Adverse effects of skin testing

April 8, 2003

What you describe could be potentially serious, but it does not sound like a response to allergy testing.

In allergy testing, a drop of each item tested for penetrates the skin through a slight scratch or prick, or a small amount of the item tested for is injected just under the top layer of skin. When the person is allergic to that item, an itchy wheal (similar to a mosquito bite) appears within approximately 15 minutes. Usually these bumps are gone within 24 hours, but a few small bumps can remain for several days. They rarely cause discomfort.

Occasionally, a person will have a delayed reaction to skin testing. Usually these delayed reactions are in the form of small bumps or knots that do not appear until several hours after testing. The area tested may become red, warm, swollen and sore for a couple of days. Antihistamines, ice packs, and cortisone cream can help relieve the discomfort. I've written more about delayed reactions here.

Any time the skin is penetrated there is always a potential for bacteria to enter the skin and cause an infection. When proper technique is used, such as cleansing the top of the vials as well as the patient's skin with alcohol prior to testing, and using only sterile needles and extracts, infection as a result of allergy testing is unlikely.

The other potentially untoward affect from allergy testing is a systemic (anaphylactic) reaction. This can include nausea, vomiting, faintness, swelling of the wind pipe, shortness of breath, and shock. My experience has been that when allergy testing is done according to standards presented by the Joint Council of Allergy, Asthma, and Immunology, or the American Academy of Otolaryngic Allergy, this sort of reaction to allergy testing is extremely rare.

A more common systemic response is what we call a vasovagal response. This is the same sort of response some people get when they pass out from having blood drawn. The person suddenly feels faint and nauseous. Their skin becomes pale, cool, and moist. Blood pressure is lowered and the pulse rate slows. Lying down with the feet elevated for a few minutes usually relieves these reactions.

The reaction you have described does not sound like any reaction to allergy testing that I am aware of. Possibly it is coincidental that you were allergy tested at the same time you began showing symptoms of another underlying condition.

The physician who supervised your testing is the best person to know whether his testing could potentially cause the symptoms you describe. You should phone his office and discuss your concerns with him or his nurse.

However, there are some very serious conditions that involve pain or numbness in the arms. Shooting pain or aching in the left arm can be a symptom of a heart attack. It's possible to survive a mild heart attack and not even be aware that it was a heart attack. Numbness in an arm, especially on one side of the body only, can be a symptom of a stroke.

You should contact your primary physician immediately and discuss these symptoms with her. Only your physician is qualified to assess your symptoms and correlate it with a physical exam and medical tests to arrive at an accurate diagnosis of what may be causing your symptoms.

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