Many children referred for possible allergies will have skin prick tests done at the time of their appointment. It is important that no antihistamine (e.g. Phenergan, Lorapaed, Cetirizine, Fexofenadine, Dimetapp etc) has been taken for 5 days prior to skin tests, as these can interfere with the results. Skin testing involves placing small drops of the allergen (the allergen is the thing being tested, such as dust mite or peanut) on the skin and then pricking through the drop with a small lancet. The prick is very superficial, and most children are not upset by having skin tests done. The results will be read after 15 minutes and your child will be seen with the result. Some allergy skin tests are more complicated. If the first stage skin prick tests show no reaction for antibiotics and venom then a second stage of intradermal (injections just under the skin) tests are done. This type of testing is often difficult in very young children, so may not always be pursued depending on the history of reaction.

Specific IgE (sIgE) tests are a way of doing allergy tests by a blood test rather than a skin test. A variety of foods and environmental allergens can be tested for. These tests involve taking a teaspoon of blood and the results are generally available after about 7 days. For these reasons skin tests are the preferred option in the allergy clinic, as results are immediately available. sIgE tests may be preferred in situations where skin tests cannot be done, such as with continuous antihistamine treatment or severe eczema. sIgE tests are sometimes used to predict the likely time course of growing out of a food allergy. Importantly neither sIgE tests nor skin tests can predict the severity of an allergic reaction.

Deciding whether a child is truly allergic to a food, or deciding whether a food allergy has resolved with time, can be difficult. At times having the child eat the food may be necessary to decide this. If there is a chance of a significant food allergic reaction then a supervised food challenge may be recommended. Waiting times for food challenge vary. The Starship service generally runs a "summer catch up" food challenge programme, doing many food challenges over summer months when the hospital is generally quieter. If your child is waiting for a food challenge make sure we have your correct phone numbers / mobile - there are often last minute cancellations for children booked for food challenge, so you may be able to be offered a cancellation slot at short notice. Food Challenge Information - advice for families (PDF, 151.8 KB)

The most important part of determining whether a child is allergic to a certain medicine (drug), such as antibiotics is through a careful and detailed history. In some cases the child may require skin and intradermal testing to help with the diagnosis. In the case of penicillin allergy, the majority of children will not be truly penicillin allergic, and based on the history the team will frequently offer observed doses of the penicillin based drug when seen in clinic. In other patients a formal supervised graded challenge will be more appropriate.

If a child has a severe allergic reaction/anaphylaxis to a bee or wasp sting, immunotherapy or desensitisation will generally be recommended. This involves giving injections of venom, initially in tiny and then in increasing doses, to make the child tolerant of the venom, which will minimise the risk of a further severe sting reaction.

Environmental immunotherapy can reduce the severity of symptoms and the need for regular medication for many children with environmental allergies, for example those with house dust mite and grass allergies. Allergen immunotherapy involves giving either injections just under the skin (subcutaneous immunotherapy or SCIT) or oral preparations (sublingual immunotherapy) of allergen extracts over 3-5 years to make the child tolerant to what they are allergic to. Immunotherapy may be beneficial for children with allergic rhinitis and allergic driven asthma when symptoms are severe and not managed adequately with medications, the cause is difficult to avoid or when they prefer to avoid regular medications. In the case of subcutaneous injections these would be started at Starship and the patient would then be transferred to the care of their GP for monthly injections. https://www.allergy.org.au/patients/allergy-treatments/immunotherapy