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.