Clinical Consultation: Allergy testing in allergic rhinitis

Should all patients with allergic rhinitis have allergy testing? When is allergy testing indicated for a patient with a clinical diagnosis of allergic rhinitis?

Allergy testing can be done any time that allergy is suspected, and it should be done if it is not clear whether the patient's symptoms are related to allergic or nonallergic causes. Seasonal allergies can often be controlled with medication--either a single medication or a combination. If this is possible, then allergy testing is not really necessary. The test results might be interesting to the patient and health care provider but would not change what they would do.

However, if medical therapy fails, skin testing can be done to identify the offending allergens, and in some patients, it can be used to guide allergen immunotherapy.

Perennial rhinitis may or may not require skin testing. The results of skin testing can be used to guide allergen avoidance measures, so skin testing is useful even if immunotherapy is not being considered. If the patient's medications are controlling the symptoms, skin testing is probably not necessary, although such testing is often desired by the patient. If medical therapy is not successful, allergy testing can be very useful in guiding avoidance measures and/or immunotherapy.