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Allergy is an excessive immune reaction to a substance that is not inherently harmful — house dust, pollen, animal dander, food or a drug — releasing inflammatory mediators that produce symptoms. Its presentations vary: sneezing, runny and blocked nose and itchy eyes; skin itching, urticaria and eczema; wheeze and breathlessness; or gastrointestinal symptoms. The step that changes outcomes is **identifying the actual trigger**, because definitive treatment begins with reducing exposure to it. But here is where many go wrong: **a positive allergy test does not necessarily mean you are allergic to that substance.** The test only detects immune sensitisation; diagnosis rests on the result matching real symptoms on exposure. Eliminating many foods based on a test list without linking it to symptoms therefore produces a poor diet with no benefit — and can be harmful in children. Treatment works on three levels together: **reducing exposure** with practical measures specific to the trigger (mite-proof covers, ventilation, confirmed avoidance of the culprit food); **medication** with antihistamines, steroid nasal sprays, eye drops and skin ointments according to the organ involved — the steroid nasal spray specifically needs **regular use for two weeks before its effect can be judged**, and many judge it after two doses and abandon it unfairly; and **immunotherapy (desensitisation)** in selected cases, the only option that may modify the disease course rather than only symptoms, requiring commitment over years. Troublesome seasonal allergy must be separated from **anaphylaxis** — a sudden whole-body reaction with swelling, breathlessness and falling blood pressure. Anyone with that history needs an emergency plan and an adrenaline auto-injector they carry and know how to use, and must go to emergency care immediately after using it.
Diagnosis is built on when symptoms appear, where, after which exposure and how long they last — the history directs and interprets the test, not the reverse.
Skin or blood testing for triggers suspected from the history, with results interpreted by linking them to symptoms — not read as a standalone list of prohibitions.
Practical measures specific to the trigger: mite-proof covers, washing at an appropriate temperature, ventilation and reducing carpeting, or confirmed avoidance of the culprit food or drug.
Antihistamines, steroid nasal spray (used regularly, not as needed), eye drops and skin ointments, at doses and durations set by the physician.
Offered for confirmed triggers where avoidance and medication are insufficient, given on a schedule spanning years in a facility able to manage a severe reaction.
**Before the visit keep a daily diary for two weeks: symptoms, severity, timing, place and what you did or ate beforehand** — this diary is more useful than any test, because it is what interprets it. Bring all your medications, ointments and inhalers. **Important: antihistamines can invalidate skin testing, so ask before the appointment how many days to stop them** — and do not stop asthma or any chronic medication on your own. Report any previous severe reaction — lip or tongue swelling, breathlessness or fainting — as this changes the whole plan and requires an emergency plan. Tell your doctor your occupation, work environment and any pets at home.
Use the steroid nasal spray **regularly every day rather than as needed, and give it two weeks before judging it** — and learn to aim it slightly outward away from the septum to reduce bleeding. Do not eliminate foods based on a test list alone — elimination is for triggers confirmed by symptoms only, and discuss any broad elimination with a dietitian, especially for children. Apply exposure-reduction measures, which are half the treatment. If an adrenaline auto-injector is prescribed: **carry it always, check its expiry, train those around you to use it, and know that using it does not replace going to emergency care immediately afterwards.** **Seek emergency care immediately for swelling of the lip, tongue or throat, difficulty swallowing or breathing, sudden wheeze, dizziness and collapse, or widespread rash with vomiting — these are signs of anaphylaxis.**
First visit 30–45 minutes, skin testing about 30 minutes, immunotherapy extends over years
Dr Faisal Mohammad Tubeilah is a consultant allergist and immunologist with a medical degree from Al-Azhar University, a fellowship from Brunel University and t…
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