What is allergy testing for hay fever really like?

I’ve finally been to see an allergist and had allergy testing for hay fever. People often ask about what to expect at the first appointment with an allergist or what allergy testing involves.

Allergies are a big part of my life. I live with and care for family members with severe food, drug and environmental allergies. A lot of what I write about comes from those experiences in managing other people’s allergies. Sometimes I hold back on sharing more personal parts of our allergy-life because I feel they aren’t mine to share. Or I can only offer a parent or partner’s perspective. Now, I can talk about this from experience.

Hay fever (allergic rhinitis)

I’ve suffered from hay fever / allergic rhinitis for years. I always used to get itchy after sitting on grass, so thought I might have a grass allergy. In my late teens, I started to suffer with the typical hay fever symptoms: sneezing, runny nose, itchy eyes and itchy skin in the peak grass pollen season (spring and early summer).

In the last 10 years it’s been getting worse and worse. We also welcomed pet guinea pigs into our family. After that I noticed that I was needing my antihistamines and nasal spray not just during spring and early summer, but pretty much all year round. Hay makes up about 80 per cent of a guinea pig’s diet, so that made sense with a grass allergy. Mind you, I was also getting hives from holding the guinea pigs, so it was probably more than the hay.

About 3 years ago my doctor ordered a blood test to check for grass allergy, and that came back positive to a “grass mix”, but negative for other things like tree pollen, cats and dust mites. We talked about a referral to an allergist, but I had a few other more important health issues to deal with first.

Fast forward to a recent weekend when we went for a family bike ride/walk through some farming areas not far from us. I ended up not only with a bad case of the usual sneezing, runny nose and itchy eyes. My eyes were so affected that I developed allergic conjunctivitis that lasted almost a week. So I rang and made an appointment with my doctor the next day and finally got a referral to an allergist for allergy testing for hay fever.

Different types of allergy tests for hay fever

As mentioned above, my usual doctor ordered some preliminary blood tests for suspected grass allergy. This blood test measures specific-IgE levels in response to particular allergens. In my case, we tested a grass mix, house dust mites, a particular tree pollen and cats. The only one that showed a high result was the grass mix, so this gave a good indication that I was sensitised to or allergic to grass. Adding this to my symptoms, it was pretty clear what was causing my hay fever. So it was a good screening test before I went to see an allergist.

Our allergists prefer to do skin prick testing for environmental or aero-allergens like pollens, moulds and dust mites. Again, the results need to be interpreted by an allergy specialist taking into account your symptoms too.

Preparing for your allergy testing appointment

If you have severe hay fever symptoms, perhaps don’t do your allergy testing in peak pollen season. Skin prick testing for allergies can only be done when you aren’t taking antihistamines. When you book your first appointment with the allergist, the staff will tell you how long before your appointment you should stop taking them. For me, it was 4 days. A very, very long 4 days. I usually take antihistamines every single day, and without them my nose was streaming, my eyes were red and itchy, I couldn’t stop sneezing and I wanted to scratch my neck until it bled. Having watched other members of my family suffer the same fate prior to annual testing, I now have even greater empathy and a deeper admiration for just how brave my child is.

Try not to have to give up antihistamines in spring if you can avoid it!

What to expect at your first allergist appointment

If this is your first appointment with your allergist, you can expect to go through your history in some detail. They will want to know about:

• your allergy symptoms;
• when they started and how often you have them;
• what you think might be triggering your allergies;
• where you live (the location, which is relevant to the types of grass, tree and weed pollen you might be exposed to, and also about your home – whether there is carpet, for example);
• whether you have pets, and if so what type and where they live in your home;
• the treatments you are currently using – which medications you use and how often, what other treatments you have tried;
• other relevant medical history, including other illnesses and other medications you take.

You might also discuss your family history of allergy, so make sure you take a note of any allergies your parents or siblings have.

Based on this discussion, your allergist will recommend the types of allergens to test. For me this was different types of grass, tree and weed pollens, moulds, dust mites and guinea pigs.

The allergist will then explain the risks associated with skin prick testing. There is a very small chance of a severe reaction to skin prick testing. This is why allergy testing should always be done at your allergist’s office with medically trained staff to look after you. You will most likely be asked to sign a consent form before having testing.

Skin prick allergy testing for hay fever

What happens during skin prick testing? Skin prick testing can be done on the forearm (which is where I had mine done) or on your back (common with children). Just like skin prick tests for foods, the allergist or allergy nurse will clean the area first. Then they will write on your skin with a pen the numbers corresponding to the different allergens being tested, as well as a control tests (saline and histamine).

The tester will then place a small drop of each allergen extract on your skin next to its corresponding number and lightly scratch it with a small lancet.

Does it hurt? Not really, although a couple of my lancet pricks stung a little.

Depending on your allergist’s practice, you then have to wait 10 or 15 minutes to see whether you have a reaction to each of the extract drops. After that time, your tester will use a small ruler to measure the size of any wheal (a mosquito bite type lump at the site of the skin prick) and sometimes the flare (the redness around the lump).

The waiting was definitely uncomfortable for me. I reacted quite strongly to a number of the extracts and I was so, so itchy! Definitely take something to distract you, like your phone or tablet or a book.

As soon as any reactions have been measured, your skin can be washed to remove any left over extract. And you can finally have some antihistamine if needed.

Side effects of skin prick testing

The most common side effect of skin prick testing is the mosquito bite type lumps if you react to any allergens. This often disappears fairly quickly afterwards, especially if you take an antihistamine. In our experience, the redness and itchiness goes quite quickly after antihistamines but sometimes the lump will stay for about a day.

Some people develop a red, swollen area at the site of the skin prick test. Yes, that was me! My reaction to some of the grasses (rye grass and timothy grass in particular) was fairly strong and that part of my arm got quite hot, red and swollen as the day went on. Almost like the reaction to a spider bite. It took a good 3 days to go away and was so itchy during that time. I just continued to take antihistamine twice a day and also used some cortisone cream on the red area.

As mentioned above, there is a very small risk of a more severe reaction to skin prick tests, including anaphylaxis. This is why testing should be done under medical supervision.

My skin prick test results

I had testing for grass and tree pollens and mould on one arm, dust mites and guinea pigs on the other. This is how my first arm looked after my 15 minutes of waiting. You can see why it was itchy.

So, as I already knew, I am allergic to grass. All the grasses as it turns out! All the ones we tested anyway – rye, timothy, bahia, couch and sudan. I am also surprisingly allergic to birch trees. (And as I type this I am sitting at my desk looking at the 3 birch trees outside my window). Now here’s an interesting one. My initial blood tests showed I wasn’t allergic to dust mites, but I got a definite positive on my skin prick testing for both types. And sadly yes, I am allergic to our guinea pigs.

Hay fever treatment options

I am going to try and get through the rest of the allergy season by increasing my antihistamines and my steroid nasal spray to twice daily. There are quite a few different types, some available over the counter and others on prescription. At the moment I use Zyrtec (cetirizine) and Nasonex (same as Flonase). Eye drops are next on the list to help prevent my terribly itchy eyes and allergic conjunctivitis. There are a few over the counter options, including Zaditen (same as Zaditor). Talk to your allergist, doctor or pharmacist about which would be best for you based on your own symptoms and other medications or health issues.

My allergist definitely thinks that based on my test results I would benefit from immunotherapy for the grasses, birch and dust mites. Secretly I was hoping I would only be allergic to rye grass and could just take tablets! But given the need to target a mix of different allergens, it looks like I’ll be having the weekly and then monthly allergy shots for the next few years. I’ll go back and start this after the pollen season has ended. You can read about my experience starting immunotherapy injections in our post Important questions to ask about starting allergy shots (immunotherapy).

In the meantime, there are lots of things I’ll be doing to minimise my pollen exposure too. You can read more practical tips about pollen minimisation here: Pollen Allergy: Practical Ways to Reduce Your Hay Fever Symptoms

I have a lot of experience with dust mites, as two other people in our family have done or are doing immunotherapy for this already. So I will keep up the dust mite minimisation too. You can read about how our family manages dust mite allergies in our post about how to get rid of dust mites.

More information about hay fever (allergic rhinitis) and allergy testing

Australia’s National Allergy Strategy recently made a fantastic video about hay fever / allergic rhinitis. It goes through symptoms and treatment options and is definitely worth watching.

The Australian Society of Clinical Immunology and Allergy also has a helpful fast fact sheet on Hay fever (Allergic Rhinitis) to download.

You might also like to read our posts:

• Guinea pig allergies: when cute cavies make you itch – managing allergies to guinea pigs and their hay.
• All about genuine allergy testing – the tests specialists use – blood tests, skin prick testing, oral challenges and more.