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Jordan Smallwood, MD, is the Section Chief, Division of Allergy/Immunology, Nemours Children's Hospital; and an Assistant Professor, University of Central Florida College of Medicine.
Disclosure: The author has no relevant financial relationships to disclose.
A common complaint of patients presenting to pediatricians or allergists is urticaria. The descriptions regarding the appearance of the rash often differ from patient to patient-some report redness, others report "whelps," and others report raised lesions. The rash is pruritic for some patients and for others it is not. Some patients can trace the onset of the rash back to a particular food they ate, varied environmental stimuli, or recent symptoms of an infection, whereas others are unable to ascertain any specific trigger for their rash. What most of the patients have in common is that they sought treatment from their pediatrician, an urgent care clinic, or an emergency department and they were all told a variation of the following: "You're probably just allergic to something."
I consider "You're probably just allergic to something" to be one of the worst "non-phrases" in the practice of medicine. Although it may be enough to temporarily assuage a parent's fears for their child, it offers no new information and, more often than not, creates undue anxiety for the family and the patient. The wait to see an allergist may be several weeks. During those weeks, the family often scrutinizes every exposure their child has and every single bite of food that they eat, nervous that the next meal might cause a return of their child's hives or progression of symptoms to something more threatening, such as anaphylaxis. By the time the child's appointment with the allergist arrives, the parents often present with the anxious demand "We want to know everything that our child is allergic to. Test them for everything so we will know."
When one considers the vast number of things to which we could have allergic sensitization, it quickly becomes apparent that it is physically impossible to test someone for everything. If the child continues to have hives at the time of testing, this only furthers confusion when reading the skin test. Additionally, if a physician decides to test only for the most common allergic triggers, there is no guarantee that a...