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Allergy Diagnostics – Tests and Methods Explained

Allergy diagnostics includes medical tests used to detect and confirm allergies. It helps identify specific triggers of allergic reactions and guides appropriate treatment decisions.

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Things worth knowing about "Allergy Diagnostics"

Allergy diagnostics includes medical tests used to detect and confirm allergies. It helps identify specific triggers of allergic reactions and guides appropriate treatment decisions.

What Is Allergy Diagnostics?

Allergy diagnostics refers to the full range of medical examinations and tests used to detect, confirm, and identify the specific substances – known as allergens – that trigger allergic reactions. An allergy is an overreaction of the immune system to normally harmless substances such as pollen, animal dander, foods, or insect venom. Accurate diagnostics form the foundation for effective treatment and allow patients to avoid relevant allergens in their daily lives.

When Is Allergy Testing Recommended?

An allergological evaluation is recommended when the following symptoms occur repeatedly or seasonally:

Frequent sneezing, runny or blocked nose (allergic rhinitis)
Itchy, red, or watery eyes (allergic conjunctivitis)
Skin rashes, hives, or eczema
Shortness of breath, coughing, or wheezing (asthma)
Gastrointestinal complaints after eating
Swelling of the face, lips, or tongue (angioedema)

Testing is especially important following a severe allergic reaction such as anaphylaxis, in order to safely identify the triggering allergen.

Methods of Allergy Diagnostics

Medical History (Anamnesis)

The first and most important step is a thorough consultation with the physician. The doctor will ask about symptoms, when they occur, family history of allergies, and possible triggers. In many cases, the medical history already provides crucial clues about the suspected allergen.

Skin Tests

Skin tests are among the most commonly used methods in allergy diagnostics:

Prick Test: Small drops of various allergen solutions are placed on the forearm and lightly pricked into the skin. A raised, red wheal appearing after 15–20 minutes indicates allergic sensitisation.
Intradermal Test: A small amount of allergen is injected directly under the skin. This test is more sensitive than the prick test and is often used for suspected insect venom or drug allergies.
Patch Test (Epicutaneous Test): Allergens are applied to adhesive patches placed on the skin for 48 hours. This method is primarily used to diagnose contact allergies, such as to nickel or fragrances.

Blood Tests

Blood tests measure specific immunoglobulin E (IgE) antibodies that the immune system produces in response to particular allergens:

Total IgE: Provides a general indication of an overall allergic predisposition.
Specific IgE (RAST/ImmunoCAP): Detects antibodies against individual allergens such as tree pollen, peanuts, or house dust mites. This test is especially useful when skin testing is not possible.
Molecular Allergy Diagnostics (Component-Resolved Diagnostics): Identifies specific allergenic proteins, enabling a more precise assessment of allergy risk and potential cross-reactivity between allergens.

Provocation Tests

In a provocation test, the suspected allergen is applied directly to the target organ under controlled medical conditions – for example, nasally, bronchially, or orally. These tests are used when other methods have not produced clear results and must always be performed under close medical supervision due to the risk of severe reactions.

The Diagnostic Process

An allergological workup typically begins with a detailed medical history, followed by one or more skin tests. If results remain unclear, or if skin tests are contraindicated – for instance, due to severe eczema or the use of antihistamines – blood tests are performed as a complementary measure. Provocation tests are reserved as a last step when the diagnosis remains uncertain.

Results and Next Steps

A positive test result does not necessarily mean a clinically relevant allergy is present – it may also indicate sensitisation without symptoms. Test results must therefore always be interpreted in the context of the patient's medical history and clinical presentation. Based on the diagnostic findings, the following measures may be initiated:

Targeted avoidance of the identified allergen
Pharmacological treatment (e.g., antihistamines, corticosteroids)
Allergen Immunotherapy (Hyposensitisation): A long-term treatment approach in which the immune system is gradually accustomed to the allergen, reducing the severity of reactions over time

References

Deutsche Gesellschaft fur Allergologie und klinische Immunologie (DGAKI): Guideline on Allergy Diagnostics, AWMF Register No. 061-001 (2021).
Kleine-Tebbe J., Wagenmann M., Jeep S. et al. - Allergen-specific immunotherapy: a practice parameter update. Annals of Allergy, Asthma and Immunology (2022).
World Allergy Organization (WAO): White Book on Allergy, WAO Publications (2013, updated 2020). Available at: www.worldallergy.org

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