responds to the injected amounts of a particular allergen, given in gradually increasing doses, by developing an immunity or tolerance to the allergen(s).

As a result of these immune changes, immunotherapy can lead to decreased, minimal or no allergy symptoms when you are exposed to the allergen(s) included in the allergy vaccine.

There generally are two phases to immunotherapy: a build-up phase and a maintenance phase.

  • Build-up phase: involves receiving injections with increasing amounts of the allergens. The frequency of injections during this phase generally ranges from one to two times a week, though more rapid build-up schedules are sometimes used. The duration of this phase depends on the frequency of the injections but generally ranges from three to six months.
  • Maintenance phase: This phase begins when the effective therapeutic dose is reached. The effective maintenance dose is different for each person, depending on their level of allergen sensitivity (how 'allergic they are' to the allergens in their vaccine) and their response to the immunotherapy build-up phase. Once the maintenance dose is reached, there will be longer periods of time between immunotherapy treatments. The intervals between maintenance immunotherapy injections generally ranges from every two to every four weeks. Your allergist/immunologist will decide what range is best for you.

The benefits of immunotherapy, in terms of reduced allergy symptoms, can begin during the build-up phase but may take as long as 12 months on the maintenance dose. Improvement with immunotherapy may be progressive throughout the immunotherapy treatment period. Effectiveness of immunotherapy appears to be related to length of treatment and the dose of the allergen. Failure to respond to immunotherapy may be due to several factors including:

  • Inadequate dose of allergen in the allergy vaccine.
  • Missing allergens not identified during the allergy evaluation.
  • High levels of allergen in environment (i.e. inadequate environmental control).
  • Significant exposure to non-allergic triggers (i.e. tobacco smoke)

If there is no improvement after a year of maintenance immunotherapy, possible reasons for failure to respond should be explored. If no apparent reason is found then discontinuation of immunotherapy should be considered and other treatment options should be pursued.

When should immunotherapy be stopped?

If immunotherapy is successful, maintenance treatment is generally continued for three to five years. The decision to stop immunotherapy should be discussed with your allergist/immunologist after three to five years of treatment. Some individuals may experience lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy. Therefore, the decision to stop immunotherapy must be individualized.

What are the possible reactions?

There are two types of adverse reactions that occur with immunotherapy: local and/or systemic reactions.

Local reactions: are fairly common and present as redness and swelling at the injection site. This can happen immediately, or several hours after the treatment.

Systemic reactions: are much less common than local reactions. Systemic reactions are usually mild and respond rapidly to medications. Symptoms can include increased allergy symptoms such as sneezing, nasal congestion or hives. Rarely, a serious systemic reaction, called anaphylaxis, can develop after an immunotherapy injection. In addition to the symptoms associated with a mild systemic reaction, symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms.

Systemic reactions require immediate treatment. Most serious systemic reactions develop within 30 minutes of the allergy injections and this is why it is recommended you wait in the office for 30 minutes after your allergy injections. Your allergist/immunologist is trained to monitor for such reactions and his or her staff is trained to identify and treat systemic reactions.


Allergy immunotherapy is a proven effective treatment for allergic rhinitis, allergic asthma, and stinging insect allergy. It also may effective in some individuals with atopic dermatitis (eczema) if they have allergies to airborne allergens. Immunotherapy can potentially modify the allergic disease leading to lasting remission of allergy symptoms. Immunotherapy may play a preventive role in pediatric allergic disease, in terms of development of asthma and new allergies, thus early involvement of the allergy specialist may be important in the child with allergy symptoms. Adverse reactions to immunotherapy are rare but do require immediate medical attention and this is why immunotherapy should be administered in a medical facility appropriately outfitted with equipment and staff capable of identifying and treating these reactions.

Your allergist/immunologist can provide you with more information on allergen immunotherapy, or "allergy shots."

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.

The content of this brochure is for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact your allergist/immunologist.