What Questions Should I Ask an Allergist on an Initial Visit?

Maybe your baby had an allergic reaction to a food and you went to the emergency room. Or maybe your child has been experiencing milder symptoms after eating certain foods. Either way, you or your pediatrician has decided it is time to see an allergist. Make sure you are visiting a board-certified allergist, and preferably, one who specializes in children.

What should you expect and how should you plan for the first visit?

Things to Bring with You

Bring with you, if you have them:

• Any notes about your child’s symptoms and reactions
• Any food ingredient labels or copies of labels of the foods your child ate around the time of a reaction
• A food diary, if you kept one

What Your Doctor Will Want to Know

Your doctor will probably ask you questions about the suspected allergy and the reaction that prompted your visit. He or she will want to know:

• How quickly did the reaction develop after eating the food?
• What symptoms occurred?
• What other foods were eaten at the same time?
• What treatments or medications were used?
• Does this happen every single time that particular food is eaten?
• What was the health of your child at the time? Was there an asthma flare, eczema flare, or any infection?

Allergy Testing

Next, you will probably discuss allergy testing.

In many parents' minds, allergy testing is sometimes the same as a trip to the allergist. It represents a way of helping to determine if your child may be allergic.

However, allergy tests themselves are not 100% accurate. Also, they are not always needed to determine if your child does or does not have an allergy.

While it is reasonable to expect your child may be tested when visiting the allergist, there are times when this is just not necessary.

Questions to Ask the Doctor About Allergy Testing If the doctor does order tests, you may ask:

• Which foods or airborne allergens should be tested?
• How will the testing be done (by blood test or skin test)?
• Which tests will you order?

Some Things to Be Cautious About

Stay on the lookout for these two things:

In general, there is little reason to test foods that your child eats without a problem, or has never eaten previously.

Such tests may lead to highly inaccurate, confusing results.

Important points to know

Accurately Confirming the Presence or Absence of a Food Allergy Sometimes a diagnosis remains in question after testing. Or, the allergist may feel that a previously diagnosed food allergy may be disappearing. In these situations, your allergist may discuss performing an in-office food challenge. The in-office food challenge – where your child eats small and increasing doses of the food to which they are suspected of being allergic – is the only test that can accurately confirm the presence (or absence) of a food allergy.

Questions to Ask after a Diagnosis of Food Allergy is Confirmed

So, once your child is diagnosed, be sure to ask:

Keep the Lines of Communication Open

Open communication with your doctor or clinic is key to getting the best care possible. Come to the appointment with written questions so you don’t forget. However, it is best to approach the visit with an open mind. Do not have any expectations that testing (and to all the foods you may be concerned about) will be performed. You are visiting a highly trained specialist – give him or her chance to check out your child and make a diagnosis. If your child is very young, bring an extra adult who can help so you can talk uninterrupted. (A visit to the allergist will also help educate the whole family about food allergies!)

If you are newly diagnosed, need support or have more questions, see these articles for more information.

• Doctors ordering IgG blood tests instead of IgE blood tests (the blood test normally associated with food allergy).
• Doctors testing for many foods, yet asking few questions about your child’s history with eating the suspect foods.

• Tests can not and do not predict how severe a reaction to the food might be.
• Skin prick and/or blood IgE tests can help predict the likelihood that a food allergy is present, but these tests cannot predict the future severity of reactions.
• There is no such thing as a test level indicating your child is “anaphylactic” to that food or only mildly reactive. Unfortunately, there are no good methods to predict reaction severity.
• There may be a link between the likelihood one would react to a food and the size of the allergy test in someone with a history that suggests an IgE-mediated food allergy. But that is the limit of what testing can tell us.
• No test is 100% accurate in determining if your child is allergic.
• The only way to avoid a potentially life-threatening allergic reaction is to avoid the food to which you are allergic!

• How should we avoid the food?
• How much of the food must be eaten to cause a reaction?
• What do I do in case of an accidental ingestion of the food?
• What are the signs and symptoms of an allergic reaction, anaphylaxis?
• When do I use an epinephrine auto-injector? If it is your first time getting a prescription, ask for a demonstration. Also be sure to review how to use the auto-injector during future visits or if you are prescribed a different device.
• Do I really need to call 911 if I use an epinephrine auto-injector?
• Will I receive a written Emergency Care Plan for my child today?
• Do I need to carry the epinephrine auto-injector with me?
• When do I go to the emergency room for an allergic reaction and why?
• Should an antihistamine be taken and when? What is an appropriate dose?
• Should the doctor be called after every allergic reaction?
• Is there a plan to reintroduce the food at an appropriate time? How will you know when my child may have outgrown the food?
• When do I need to see you again?
• Who can I call if I have questions after I leave the clinic?
• What is my follow-up plan? If/when is retesting necessary?

Keep the Lines of Communication Open

Open communication with your doctor or clinic is key to getting the best care possible. Come to the appointment with written questions so you don’t forget. However, it is best to approach the visit with an open mind. Do not have any expectations that testing (and to all the foods you may be concerned about) will be performed. You are visiting a highly trained specialist – give him or her chance to check out your child and make a diagnosis. If your child is very young, bring an extra adult who can help so you can talk uninterrupted. (A visit to the allergist will also help educate the whole family about food allergies!)

If you are newly diagnosed, need support or have more questions, see these articles for more information.